Overview of Lower Limb

Written Learning Objectives

1. Describe the main muscle groups or muscle compartments of the lower limb.

The lower limb is specialized for bipedal locomotion. It is connected to the trunk via the sacro-iliac (SI) joints – the hip bones (coxal bones) articulate with the sacrum. The hip bones together with the sacrum and coccyx form the bony pelvis. Some of the muscles that act on the lower limb arise from the bony pelvis and the inferior part of the vertebral column; consequently, it is customary to include these transitional regions when describing the lower limb.

2. Understand the details (attachments, actions, innervation, blood supply, etc.) regarding the compartments of the thigh and leg.

Click here to download the PDF version of all individual muscle tables. 

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*Students are only responsible for muscles discussed in the main text of the learning objectives and list of structures

Anterior compartment of thigh generalizations

Medial compartment of thigh generalizations

Posterior compartment of thigh generalizations

Anterior compartment of leg generalizations

Lateral compartment of leg generalizations

Posterior compartment of leg generalizations

3. Describe the cutaneous innervation of the lower limb.

The cutaneous innervation of the lower limb is almost exclusively derived from the lumbar (L1-L4) and sacral (L4-S4) plexuses. Lumbar plexus branches innervate the superior thigh region and the majority of the anterior lower limb. Sacral plexus branches innervate the majority of the posterior lower limb. These cutaneous nerves are derived from larger, source branches, including femoral, obturator, common fibular, and tibial nerves. The sural n. is a cutaneous nerve that has contributions from both the tibial & common fibular nn.

See the images below for a peripheral cutaneous nerve maps of the lower limb.

4. Describe the deep fascia of the lower limb, and give an example of a specialization of this fascia.

The deep fascia of the limbs envelopes the muscles and separates the muscles into compartments associated with each segment of the limb. The muscles are “collected” into compartments or groups of muscle by portions of deep fascia, and typically separated by intermuscular septa.

The deep fascia of the lower limb has many functions, but of particular importance is resistance of excessive muscle expansion during contraction. This allows the muscles to compress the veins, and assists venous valves in directing blood flow towards the heart.

The deep fascia of the lower limb is called the fascia lata in the thigh and crural fascia in the leg. In specific areas, this fascia is thickened and serves specialized functions. Important examples in the lower limb are:

The lower limb, due to typically tight closure of the fascial compartments, are more susceptible to compartment syndromes. Compartment syndromes can be caused by trauma to any structures within the compartment, which may lead to inflammation, hemorrhage, and edema. This can lead to entrapment or compression of structures within. The anterior leg compartment is particularly susceptible to this type of syndrome.

5. Describe the primary venous drainage of the lower limb.

The veins in the lower limbs have numerous valves to allow for proper directional flow (towards the heart), working against gravitational pull.

Veins are divided into superficial (located in subcutaneous tissue) and deep (accompanying arteries). Superficial veins of lower limbs always drain into deep veins by means of perforating veins.

There are two main superficial veins of the lower limbs:

As mentioned above, deep veins of the lower limb accompany arteries and are often have similar names. These are the major (largest) veins of the lower limb. These veins (which often are paired - venae comitantes) are often packaged with the arteries within a vascular sheath.

Competency of venous valves are vital in directing blood flow in the proper direction. If competency has been compromised (potentially due to rotation or dilation), veins may become varicose. Varicose veins present as a dilated vein with valves that do not close - allowing blood to flow away from the heart.

6. Describe the primary arterial supply of the lower limb.

The primary blood supply to the lower limb is via the femoral a., a continuation of the external iliac a. beyond the inguinal ligament. The femoral a. is proximally located in the femoral triangle.

The boundaries of the femoral triangle are:

Femoral neurovasculature lie in this triangular space as they enter the lower limb. The relationship of the neurovascular structures is important when accessing the vasculature – medial to lateral: femoral Vein, femoral Artery, femoral Nerve (VAN). Understanding this organization is of importance when trying to locate the femoral vein for cannulation. It is easily located by palpating the pulsations of the femoral artery (femoral pulse) and moving medially.

The femoral a. supplies the entire lower limb.

As the artery nears the distal end of the femoral triangle, it gives off the deep artery of thigh, which dives deep into the thigh muscles and runs medial to the femur to supply the deep muscles. It sends branches that perforate through the deep adductor muscles to supply the posterior compartment of the thigh. The deep artery of thigh terminates in the thigh.

The femoral a., on the other hand, continues through the anterior and medial thigh. As it nears the knee, it passes through a hiatus in an adductor muscle to relocate on the posterior surface of the distal femur. At this point it is behind the knee in the popliteal fossa and its name changes to popliteal a. The popliteal a. gives off numerous branches that supply the knee joint and form a complex anastomosis around this area.

The popliteal a. continues through the popliteal fossa to enter the leg. As it does, it splits into the anterior tibial a. and the posterior tibial a.

The anterior tibial artery passes through a space between the tibia and fibula just above the superior edge of the interosseous membrane to course down the leg on the anterior surface of the interosseous membrane. It supplies the anterior leg muscles. It passes across the dorsal ankle to run onto the dorsum of the foot as the dorsalis pedis a.

At the proximal leg, the posterior tibial a. gives off a lateral branch, the fibular (peroneal) a., which is a minor supply to the lateral compartment leg muscles (anterior tibial a. is the major supply). The posterior tibial artery continues down the posterior leg to supply the superficial and deep groups of posterior leg muscles. It courses around and behind the medial malleolus with the tendons of the deep posterior leg muscles to enter the plantar region of the foot. Here it splits into medial & lateral plantar aa. that connect to form the plantar arch at the metatarsal portion of the foot.

7. Describe the lymphatic drainage of the lower limb.

The majority of lymph in the lower limbs drains via lymph vessels and nodes that are associated with the superficial veins of the lower limb, in particular the greater & small saphenous veins. The lymph associated with the greater saphenous vein typically drains into the superficial inguinal lymph nodes, which either enters the external iliac lymph nodes or deep inguinal lymph nodes. The lymph associated with the small saphenous vein typically drains into the popliteal lymph nodes.

In terms of directionality of lymph associated with deep veins, it typically proceeds in this manner:

Popliteal lymph nodes → Deep inguinal lymph nodes → External iliac lymph nodes → Common iliac lymph nodes → Lumbar lymphatic trunks