PHT1010 FUNCTIONAL ANATOMY FOR PHYSIOTHERAPY

Lecture 6
Lower Limb skeleton and bony features
The contents of this lecture is solely for the education purpose for the TWC BSc (Hons) Physiotherapy students

Dr Anthony Kwok
Associate Professor & Deputy Programme Leader (Physiotherapy)

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Skeleton of the Lower Limb (LL)
Pelvic girdle: 2 pelvic bones + sacrum
Pelvic (coxal/hip bone) = ilium + ischium + pubis bones fused
together
The 2 coxal bones joined anteriorly by the pubic symphysis
(fibrocartilage), and posteriorly by the sacrum forming the
sacroiliac joints (SIJ).

On each side: Thigh, Leg, Knee cap, leg, Ankle & Foot
1 Femur, 1 Patella,
1 Tibia, 1 Fibula,
7 tarsal, 5 metatarsal and 14 phalanges

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Pelvis
Bone

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Pelvic
Girdle

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 The Pelvis
1. Ilium: Largest of the 3 hip bones (the superior part of the hip bone)
• Consists of a superior ala and inferior body to form the acetabulum, housing the socket for
the head of the femur.
• Superior border - iliac crest
• Hip pointer - occurs at anterior superior iliac spine (ASIS)
• Greater sciatic notch - allows passage of sciatic nerve

2. Ischium - inferior and posterior part of the hip bone

• Most prominent feature is the ischial tuberosity (meets the chair when you are sitting)

3. Pubis - inferior and anterior part of the hip bone

• Superior and inferior rami and body

Acetabulum: formed by the illium, ischium, and pubis + the socket that accepts the rounded
head of the femur → forming the hip joint.
Obturator foramen: the ischium and pubis surround this foramen.
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False and True Pelves
• Pelvic brim: a line from the sacral
promontory to the upper part of the
pubic symphysis.

• False pelvis: lies above this line

• True pelvis: inferior to the pelvic brim

• Pubic arch – converging of inferior rami

of two pubic bones under the pubic
symphysis

• Pelvic axis – path of baby during birth

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Femur and Patella
• Femur - longest, heaviest,
and strongest bone in the
body
• Head
• Neck
• Medial and lateral
condyles
• Also articulates with
patella

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The femur (thigh bone):
Head of the femur articulates with the
acetabulum in the pelvic bone to form
the hip joint.
Distal part of the femur articulates with
the tibia and kneecap to form the knee
joint.
Femur: the strongest and longest bone in
the human body.
Length on average: 26.74% of a person's
height (in both genders, and most ethnic
groups).
Femur: comprises a diaphysis
(shaft/body) + 2 epiphyses (extremities).
Area between the head and neck:
attachment of muscles and the hip
joint capsule.
Greater trochanter: the most lateral
prominent of the femur, box-shaped
and easily be felt.
Trochanteric fossa:
Trochanteric fossa: a deep a depression
depression bounded posteriorly by
the intertrochanteric crest on
medial surface of the greater
trochanter.
Lesser trochanter: a cone-shaped
extension of the lowest part of the
femur neck.
Body/Shaft of the femur:
Long, slender & cylindrical in form: slightly
arched: convex in front, and concave behind.
Strengthened by a prominent longitudinal ridge,
the linea aspera (in the posterior aspect) which
diverges proximal and distal as the medial and
lateral ridge.
Gluteal tuberosity: proximal to the lateral ridge
of the linea aspera
Pectineal line: continuation of the medial ridge.
The shaft: 2 bordes = lateral & medial border.

Lower/Distal extremity of femur:

larger than the upper extremity + somewhat
cuboid in form.
Its transverse diameter is > its antero-posterior
(front to back): consists of 2 oblong eminences
known as the condyles.
Articular surface of the lower end of the femur: the anterior, inferior, and posterior surfaces of the condyles.
Each condyle: surmounted by the epicondyle.
Medial epicondyle: a large convex eminence for the tibial collateral ligament of the knee-joint attachment.
Upper part is the adductor tubercle: behind it a rough impression for the origin to the medial head of the
gastrocnemius.
Lateral epicondyle: smaller & less prominent to give attachment to the fibular collateral ligament of the knee-
joint.
Muscles in the lower limb
Muscles attachment to the Pelvis and the Femur
Muscles attachment to the bones
in the lower limb
Muscles in the Lower Limb Direction Attachment to the femur bone

Iliacus muscle Insertion Lesser trochanter

Psoas major muscle Insertion Lesser trochanter

Gluteus maximus muscle Insertion Gluteal tuberosity

Gluteus medius muscle Insertion Lateral surface of greater trochanter

Gluteus minimus muscle Insertion Forefront of greater trochanter

Piriformis muscle Insertion Superior boundary of greater trochanter

Gemellus superior muscle Insertion Upper edge of Obturator internus's tendon (indirectly greater trochanter)

Obturator internus muscle Insertion Medial surface of greater trochanter

Gemellus inferior muscle Insertion Lower edge of Obturator internus's tendon (indirectly greater trochanter)

Quadratus femoris muscle Insertion Intertrochanteric crest

Obturator externus muscle Insertion Trochanteric fossa

Muscles in the Lower Limb Direction Attachment to the femur bone

Adductor longus muscle Insertion Medial ridge of linea aspera

Adductor brevis muscle Insertion Medial ridge of linea aspera

Adductor magnus muscle Insertion Medial ridge of linea aspera and the adductor tubercle

Vastus lateralis muscle Origin Greater trochanter and lateral ridge of linea aspera

Vastus intermedius muscle Origin Front and lateral surface of femur

Distal part of intertrochanteric line and medial ridge of linea
Vastus medialis muscle Origin
aspera
Short head of biceps femoris Origin Lateral ridge of linea aspera

Popliteus muscle Origin Under the lateral epicondyle

Articularis genu muscle Origin Lower 1/4 of anterior femur deep to vastus intermedius
Behind the adductor tubercle, over the lateral epicondyle and
Gastrocnemius muscle Origin
the popliteal facies
Plantaris muscle Origin Over the lateral condyle

Adductor longus muscle Insertion Medial ridge of linea aspera

Femoral-tibial angle (the angle between
the femur and tibia): formed when the 2
femurs converge medially toward the knees,
and articulate with the proximal ends of
the tibiae.
Angle of convergence of the femora: a major
factor in determining the femoral-tibial angle.
Females: the femora converge more than in
males because of the wider pelvic bone:
Genu valgum (knock knee) the femurs
converge so much that the knees touch one
another.
Genu varum (bow-leggedness): the 2 knees
not touching to each other.
If without either genu valgum or genu varum,
the femoral-tibial angle is about 175 degrees
(when observed in the frontal plane).
In normal alignment, the femoral-tibial angle is about 175 degrees.
 Q angle

Q angle:
formed between
the axis of femur to
the axis of tibia
Coxa valga: an abnormal
increase in the femoral angle.
Coxa vara: an abnormal
reduction.
The head & neck of the femur is
vastly embedded in the hip
musculature and cannot be
directly palpated.
In skinny people with the thigh
laterally rotated, the head of the
femur can be felt deep as a
resistance deep for the femoral
artery.
 Patella

Patella/kneecap: a thick, circular-triangular bone articulating with the femur.

• Covers and protects the anterior articular surface of the knee joint.
• Babies are born with a patella of soft cartilage which begins to ossify into bone at
about 3 years of age.
Largest sesamoid bone in the body
• Superior surface is the base
• Inferior, narrower surface is the apex
• Thick articular cartilage lines the posterior surface
• Increases the leverage of the quadriceps femoris muscle
• Forms the patellofemoral joint (PFJ)
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 Leg: Tibia (shin bone)+ Fibula
Tibia/shin bone: larger & medial weight-bearing bone of the leg
Lateral and medial condyles: at the proximal end articulating with the femur
Distally articulates with talus (ankle) and fibula
Tibial tuberosity - attachment site for the patellar ligament
Medial malleolus - medial surface of distal end (medial surface of ankle joint)

Fibula: Not a main weight bearing bone: small & lateralbone of the leg
• Non-weight bearing
• The head forms the proximal tibiofibular joint
• Lateral malleolus - distal end, articulates with the tibia and the talus at the ankle

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Tibia and Fibula

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Muscle Direction Attachment[7]

Tensor fasciae latae muscle Insertion Gerdy's tubercle

Quadriceps femoris muscle Insertion Tuberosity of the tibia

Sartorius muscle Insertion Pes anserinus

Gracilis muscle Insertion Pes anserinus

Semitendinosus muscle Insertion Pes anserinus

Horizontal head of
Insertion Medial condyle
the semimembranosus muscle

Popliteus muscle Insertion Posterior side of the tibia over the soleal line

Tibialis anterior muscle Origin Lateral side of the tibia

Extensor digitorum longus muscle Origin Lateral condyle

Soleus muscle Origin Posterior side of the tibia under the soleal line

Flexor digitorum longus muscle Origin Posterior side of the tibia under the soleal line
Foot: Tarsals,
Metatarsals,
and Phalanges
7 tarsal bones:
talus (articulates with tibia
and fibula), calcaneus (the
heel bone, the largest and
strongest), navicular, cuboid
and 3 cuneiforms
5 metatarsals:
(I-V) base, shaft, head
14 phalanges:
(big toe is the hallux)
Tarsus = ankle 36
Foot
 Arches of the Foot
2 longitudinal arches + 1 transverse
arch
maintained by the interlocking shapes
of the foot bones, strong ligaments,
and pulling muscles during activity.

The 2 longitudinal arches serve as

pillars for the transverse arch which
run obliquely across the
tarsometatarsal joints.
Excessive strain on the tendons and
ligaments of the feet can result in
fallen arches or flat feet Flat foot
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 Anatomy Education Video
In summary, please see the additional information in the following video:
• Clinical Anatomy - Lower Limb (Bones), Inguinal ligament, Hip, Knee and
ankle Joints
• https://www.youtube.com/watch?v=Mg2Kw8tqOuM

Revision on the anatomy that you have learnt in the upper limb:
• Upper Limb Muscle Anatomy | 3D Anatomy with Actions of muscles,
Forearm muscles, muscles of hand
• https://www.youtube.com/watch?v=pSOa5UVv4sM
Self-test
 References
• Agur AMR. & Dalley AF. (2009). Grant’s Atlas of Anatomy. (12th ed.). Philadelphia: Lippincott Williams
& Wilkins.
• Anatomy & Physiology Revealed (APR) Version 2.0 (2008) An Interactive Cadaver Dissection
Experience, CD-ROM, McGraw-Hill.
• Drake, RL, Vogl, W, and Mitchell, A. (2014) Gray's Anatomy for Students (3rd ed.). Elsevier.
• Ebrall, Phillip S.; Sportelli, Louis; Donato, Phillip R. (2004). Assessment of the Spine. Elsevier Health
Sciences.
• Jacob, S. (2002) Atlas of human anatomy. Edinburgh: Churchill Livingstone.
• Kendall, FP; McCreary, EK; Provance, PG; Rodgers, MM; Romani, WA. (2005). Muscle Testing &
Function with Posture and Pain (5th Edition), Lippincott Williams & Wilkins.
• Moore, Keith L. (2014). Clinically oriented anatomy. Williams & Wilkins.
• Moore KL, Dalley AF, Agur AMR. (2010). Clinically Oriented Anatomy. (6th ed.). Philadelphia: Lippincott
Williams & Wilkins.
• Netter, FH. (2014) Atlas of human anatomy (6th ed.). Saunders/Elsevier.
• Platzer, Werner (2004). Color Atlas of Human Anatomy, Vol. 1: Locomotor System (5th ed.). Thieme.
• Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. 2006.
• Tortora, G.J. & Nielsen, M. T. (2013) Principles of human anatomy (13th ed.), John Wiley & Sons.
Any question?

•Q&A