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Structure

Bones of the lower limb

Not medically reviewed · Content last updated · 2 min read ·

This is the date the draft was written, not a medical review date.

The lower limb skeleton consists of the pelvic girdle and the free limb: femur, patella, tibia, fibula, tarsal bones, metatarsals and phalanges. It is adapted to weight bearing, balance and locomotion.

Terminologia Anatomica (Latin): Ossa membri inferioris · Open in the 3D atlas

Location

The femur lies in the thigh, the patella in the quadriceps tendon at the front of the knee, the tibia (medial, weight bearing) and fibula (lateral) in the leg, and seven tarsal bones, five metatarsals and fourteen phalanges form the foot.

Structure

Femur: head with fovea, neck, greater and lesser trochanters, linea aspera, medial and lateral condyles. Tibia: condyles, tibial tuberosity, anterior border, medial malleolus. Fibula: head, shaft, lateral malleolus. Tarsus: talus, calcaneus, navicular, cuboid and three cuneiforms. The foot has medial and lateral longitudinal arches and a transverse arch.

Blood supply

The femoral head and neck depend on the medial and lateral circumflex femoral arteries (retinacular branches) and, minimally in adults, the artery of the ligament of the head. Shafts receive nutrient arteries from the profunda femoris, popliteal and posterior tibial/peroneal arteries.

Innervation

Periosteal and joint-capsule innervation follows the adjacent nerves: femoral, obturator and sciatic in the thigh and hip, and the tibial and common fibular nerves below the knee. Hip and knee pain may be referred between the two via the obturator nerve.

Function

The lower limb bones transmit body weight from the pelvis to the ground, provide levers for the large muscles of locomotion, and the arched foot absorbs shock and adapts to uneven surfaces.

Clinical correlations

Femoral neck fractures, common in older adults, may disrupt the retinacular branches of the medial circumflex femoral artery and cause avascular necrosis of the head. Tibial shaft fractures are often open because of the subcutaneous anterior border and may cause compartment syndrome. Fibular neck injury risks the common fibular nerve (foot drop).

Common exam points

  • Femoral neck fracture: medial circumflex femoral artery, risk of avascular necrosis; the limb is classically shortened and externally rotated.
  • Fibular neck: common fibular nerve, foot drop and loss of dorsiflexion and eversion.
  • Tibia: subcutaneous anterior border, open fractures and compartment syndrome.
  • Tarsal bones: talus, calcaneus, navicular, cuboid, three cuneiforms.
  • Foot arches: medial and lateral longitudinal, and transverse.

References

  1. Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy for Students. Elsevier — Tier 3 (textbook)
  2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer, 8th edition (2018) — Tier 3 (textbook)
  3. Netter FH. Atlas of Human Anatomy. Elsevier — Tier 3 (textbook)

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