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Anatomy_Gray_1500 | Anatomy_Gray | Muscles that provide dynamic support for the arches during walking include the tibialis anterior and posterior and the fibularis longus. The plantar aponeurosis is a thickening of deep fascia in the sole of the foot (Fig. 6.115). It is firmly anchored to the medial process of the calcaneal tuberosity and extends forward as a thick band of longitudinally arranged connective tissue fibers. The fibers diverge as they pass anteriorly and form digital bands, which enter the toes and connect with bones, ligaments, and dermis of the skin. Distal to the metatarsophalangeal joints, the digital bands of the plantar aponeurosis are interconnected by transverse fibers, which form superficial transverse metatarsal ligaments. The plantar aponeurosis supports the longitudinal arch of the foot and protects deeper structures in the sole. Fibrous sheaths of toes | Anatomy_Gray. Muscles that provide dynamic support for the arches during walking include the tibialis anterior and posterior and the fibularis longus. The plantar aponeurosis is a thickening of deep fascia in the sole of the foot (Fig. 6.115). It is firmly anchored to the medial process of the calcaneal tuberosity and extends forward as a thick band of longitudinally arranged connective tissue fibers. The fibers diverge as they pass anteriorly and form digital bands, which enter the toes and connect with bones, ligaments, and dermis of the skin. Distal to the metatarsophalangeal joints, the digital bands of the plantar aponeurosis are interconnected by transverse fibers, which form superficial transverse metatarsal ligaments. The plantar aponeurosis supports the longitudinal arch of the foot and protects deeper structures in the sole. Fibrous sheaths of toes | [
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Anatomy_Gray_1501 | Anatomy_Gray | The plantar aponeurosis supports the longitudinal arch of the foot and protects deeper structures in the sole. Fibrous sheaths of toes The tendons of the flexor digitorum longus, flexor digitorum brevis, and flexor hallucis longus muscles enter fibrous digital sheaths or tunnels on the plantar aspect of the digits (Fig. 6.116). These fibrous sheaths begin anterior to the metatarsophalangeal joints and extend to the distal phalanges. They are formed by fibrous arches and cruciate (cross-shaped) ligaments attached posteriorly to the margins of the phalanges and to the plantar ligaments associated with the metatarsophalangeal and interphalangeal joints. These fibrous tunnels hold the tendons to the bony plane and prevent tendon bowing when the toes are flexed. Within each tunnel, the tendons are surrounded by a synovial sheath. | Anatomy_Gray. The plantar aponeurosis supports the longitudinal arch of the foot and protects deeper structures in the sole. Fibrous sheaths of toes The tendons of the flexor digitorum longus, flexor digitorum brevis, and flexor hallucis longus muscles enter fibrous digital sheaths or tunnels on the plantar aspect of the digits (Fig. 6.116). These fibrous sheaths begin anterior to the metatarsophalangeal joints and extend to the distal phalanges. They are formed by fibrous arches and cruciate (cross-shaped) ligaments attached posteriorly to the margins of the phalanges and to the plantar ligaments associated with the metatarsophalangeal and interphalangeal joints. These fibrous tunnels hold the tendons to the bony plane and prevent tendon bowing when the toes are flexed. Within each tunnel, the tendons are surrounded by a synovial sheath. | [
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Anatomy_Gray_1502 | Anatomy_Gray | These fibrous tunnels hold the tendons to the bony plane and prevent tendon bowing when the toes are flexed. Within each tunnel, the tendons are surrounded by a synovial sheath. The tendons of the extensor digitorum longus, extensor digitorum brevis, and extensor hallucis longus pass into the dorsal aspect of the digits and expand over the proximal phalanges to form complex dorsal digital expansions (“extensor hoods”) (Fig. 6.117). Each extensor hood is triangular in shape with the apex attached to the distal phalanx, the central region attached to the middle (toes II to V) or proximal (toe I) phalanx, and each corner of the base wrapped around the sides of the metatarsophalangeal joint. The corners of the hoods attach mainly to the deep transverse metatarsal ligaments. | Anatomy_Gray. These fibrous tunnels hold the tendons to the bony plane and prevent tendon bowing when the toes are flexed. Within each tunnel, the tendons are surrounded by a synovial sheath. The tendons of the extensor digitorum longus, extensor digitorum brevis, and extensor hallucis longus pass into the dorsal aspect of the digits and expand over the proximal phalanges to form complex dorsal digital expansions (“extensor hoods”) (Fig. 6.117). Each extensor hood is triangular in shape with the apex attached to the distal phalanx, the central region attached to the middle (toes II to V) or proximal (toe I) phalanx, and each corner of the base wrapped around the sides of the metatarsophalangeal joint. The corners of the hoods attach mainly to the deep transverse metatarsal ligaments. | [
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Anatomy_Gray_1503 | Anatomy_Gray | Many of the intrinsic muscles of the foot insert into the free margin of the hood on each side. The attachment of these muscles into the extensor hoods allows the forces from these muscles to be distributed over the toes to cause flexion of the metatarsophalangeal joints while at the same time extending the interphalangeal joints (Fig. 6.117). The function of these movements in the foot is uncertain, but they may prevent overextension of the metatarsophalangeal joints and flexion of the interphalangeal joints when the heel is elevated off the ground and the toes grip the ground during walking. | Anatomy_Gray. Many of the intrinsic muscles of the foot insert into the free margin of the hood on each side. The attachment of these muscles into the extensor hoods allows the forces from these muscles to be distributed over the toes to cause flexion of the metatarsophalangeal joints while at the same time extending the interphalangeal joints (Fig. 6.117). The function of these movements in the foot is uncertain, but they may prevent overextension of the metatarsophalangeal joints and flexion of the interphalangeal joints when the heel is elevated off the ground and the toes grip the ground during walking. | [
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Anatomy_Gray_1504 | Anatomy_Gray | Intrinsic muscles of the foot originate and insert in the foot: the extensor digitorum brevis and extensor hallucis brevis on the dorsal aspect of the foot; all other intrinsic muscles—the dorsal and plantar interossei, flexor digiti minimi brevis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae (flexor accessorius), abductor digiti minimi, abductor hallucis, and lumbricals—are on the plantar side of the foot in the sole where they are organized into four layers. Intrinsic muscles mainly modify the actions of the long tendons and generate fine movements of the toes. All intrinsic muscles of the foot are innervated by the medial and lateral plantar branches of the tibial nerve except for the extensor digitorum brevis, which is innervated by the deep fibular nerve. The first two dorsal interossei also may receive part of their innervation from the deep fibular nerve. On the dorsal aspect | Anatomy_Gray. Intrinsic muscles of the foot originate and insert in the foot: the extensor digitorum brevis and extensor hallucis brevis on the dorsal aspect of the foot; all other intrinsic muscles—the dorsal and plantar interossei, flexor digiti minimi brevis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae (flexor accessorius), abductor digiti minimi, abductor hallucis, and lumbricals—are on the plantar side of the foot in the sole where they are organized into four layers. Intrinsic muscles mainly modify the actions of the long tendons and generate fine movements of the toes. All intrinsic muscles of the foot are innervated by the medial and lateral plantar branches of the tibial nerve except for the extensor digitorum brevis, which is innervated by the deep fibular nerve. The first two dorsal interossei also may receive part of their innervation from the deep fibular nerve. On the dorsal aspect | [
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Anatomy_Gray_1505 | Anatomy_Gray | On the dorsal aspect The extensor digitorum brevis is attached to a roughened area on the superolateral surface of the calcaneus lateral to the tarsal sinus (Fig. 6.118 and Table 6.10). The flat muscle belly passes anteromedially over the foot, deep to the tendons of the extensor digitorum longus, and forms three tendons, which enter digits II, III, and IV. The tendons join the lateral sides of the tendons of the extensor digitorum longus. The extensor digitorum brevis extends the middle three toes through attachments to the long extensor tendons and extensor hoods. It is innervated by the deep fibular nerve. The extensor hallucis brevis originates in conjunction with the extensor digitorum brevis. Its tendon attaches to the base of the proximal phalanx of the great toes. The muscle extends the metatarsophalangeal joint of the great toe and is innervated by the deep fibular nerve. In the sole | Anatomy_Gray. On the dorsal aspect The extensor digitorum brevis is attached to a roughened area on the superolateral surface of the calcaneus lateral to the tarsal sinus (Fig. 6.118 and Table 6.10). The flat muscle belly passes anteromedially over the foot, deep to the tendons of the extensor digitorum longus, and forms three tendons, which enter digits II, III, and IV. The tendons join the lateral sides of the tendons of the extensor digitorum longus. The extensor digitorum brevis extends the middle three toes through attachments to the long extensor tendons and extensor hoods. It is innervated by the deep fibular nerve. The extensor hallucis brevis originates in conjunction with the extensor digitorum brevis. Its tendon attaches to the base of the proximal phalanx of the great toes. The muscle extends the metatarsophalangeal joint of the great toe and is innervated by the deep fibular nerve. In the sole | [
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Anatomy_Gray_1506 | Anatomy_Gray | In the sole The muscles in the sole of the foot are organized into four layers. From superficial to deep, or plantar to dorsal, these layers are the first, second, third, and fourth layers. There are three components in the first layer of muscles, which is the most superficial of the four layers and is immediately deep to the plantar aponeurosis (Fig. 6.119 and Table 6.11). From medial to lateral, these muscles are the abductor hallucis, flexor digitorum brevis, and abductor digiti minimi. The abductor hallucis muscle forms the medial margin of the foot and contributes to a soft tissue bulge on the medial side of the sole (Fig. 6.119). It originates from the medial process of the calcaneal tuberosity and adjacent margins of the flexor retinaculum and plantar aponeurosis. It forms a tendon that inserts on the medial side of the base of the proximal phalanx of the great toe and on the medial sesamoid bone associated with the tendon of the flexor hallucis brevis muscle. | Anatomy_Gray. In the sole The muscles in the sole of the foot are organized into four layers. From superficial to deep, or plantar to dorsal, these layers are the first, second, third, and fourth layers. There are three components in the first layer of muscles, which is the most superficial of the four layers and is immediately deep to the plantar aponeurosis (Fig. 6.119 and Table 6.11). From medial to lateral, these muscles are the abductor hallucis, flexor digitorum brevis, and abductor digiti minimi. The abductor hallucis muscle forms the medial margin of the foot and contributes to a soft tissue bulge on the medial side of the sole (Fig. 6.119). It originates from the medial process of the calcaneal tuberosity and adjacent margins of the flexor retinaculum and plantar aponeurosis. It forms a tendon that inserts on the medial side of the base of the proximal phalanx of the great toe and on the medial sesamoid bone associated with the tendon of the flexor hallucis brevis muscle. | [
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Anatomy_Gray_1507 | Anatomy_Gray | The abductor hallucis abducts and flexes the great toe at the metatarsophalangeal joint and is innervated by the medial plantar branch of the tibial nerve. The flexor digitorum brevis muscle lies immediately superior to the plantar aponeurosis and inferior to the tendons of the flexor digitorum longus in the sole of the foot (Fig. 6.119). The flat spindle-shaped muscle belly originates as a tendon from the medial process of the calcaneal tuberosity and from the adjacent plantar aponeurosis. The muscle fibers of the flexor digitorum brevis converge anteriorly to form four tendons, which each enter one of the lateral four toes. Near the base of the proximal phalanx of the toe, each tendon splits to pass dorsally around each side of the tendon of the flexor digitorum longus and attach to the margins of the middle phalanx. The flexor digitorum brevis flexes the lateral four toes at the proximal interphalangeal joints and is innervated by the medial plantar branch of the tibial nerve. | Anatomy_Gray. The abductor hallucis abducts and flexes the great toe at the metatarsophalangeal joint and is innervated by the medial plantar branch of the tibial nerve. The flexor digitorum brevis muscle lies immediately superior to the plantar aponeurosis and inferior to the tendons of the flexor digitorum longus in the sole of the foot (Fig. 6.119). The flat spindle-shaped muscle belly originates as a tendon from the medial process of the calcaneal tuberosity and from the adjacent plantar aponeurosis. The muscle fibers of the flexor digitorum brevis converge anteriorly to form four tendons, which each enter one of the lateral four toes. Near the base of the proximal phalanx of the toe, each tendon splits to pass dorsally around each side of the tendon of the flexor digitorum longus and attach to the margins of the middle phalanx. The flexor digitorum brevis flexes the lateral four toes at the proximal interphalangeal joints and is innervated by the medial plantar branch of the tibial nerve. | [
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Anatomy_Gray_1508 | Anatomy_Gray | The flexor digitorum brevis flexes the lateral four toes at the proximal interphalangeal joints and is innervated by the medial plantar branch of the tibial nerve. The abductor digiti minimi muscle is on the lateral side of the foot and contributes to the large lateral plantar eminence on the sole (Fig. 6.119). It has a broad base of origin, mainly from the lateral and medial processes of the calcaneal tuberosity and from a fibrous band of connective tissue, which connects the calcaneus with the base of metatarsal V. The abductor digiti minimi forms a tendon, which travels in a shallow groove on the plantar surface of the base of metatarsal V and continues forward to attach to the lateral side of the base of the proximal phalanx of the little toe. The abductor digiti minimi abducts the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar branch of the tibial nerve. | Anatomy_Gray. The flexor digitorum brevis flexes the lateral four toes at the proximal interphalangeal joints and is innervated by the medial plantar branch of the tibial nerve. The abductor digiti minimi muscle is on the lateral side of the foot and contributes to the large lateral plantar eminence on the sole (Fig. 6.119). It has a broad base of origin, mainly from the lateral and medial processes of the calcaneal tuberosity and from a fibrous band of connective tissue, which connects the calcaneus with the base of metatarsal V. The abductor digiti minimi forms a tendon, which travels in a shallow groove on the plantar surface of the base of metatarsal V and continues forward to attach to the lateral side of the base of the proximal phalanx of the little toe. The abductor digiti minimi abducts the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar branch of the tibial nerve. | [
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Anatomy_Gray_1509 | Anatomy_Gray | The abductor digiti minimi abducts the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar branch of the tibial nerve. The second muscle layer in the sole of the foot is associated with the tendons of the flexor digitorum longus muscle, which pass through this layer, and consists of the quadratus plantae and four lumbrical muscles (Fig. 6.120 and Table 6.12). The quadratus plantae muscle is a flat quadrangular muscle with two heads of origin (Fig. 6.120): One of the heads originates from the medial surface of the calcaneus inferior to the sustentaculum tali. The other head originates from the inferior surface of the calcaneus anterior to the lateral process of the calcaneal tuberosity and the attachment of the long plantar ligament. The quadratus plantae muscle inserts into the lateral side of the tendon of the flexor digitorum longus in the proximal half of the sole of the foot near where the tendon divides. | Anatomy_Gray. The abductor digiti minimi abducts the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar branch of the tibial nerve. The second muscle layer in the sole of the foot is associated with the tendons of the flexor digitorum longus muscle, which pass through this layer, and consists of the quadratus plantae and four lumbrical muscles (Fig. 6.120 and Table 6.12). The quadratus plantae muscle is a flat quadrangular muscle with two heads of origin (Fig. 6.120): One of the heads originates from the medial surface of the calcaneus inferior to the sustentaculum tali. The other head originates from the inferior surface of the calcaneus anterior to the lateral process of the calcaneal tuberosity and the attachment of the long plantar ligament. The quadratus plantae muscle inserts into the lateral side of the tendon of the flexor digitorum longus in the proximal half of the sole of the foot near where the tendon divides. | [
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Anatomy_Gray_1510 | Anatomy_Gray | The quadratus plantae muscle inserts into the lateral side of the tendon of the flexor digitorum longus in the proximal half of the sole of the foot near where the tendon divides. The quadratus plantae assists the flexor digitorum longus tendon in flexing the toes and may also adjust the “line of pull” of this tendon as it enters the sole of the foot from the medial side. The muscle is innervated by the lateral plantar nerve. The lumbrical muscles are four worm-like muscles that originate from the tendons of the flexor digitorum longus and pass dorsally to insert into the free medial margins of the extensor hoods of the four lateral toes (Fig. 6.120). The first lumbrical originates from the medial side of the tendon of the flexor digitorum longus that is associated with the second toe. The remaining three muscles are bipennate and originate from the sides of adjacent tendons. | Anatomy_Gray. The quadratus plantae muscle inserts into the lateral side of the tendon of the flexor digitorum longus in the proximal half of the sole of the foot near where the tendon divides. The quadratus plantae assists the flexor digitorum longus tendon in flexing the toes and may also adjust the “line of pull” of this tendon as it enters the sole of the foot from the medial side. The muscle is innervated by the lateral plantar nerve. The lumbrical muscles are four worm-like muscles that originate from the tendons of the flexor digitorum longus and pass dorsally to insert into the free medial margins of the extensor hoods of the four lateral toes (Fig. 6.120). The first lumbrical originates from the medial side of the tendon of the flexor digitorum longus that is associated with the second toe. The remaining three muscles are bipennate and originate from the sides of adjacent tendons. | [
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Anatomy_Gray_1511 | Anatomy_Gray | The lumbrical muscles act through the extensor hoods to resist excessive extension of the metatarsophalangeal joints and flexion of the interphalangeal joints when the heel leaves the ground during walking. The first lumbrical is innervated by the medial plantar nerve, while the other three are innervated by the lateral plantar nerve. There are three muscles in the third layer in the sole of the foot (Fig. 6.122 and Table 6.13): Two (the flexor hallucis brevis and adductor hallucis) are associated with the great toe. The third (the flexor digiti minimi brevis) is associated with the little toe. The flexor hallucis brevis muscle has two tendinous heads of origin (Fig. 6.122): The lateral head originates from the plantar surfaces of the cuboid, behind the groove for the fibularis longus, and adjacent surface of the lateral cuneiform. The medial head originates from the tendon of the tibialis posterior muscle as it passes into the sole of the foot. | Anatomy_Gray. The lumbrical muscles act through the extensor hoods to resist excessive extension of the metatarsophalangeal joints and flexion of the interphalangeal joints when the heel leaves the ground during walking. The first lumbrical is innervated by the medial plantar nerve, while the other three are innervated by the lateral plantar nerve. There are three muscles in the third layer in the sole of the foot (Fig. 6.122 and Table 6.13): Two (the flexor hallucis brevis and adductor hallucis) are associated with the great toe. The third (the flexor digiti minimi brevis) is associated with the little toe. The flexor hallucis brevis muscle has two tendinous heads of origin (Fig. 6.122): The lateral head originates from the plantar surfaces of the cuboid, behind the groove for the fibularis longus, and adjacent surface of the lateral cuneiform. The medial head originates from the tendon of the tibialis posterior muscle as it passes into the sole of the foot. | [
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Anatomy_Gray_1512 | Anatomy_Gray | The medial head originates from the tendon of the tibialis posterior muscle as it passes into the sole of the foot. The medial and lateral heads unite and give rise to a muscle belly, which itself is separated into medial and lateral parts adjacent to the plantar surface of metatarsal I. Each part of the muscle gives rise to a tendon that inserts on either the lateral or medial side of the base of the proximal phalanx of the great toe. A sesamoid bone occurs in each tendon of the flexor hallucis brevis as it crosses the plantar surface of the head of metatarsal I. The tendon of the flexor hallucis longus passes between the sesamoid bones. The flexor hallucis brevis flexes the metatarsophalangeal joint of the great toe and is innervated by the medial plantar nerve. The adductor hallucis muscle originates by two muscular heads, transverse and oblique, which join near their ends to insert into the lateral side of the base of the proximal phalanx of the great toe (Fig. 6.122): | Anatomy_Gray. The medial head originates from the tendon of the tibialis posterior muscle as it passes into the sole of the foot. The medial and lateral heads unite and give rise to a muscle belly, which itself is separated into medial and lateral parts adjacent to the plantar surface of metatarsal I. Each part of the muscle gives rise to a tendon that inserts on either the lateral or medial side of the base of the proximal phalanx of the great toe. A sesamoid bone occurs in each tendon of the flexor hallucis brevis as it crosses the plantar surface of the head of metatarsal I. The tendon of the flexor hallucis longus passes between the sesamoid bones. The flexor hallucis brevis flexes the metatarsophalangeal joint of the great toe and is innervated by the medial plantar nerve. The adductor hallucis muscle originates by two muscular heads, transverse and oblique, which join near their ends to insert into the lateral side of the base of the proximal phalanx of the great toe (Fig. 6.122): | [
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Anatomy_Gray_1513 | Anatomy_Gray | The transverse head originates from the plantar ligaments associated with the metatarsophalangeal joints of the lateral three toes and from the associated deep transverse metatarsal ligaments—the muscle crosses the sole of the foot transversely from lateral to medial and joins the oblique head near the base of the great toe. The oblique head is larger than the transverse head and originates from the plantar surfaces of the bases of metatarsals II to IV and from the sheath covering the fibularis longus muscle—this head passes anterolaterally through the sole of the foot and joins the transverse head. The tendon of insertion of the adductor hallucis attaches to the lateral sesamoid bone associated with the tendon of the flexor hallucis brevis muscle in addition to attaching to the proximal phalanx. The adductor hallucis adducts the great toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. | Anatomy_Gray. The transverse head originates from the plantar ligaments associated with the metatarsophalangeal joints of the lateral three toes and from the associated deep transverse metatarsal ligaments—the muscle crosses the sole of the foot transversely from lateral to medial and joins the oblique head near the base of the great toe. The oblique head is larger than the transverse head and originates from the plantar surfaces of the bases of metatarsals II to IV and from the sheath covering the fibularis longus muscle—this head passes anterolaterally through the sole of the foot and joins the transverse head. The tendon of insertion of the adductor hallucis attaches to the lateral sesamoid bone associated with the tendon of the flexor hallucis brevis muscle in addition to attaching to the proximal phalanx. The adductor hallucis adducts the great toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. | [
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Anatomy_Gray_1514 | Anatomy_Gray | The adductor hallucis adducts the great toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. The flexor digiti minimi brevis muscle originates from the plantar surface of the base of metatarsal V and adjacent sheath of the fibularis longus tendon (Fig. 6.122). It inserts on the lateral side of the base of the proximal phalanx of the little toe. The flexor digiti minimi brevis flexes the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. There are two muscle groups in the deepest muscle layer in the sole of the foot, the dorsal and plantar interossei (Fig. 6.123 and Table 6.14). The four dorsal interossei are the most superior muscles in the sole of the foot and abduct the second to fourth toes relative to the long axis through the second toe (Fig. 6.123). All four muscles are bipennate and originate from the sides of adjacent metatarsals. | Anatomy_Gray. The adductor hallucis adducts the great toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. The flexor digiti minimi brevis muscle originates from the plantar surface of the base of metatarsal V and adjacent sheath of the fibularis longus tendon (Fig. 6.122). It inserts on the lateral side of the base of the proximal phalanx of the little toe. The flexor digiti minimi brevis flexes the little toe at the metatarsophalangeal joint and is innervated by the lateral plantar nerve. There are two muscle groups in the deepest muscle layer in the sole of the foot, the dorsal and plantar interossei (Fig. 6.123 and Table 6.14). The four dorsal interossei are the most superior muscles in the sole of the foot and abduct the second to fourth toes relative to the long axis through the second toe (Fig. 6.123). All four muscles are bipennate and originate from the sides of adjacent metatarsals. | [
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Anatomy_Gray_1515 | Anatomy_Gray | The tendons of the dorsal interossei insert into the free margin of the extensor hoods and base of the proximal phalanges of the toes. The second toe can be abducted to either side of its long axis, so it has two dorsal interossei associated with it, one on each side. The third and fourth toes have a dorsal interosseous muscle on their lateral sides only. The great and little toes have their own abductors (the abductor hallucis and abductor digiti minimi) in the first layer of muscles in the sole of the foot. In addition to abduction, the dorsal interossei act through the extensor hoods to resist extension of the metatarsophalangeal joints and flexion of the interphalangeal joints. The dorsal interossei are innervated by the lateral plantar nerve. The first and second dorsal interossei also receive branches on their superior surfaces from the deep fibular nerve. | Anatomy_Gray. The tendons of the dorsal interossei insert into the free margin of the extensor hoods and base of the proximal phalanges of the toes. The second toe can be abducted to either side of its long axis, so it has two dorsal interossei associated with it, one on each side. The third and fourth toes have a dorsal interosseous muscle on their lateral sides only. The great and little toes have their own abductors (the abductor hallucis and abductor digiti minimi) in the first layer of muscles in the sole of the foot. In addition to abduction, the dorsal interossei act through the extensor hoods to resist extension of the metatarsophalangeal joints and flexion of the interphalangeal joints. The dorsal interossei are innervated by the lateral plantar nerve. The first and second dorsal interossei also receive branches on their superior surfaces from the deep fibular nerve. | [
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Anatomy_Gray_1516 | Anatomy_Gray | The dorsal interossei are innervated by the lateral plantar nerve. The first and second dorsal interossei also receive branches on their superior surfaces from the deep fibular nerve. The three plantar interossei adduct the third, fourth, and little toes toward the long axis through the second toe (Fig. 6.123). Each plantar interosseous muscle originates from the medial side of its associated metatarsal and inserts into the medial free margin of the extensor hood and base of the proximal phalanx. The great toe has its own adductor (the adductor hallucis) in the third layer of muscles in the sole of the foot and the second toe is adducted back to its longitudinal axis by using one of its dorsal interossei. In addition to adduction, the plantar interossei act through the extensor hoods to resist extension of the metatarsophalangeal joints and flexion of the interphalangeal joints. All are innervated by the lateral plantar nerve. | Anatomy_Gray. The dorsal interossei are innervated by the lateral plantar nerve. The first and second dorsal interossei also receive branches on their superior surfaces from the deep fibular nerve. The three plantar interossei adduct the third, fourth, and little toes toward the long axis through the second toe (Fig. 6.123). Each plantar interosseous muscle originates from the medial side of its associated metatarsal and inserts into the medial free margin of the extensor hood and base of the proximal phalanx. The great toe has its own adductor (the adductor hallucis) in the third layer of muscles in the sole of the foot and the second toe is adducted back to its longitudinal axis by using one of its dorsal interossei. In addition to adduction, the plantar interossei act through the extensor hoods to resist extension of the metatarsophalangeal joints and flexion of the interphalangeal joints. All are innervated by the lateral plantar nerve. | [
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Anatomy_Gray_1517 | Anatomy_Gray | Blood supply to the foot is by branches of the posterior tibial and dorsalis pedis (dorsal artery of the foot) arteries. The posterior tibial artery enters the sole and bifurcates into lateral and medial plantar arteries. The lateral plantar artery joins with the terminal end of the dorsalis pedis artery (the deep plantar artery) to form the deep plantar arch. Branches from this arch supply the toes. The dorsalis pedis artery is the continuation of the anterior tibial artery, passes onto the dorsal aspect of the foot and then inferiorly, as the deep plantar artery, between metatarsals I and II to enter the sole of the foot. | Anatomy_Gray. Blood supply to the foot is by branches of the posterior tibial and dorsalis pedis (dorsal artery of the foot) arteries. The posterior tibial artery enters the sole and bifurcates into lateral and medial plantar arteries. The lateral plantar artery joins with the terminal end of the dorsalis pedis artery (the deep plantar artery) to form the deep plantar arch. Branches from this arch supply the toes. The dorsalis pedis artery is the continuation of the anterior tibial artery, passes onto the dorsal aspect of the foot and then inferiorly, as the deep plantar artery, between metatarsals I and II to enter the sole of the foot. | [
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Anatomy_Gray_1518 | Anatomy_Gray | The posterior tibial artery enters the foot through the tarsal tunnel on the medial side of the ankle and posterior to the medial malleolus. Midway between the medial malleolus and the heel, the pulse of the posterior tibial artery is palpable because here the artery is covered only by a thin layer of retinaculum, by superficial connective tissue, and by skin. Near this location, the posterior tibial artery bifurcates into a small medial plantar artery and a much larger lateral plantar artery. | Anatomy_Gray. The posterior tibial artery enters the foot through the tarsal tunnel on the medial side of the ankle and posterior to the medial malleolus. Midway between the medial malleolus and the heel, the pulse of the posterior tibial artery is palpable because here the artery is covered only by a thin layer of retinaculum, by superficial connective tissue, and by skin. Near this location, the posterior tibial artery bifurcates into a small medial plantar artery and a much larger lateral plantar artery. | [
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Anatomy_Gray_1519 | Anatomy_Gray | The lateral plantar artery passes anterolaterally into the sole of the foot, first deep to the proximal end of the abductor hallucis muscle and then between the quadratus plantae and flexor digitorum brevis muscles (Fig. 6.124). It reaches the base of metatarsal V where it lies in the groove between the flexor digitorum brevis and abductor digiti minimi muscles. From here, the lateral plantar artery curves medially to form the deep plantar arch, which crosses the deep plane of the sole on the metatarsal bases and the interossei muscles. Between the bases of metatarsals I and II, the deep plantar arch joins with the terminal branch (deep plantar artery) of the dorsalis pedis artery, which enters the sole from the dorsal side of the foot. | Anatomy_Gray. The lateral plantar artery passes anterolaterally into the sole of the foot, first deep to the proximal end of the abductor hallucis muscle and then between the quadratus plantae and flexor digitorum brevis muscles (Fig. 6.124). It reaches the base of metatarsal V where it lies in the groove between the flexor digitorum brevis and abductor digiti minimi muscles. From here, the lateral plantar artery curves medially to form the deep plantar arch, which crosses the deep plane of the sole on the metatarsal bases and the interossei muscles. Between the bases of metatarsals I and II, the deep plantar arch joins with the terminal branch (deep plantar artery) of the dorsalis pedis artery, which enters the sole from the dorsal side of the foot. | [
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Anatomy_Gray_1520 | Anatomy_Gray | Major branches of the deep plantar arch include: a digital branch to the lateral side of the little toe; four plantar metatarsal arteries, which supply digital branches to adjacent sides of toes I to V and the medial side of the great toe; and three perforating arteries, which pass between the bases of metatarsals II to V to anastomose with vessels on the dorsal aspect of the foot. The medial plantar artery passes into the sole of the foot by passing deep to the proximal end of the abductor hallucis muscle (Fig. 6.124). It supplies a deep branch to adjacent muscles and then passes forward in the groove between the abductor hallucis and the flexor digitorum brevis muscles. It ends by joining the digital branch of the deep plantar arch, which supplies the medial side of the great toe. | Anatomy_Gray. Major branches of the deep plantar arch include: a digital branch to the lateral side of the little toe; four plantar metatarsal arteries, which supply digital branches to adjacent sides of toes I to V and the medial side of the great toe; and three perforating arteries, which pass between the bases of metatarsals II to V to anastomose with vessels on the dorsal aspect of the foot. The medial plantar artery passes into the sole of the foot by passing deep to the proximal end of the abductor hallucis muscle (Fig. 6.124). It supplies a deep branch to adjacent muscles and then passes forward in the groove between the abductor hallucis and the flexor digitorum brevis muscles. It ends by joining the digital branch of the deep plantar arch, which supplies the medial side of the great toe. | [
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Anatomy_Gray_1521 | Anatomy_Gray | Near the base of metatarsal I, the medial plantar artery gives rise to a superficial branch, which divides into three vessels that pass superficial to the flexor digitorum brevis muscle to join the plantar metatarsal arteries from the deep plantar arch. The dorsalis pedis artery is the continuation of the anterior tibial artery and begins as the anterior tibial artery crosses the ankle joint (Fig. 6.125). It passes anteriorly over the dorsal aspect of the talus, navicular, and intermediate cuneiform bones, and then passes inferiorly, as the deep plantar artery, between the two heads of the first dorsal interosseous muscle to join the deep plantar arch in the sole of the foot. The pulse of the dorsalis pedis artery on the dorsal surface of the foot can be felt by gently palpating the vessel against the underlying tarsal bones between the tendons of the extensor hallucis longus and the extensor digitorum longus to the second toe. | Anatomy_Gray. Near the base of metatarsal I, the medial plantar artery gives rise to a superficial branch, which divides into three vessels that pass superficial to the flexor digitorum brevis muscle to join the plantar metatarsal arteries from the deep plantar arch. The dorsalis pedis artery is the continuation of the anterior tibial artery and begins as the anterior tibial artery crosses the ankle joint (Fig. 6.125). It passes anteriorly over the dorsal aspect of the talus, navicular, and intermediate cuneiform bones, and then passes inferiorly, as the deep plantar artery, between the two heads of the first dorsal interosseous muscle to join the deep plantar arch in the sole of the foot. The pulse of the dorsalis pedis artery on the dorsal surface of the foot can be felt by gently palpating the vessel against the underlying tarsal bones between the tendons of the extensor hallucis longus and the extensor digitorum longus to the second toe. | [
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Anatomy_Gray_1522 | Anatomy_Gray | Branches of the dorsalis pedis artery include lateral and medial tarsal branches, an arcuate artery, and a first dorsal metatarsal artery: The tarsal arteries pass medially and laterally over the tarsal bones, supplying adjacent structures and anastomosing with a network of vessels formed around the ankle. The arcuate artery passes laterally over the dorsal aspect of the metatarsals near their bases and gives rise to three dorsal metatarsal arteries, which supply dorsal digital arteries to adjacent sides of digits II to V, and to a dorsal digital artery that supplies the lateral side of digit V. The first dorsal metatarsal artery (the last branch of the dorsalis pedis artery before the dorsalis pedis artery continues as the deep plantar artery into the sole of the foot) supplies dorsal digital branches to adjacent sides of the great and second toes. | Anatomy_Gray. Branches of the dorsalis pedis artery include lateral and medial tarsal branches, an arcuate artery, and a first dorsal metatarsal artery: The tarsal arteries pass medially and laterally over the tarsal bones, supplying adjacent structures and anastomosing with a network of vessels formed around the ankle. The arcuate artery passes laterally over the dorsal aspect of the metatarsals near their bases and gives rise to three dorsal metatarsal arteries, which supply dorsal digital arteries to adjacent sides of digits II to V, and to a dorsal digital artery that supplies the lateral side of digit V. The first dorsal metatarsal artery (the last branch of the dorsalis pedis artery before the dorsalis pedis artery continues as the deep plantar artery into the sole of the foot) supplies dorsal digital branches to adjacent sides of the great and second toes. | [
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Anatomy_Gray_1523 | Anatomy_Gray | The dorsal metatarsal arteries connect with perforating branches from the deep plantar arch and similar branches from the plantar metatarsal arteries. There are interconnected networks of deep and superficial veins in the foot. The deep veins follow the arteries. Superficial veins drain into a dorsal venous arch on the dorsal surface of the foot over the metatarsals (Fig. 6.126): The great saphenous vein originates from the medial side of the arch and passes anterior to the medial malleolus and onto the medial side of the leg. The small saphenous vein originates from the lateral side of the arch and passes posterior to the lateral malleolus and onto the back of the leg. The foot is supplied by the tibial, deep fibular, superficial fibular, sural, and saphenous nerves: All five nerves contribute to cutaneous or general sensory innervation. | Anatomy_Gray. The dorsal metatarsal arteries connect with perforating branches from the deep plantar arch and similar branches from the plantar metatarsal arteries. There are interconnected networks of deep and superficial veins in the foot. The deep veins follow the arteries. Superficial veins drain into a dorsal venous arch on the dorsal surface of the foot over the metatarsals (Fig. 6.126): The great saphenous vein originates from the medial side of the arch and passes anterior to the medial malleolus and onto the medial side of the leg. The small saphenous vein originates from the lateral side of the arch and passes posterior to the lateral malleolus and onto the back of the leg. The foot is supplied by the tibial, deep fibular, superficial fibular, sural, and saphenous nerves: All five nerves contribute to cutaneous or general sensory innervation. | [
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Anatomy_Gray_1524 | Anatomy_Gray | The foot is supplied by the tibial, deep fibular, superficial fibular, sural, and saphenous nerves: All five nerves contribute to cutaneous or general sensory innervation. The tibial nerve innervates all intrinsic muscles of the foot except for the extensor digitorum brevis, which is innervated by the deep fibular nerve. The deep fibular nerve often also contributes to the innervation of the first and second dorsal interossei. The tibial nerve enters the foot through the tarsal tunnel posterior to the medial malleolus. In the tunnel, the nerve is lateral to the posterior tibial artery, and gives origin to medial calcaneal branches, which penetrate the flexor retinaculum to supply the heel. Midway between the medial malleolus and the heel, the tibial nerve bifurcates with the posterior tibial artery into: a large medial plantar nerve, and a smaller lateral plantar nerve (Fig. 6.127). The medial and lateral plantar nerves lie together between their corresponding arteries. | Anatomy_Gray. The foot is supplied by the tibial, deep fibular, superficial fibular, sural, and saphenous nerves: All five nerves contribute to cutaneous or general sensory innervation. The tibial nerve innervates all intrinsic muscles of the foot except for the extensor digitorum brevis, which is innervated by the deep fibular nerve. The deep fibular nerve often also contributes to the innervation of the first and second dorsal interossei. The tibial nerve enters the foot through the tarsal tunnel posterior to the medial malleolus. In the tunnel, the nerve is lateral to the posterior tibial artery, and gives origin to medial calcaneal branches, which penetrate the flexor retinaculum to supply the heel. Midway between the medial malleolus and the heel, the tibial nerve bifurcates with the posterior tibial artery into: a large medial plantar nerve, and a smaller lateral plantar nerve (Fig. 6.127). The medial and lateral plantar nerves lie together between their corresponding arteries. | [
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Anatomy_Gray_1525 | Anatomy_Gray | The medial and lateral plantar nerves lie together between their corresponding arteries. The medial plantar nerve is the major sensory nerve in the sole of the foot (Fig. 6.127). It innervates skin on most of the anterior two-thirds of the sole and adjacent surfaces of the medial three and one-half toes, which includes the great toe. In addition to this large area of plantar skin, the nerve also innervates four intrinsic muscles—the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and first lumbrical. The medial plantar nerve passes into the sole of the foot deep to the abductor hallucis muscle and forward in the groove between the abductor hallucis and flexor digitorum brevis, supplying branches to both these muscles. | Anatomy_Gray. The medial and lateral plantar nerves lie together between their corresponding arteries. The medial plantar nerve is the major sensory nerve in the sole of the foot (Fig. 6.127). It innervates skin on most of the anterior two-thirds of the sole and adjacent surfaces of the medial three and one-half toes, which includes the great toe. In addition to this large area of plantar skin, the nerve also innervates four intrinsic muscles—the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and first lumbrical. The medial plantar nerve passes into the sole of the foot deep to the abductor hallucis muscle and forward in the groove between the abductor hallucis and flexor digitorum brevis, supplying branches to both these muscles. | [
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Anatomy_Gray_1526 | Anatomy_Gray | The medial plantar nerve supplies a digital branch (proper plantar digital nerve) to the medial side of the great toe and then divides into three nerves (common plantar digital nerves) on the plantar surface of the flexor digitorum brevis, which continue forward to supply proper plantar digital branches to adjacent surfaces of toes I to IV. The nerve to the first lumbrical originates from the first common plantar digital nerve. The lateral plantar nerve is an important motor nerve in the foot because it innervates all intrinsic muscles in the sole, except for the muscles supplied by the medial plantar nerve (the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and first lumbrical) (Fig. 6.127). It also innervates a strip of skin on the lateral side of the anterior two-thirds of the sole and the adjacent plantar surfaces of the lateral one and one-half digits. | Anatomy_Gray. The medial plantar nerve supplies a digital branch (proper plantar digital nerve) to the medial side of the great toe and then divides into three nerves (common plantar digital nerves) on the plantar surface of the flexor digitorum brevis, which continue forward to supply proper plantar digital branches to adjacent surfaces of toes I to IV. The nerve to the first lumbrical originates from the first common plantar digital nerve. The lateral plantar nerve is an important motor nerve in the foot because it innervates all intrinsic muscles in the sole, except for the muscles supplied by the medial plantar nerve (the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and first lumbrical) (Fig. 6.127). It also innervates a strip of skin on the lateral side of the anterior two-thirds of the sole and the adjacent plantar surfaces of the lateral one and one-half digits. | [
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Anatomy_Gray_1527 | Anatomy_Gray | The lateral plantar nerve enters the sole of the foot by passing deep to the proximal attachment of the abductor hallucis muscle. It continues laterally and anteriorly across the sole between the flexor digitorum brevis and quadratus plantae muscles, supplying branches to both these muscles, and then divides near the head of metatarsal V into deep and superficial branches. The superficial branch of the lateral plantar nerve gives rise to a proper plantar digital nerve, which supplies skin on the lateral side of the little toe, and to a common plantar digital nerve, which divides to supply proper plantar digital nerves to skin on the adjacent sides of toes IV and V. The proper plantar digital nerve to the lateral side of the little toe also innervates the flexor digiti minimi brevis and the dorsal and plantar interossei muscles between metatarsals IV and V. | Anatomy_Gray. The lateral plantar nerve enters the sole of the foot by passing deep to the proximal attachment of the abductor hallucis muscle. It continues laterally and anteriorly across the sole between the flexor digitorum brevis and quadratus plantae muscles, supplying branches to both these muscles, and then divides near the head of metatarsal V into deep and superficial branches. The superficial branch of the lateral plantar nerve gives rise to a proper plantar digital nerve, which supplies skin on the lateral side of the little toe, and to a common plantar digital nerve, which divides to supply proper plantar digital nerves to skin on the adjacent sides of toes IV and V. The proper plantar digital nerve to the lateral side of the little toe also innervates the flexor digiti minimi brevis and the dorsal and plantar interossei muscles between metatarsals IV and V. | [
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Anatomy_Gray_1528 | Anatomy_Gray | The proper plantar digital nerve to the lateral side of the little toe also innervates the flexor digiti minimi brevis and the dorsal and plantar interossei muscles between metatarsals IV and V. The deep branch of the lateral plantar nerve is motor and accompanies the lateral plantar artery deep to the long flexor tendons and the adductor hallucis muscle. It supplies branches to the second to fourth lumbrical muscles, the adductor hallucis muscle, and all interossei except those between metatarsals IV and V, which are innervated by the superficial branch. The deep fibular nerve innervates the extensor digitorum brevis, contributes to the innervation of the first two dorsal interossei muscles, and supplies general sensory branches to the skin on the adjacent dorsal sides of the first and second toes and to the web space between them (Fig. 6.128). | Anatomy_Gray. The proper plantar digital nerve to the lateral side of the little toe also innervates the flexor digiti minimi brevis and the dorsal and plantar interossei muscles between metatarsals IV and V. The deep branch of the lateral plantar nerve is motor and accompanies the lateral plantar artery deep to the long flexor tendons and the adductor hallucis muscle. It supplies branches to the second to fourth lumbrical muscles, the adductor hallucis muscle, and all interossei except those between metatarsals IV and V, which are innervated by the superficial branch. The deep fibular nerve innervates the extensor digitorum brevis, contributes to the innervation of the first two dorsal interossei muscles, and supplies general sensory branches to the skin on the adjacent dorsal sides of the first and second toes and to the web space between them (Fig. 6.128). | [
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Anatomy_Gray_1529 | Anatomy_Gray | The deep fibular nerve enters the dorsal aspect of the foot on the lateral side of the dorsalis pedis artery, and is parallel with and lateral to the tendon of the extensor hallucis longus muscle. Just distal to the ankle joint, the nerve gives origin to a lateral branch, which innervates the extensor digitorum brevis from its deep surface. The deep fibular nerve continues forward on the dorsal surface of the foot, penetrates deep fascia between metatarsals I and II near the metatarsophalangeal joints, and then divides into two dorsal digital nerves, which supply skin over adjacent surfaces of toes I and II down to the beginning of the nail beds. Small motor branches, which contribute to the supply of the first two dorsal interossei muscles, originate from the deep fibular nerve before it penetrates deep fascia. | Anatomy_Gray. The deep fibular nerve enters the dorsal aspect of the foot on the lateral side of the dorsalis pedis artery, and is parallel with and lateral to the tendon of the extensor hallucis longus muscle. Just distal to the ankle joint, the nerve gives origin to a lateral branch, which innervates the extensor digitorum brevis from its deep surface. The deep fibular nerve continues forward on the dorsal surface of the foot, penetrates deep fascia between metatarsals I and II near the metatarsophalangeal joints, and then divides into two dorsal digital nerves, which supply skin over adjacent surfaces of toes I and II down to the beginning of the nail beds. Small motor branches, which contribute to the supply of the first two dorsal interossei muscles, originate from the deep fibular nerve before it penetrates deep fascia. | [
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Anatomy_Gray_1530 | Anatomy_Gray | Small motor branches, which contribute to the supply of the first two dorsal interossei muscles, originate from the deep fibular nerve before it penetrates deep fascia. The superficial fibular nerve is sensory to most skin on the dorsal aspect of the foot and toes except for skin on adjacent sides of toes I and II (which is innervated by the deep fibular nerve) and skin on the lateral side of the foot and little toe (which is innervated by the sural nerve; Fig. 6.128). The superficial fibular nerve penetrates deep fascia on the anterolateral side of the lower leg and enters the dorsal aspect of the foot in superficial fascia. It gives rise to cutaneous branches and dorsal digital nerves along its course. | Anatomy_Gray. Small motor branches, which contribute to the supply of the first two dorsal interossei muscles, originate from the deep fibular nerve before it penetrates deep fascia. The superficial fibular nerve is sensory to most skin on the dorsal aspect of the foot and toes except for skin on adjacent sides of toes I and II (which is innervated by the deep fibular nerve) and skin on the lateral side of the foot and little toe (which is innervated by the sural nerve; Fig. 6.128). The superficial fibular nerve penetrates deep fascia on the anterolateral side of the lower leg and enters the dorsal aspect of the foot in superficial fascia. It gives rise to cutaneous branches and dorsal digital nerves along its course. | [
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Anatomy_Gray_1531 | Anatomy_Gray | The sural nerve is a cutaneous branch of the tibial nerve that originates high in the leg. It enters the foot in superficial fascia posterior to the lateral malleolus close to the short saphenous vein. Terminal branches innervate skin on the lateral side of the foot and dorsolateral surface of the little toe (Fig. 6.128B). The saphenous nerve is a cutaneous branch of the femoral nerve that originates in the thigh. Terminal branches enter the foot in superficial fascia on the medial side of the ankle and supply skin on the medial side of the proximal foot (Fig. 6.128B). Tendons, muscles, and bony landmarks in the lower limb are used to locate major arteries, veins, and nerves. | Anatomy_Gray. The sural nerve is a cutaneous branch of the tibial nerve that originates high in the leg. It enters the foot in superficial fascia posterior to the lateral malleolus close to the short saphenous vein. Terminal branches innervate skin on the lateral side of the foot and dorsolateral surface of the little toe (Fig. 6.128B). The saphenous nerve is a cutaneous branch of the femoral nerve that originates in the thigh. Terminal branches enter the foot in superficial fascia on the medial side of the ankle and supply skin on the medial side of the proximal foot (Fig. 6.128B). Tendons, muscles, and bony landmarks in the lower limb are used to locate major arteries, veins, and nerves. | [
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Anatomy_Gray_1532 | Anatomy_Gray | Tendons, muscles, and bony landmarks in the lower limb are used to locate major arteries, veins, and nerves. Because vessels are large, they can be used as entry points to the vascular system. In addition, vessels in the lower limb are farthest from the heart and the most inferior in the body. Therefore, the nature of peripheral pulses in the lower limb can give important information about the status of the circulatory system in general. Sensation and muscle action in the lower limb are tested to assess lumbar and sacral regions of the spinal cord. Avoiding the sciatic nerve | Anatomy_Gray. Tendons, muscles, and bony landmarks in the lower limb are used to locate major arteries, veins, and nerves. Because vessels are large, they can be used as entry points to the vascular system. In addition, vessels in the lower limb are farthest from the heart and the most inferior in the body. Therefore, the nature of peripheral pulses in the lower limb can give important information about the status of the circulatory system in general. Sensation and muscle action in the lower limb are tested to assess lumbar and sacral regions of the spinal cord. Avoiding the sciatic nerve | [
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Anatomy_Gray_1533 | Anatomy_Gray | Sensation and muscle action in the lower limb are tested to assess lumbar and sacral regions of the spinal cord. Avoiding the sciatic nerve The sciatic nerve innervates muscles in the posterior compartment of the thigh, muscles in the leg and foot, and an appreciable area of skin. It enters the lower limb in the gluteal region (Fig. 6.129) and passes inferiorly midway between two major palpable bony landmarks, the greater trochanter and the ischial tuberosity. The greater trochanter can be easily felt as a hard bony protuberance about one hand’s width inferior to the midpoint of the iliac crest. The ischial tuberosity is palpable just above the gluteal fold. The gluteal region can be divided into quadrants by two lines positioned using palpable bony landmarks. One line descends vertically from the highest point of the iliac crest. | Anatomy_Gray. Sensation and muscle action in the lower limb are tested to assess lumbar and sacral regions of the spinal cord. Avoiding the sciatic nerve The sciatic nerve innervates muscles in the posterior compartment of the thigh, muscles in the leg and foot, and an appreciable area of skin. It enters the lower limb in the gluteal region (Fig. 6.129) and passes inferiorly midway between two major palpable bony landmarks, the greater trochanter and the ischial tuberosity. The greater trochanter can be easily felt as a hard bony protuberance about one hand’s width inferior to the midpoint of the iliac crest. The ischial tuberosity is palpable just above the gluteal fold. The gluteal region can be divided into quadrants by two lines positioned using palpable bony landmarks. One line descends vertically from the highest point of the iliac crest. | [
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Anatomy_Gray_1534 | Anatomy_Gray | The gluteal region can be divided into quadrants by two lines positioned using palpable bony landmarks. One line descends vertically from the highest point of the iliac crest. The other line passes horizontally through the first line midway between the highest point of the iliac crest and the horizontal plane through the ischial tuberosity. The sciatic nerve curves through the upper lateral corner of the lower medial quadrant and descends along the lateral margin of the lower medial quadrant. Injections can be carried out in the anterior corner of the upper lateral quadrant to avoid injury to the sciatic nerve and major vessels in the region (Fig. 6.129B). Finding the femoral artery in the femoral triangle The femoral artery passes into the femoral triangle (Fig. 6.130) of the lower limb from the abdomen. | Anatomy_Gray. The gluteal region can be divided into quadrants by two lines positioned using palpable bony landmarks. One line descends vertically from the highest point of the iliac crest. The other line passes horizontally through the first line midway between the highest point of the iliac crest and the horizontal plane through the ischial tuberosity. The sciatic nerve curves through the upper lateral corner of the lower medial quadrant and descends along the lateral margin of the lower medial quadrant. Injections can be carried out in the anterior corner of the upper lateral quadrant to avoid injury to the sciatic nerve and major vessels in the region (Fig. 6.129B). Finding the femoral artery in the femoral triangle The femoral artery passes into the femoral triangle (Fig. 6.130) of the lower limb from the abdomen. | [
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Anatomy_Gray_1535 | Anatomy_Gray | Finding the femoral artery in the femoral triangle The femoral artery passes into the femoral triangle (Fig. 6.130) of the lower limb from the abdomen. The femoral triangle is the depression formed in the anterior thigh between the medial margin of the adductor longus muscle, the medial margin of the sartorius muscle, and the inguinal ligament. The tendon of the adductor longus muscle can be palpated as a cord-like structure that attaches to bone immediately inferior to the pubic tubercle. The sartorius muscle originates from the anterior superior iliac spine and crosses anteriorly over the thigh to attach to the medial aspect of the tibia below the knee joint. The inguinal ligament attaches to the anterior superior iliac spine laterally and the pubic tubercle medially. | Anatomy_Gray. Finding the femoral artery in the femoral triangle The femoral artery passes into the femoral triangle (Fig. 6.130) of the lower limb from the abdomen. The femoral triangle is the depression formed in the anterior thigh between the medial margin of the adductor longus muscle, the medial margin of the sartorius muscle, and the inguinal ligament. The tendon of the adductor longus muscle can be palpated as a cord-like structure that attaches to bone immediately inferior to the pubic tubercle. The sartorius muscle originates from the anterior superior iliac spine and crosses anteriorly over the thigh to attach to the medial aspect of the tibia below the knee joint. The inguinal ligament attaches to the anterior superior iliac spine laterally and the pubic tubercle medially. | [
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Anatomy_Gray_1536 | Anatomy_Gray | The inguinal ligament attaches to the anterior superior iliac spine laterally and the pubic tubercle medially. The femoral artery descends into the thigh from the abdomen by passing under the inguinal ligament and into the femoral triangle. In the femoral triangle, its pulse is easily felt just inferior to the inguinal ligament midway between the pubic symphysis and the anterior superior iliac spine. Medial to the artery is the femoral vein and medial to the vein is the femoral canal, which contains lymphatics and lies immediately lateral to the pubic tubercle. The femoral nerve lies lateral to the femoral artery. Identifying structures around the knee | Anatomy_Gray. The inguinal ligament attaches to the anterior superior iliac spine laterally and the pubic tubercle medially. The femoral artery descends into the thigh from the abdomen by passing under the inguinal ligament and into the femoral triangle. In the femoral triangle, its pulse is easily felt just inferior to the inguinal ligament midway between the pubic symphysis and the anterior superior iliac spine. Medial to the artery is the femoral vein and medial to the vein is the femoral canal, which contains lymphatics and lies immediately lateral to the pubic tubercle. The femoral nerve lies lateral to the femoral artery. Identifying structures around the knee | [
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Anatomy_Gray_1537 | Anatomy_Gray | Identifying structures around the knee The patella is a prominent palpable feature at the knee. The quadriceps femoris tendon attaches superiorly to it and the patellar ligament connects the inferior surface of the patella to the tibial tuberosity (Fig. 6.131). The patellar ligament and the tibial tuberosity are easily palpable. A tap on the patellar ligament (tendon) tests reflex activity mainly at spinal cord levels L3 and L4. The head of the fibula is palpable as a protuberance on the lateral surface of the knee just inferior to the lateral condyle of the tibia. It can also be located by following the tendon of the biceps femoris inferiorly. The common fibular nerve passes around the lateral surface of the neck of the fibula just inferior to the head and can often be felt as a cord-like structure in this position. | Anatomy_Gray. Identifying structures around the knee The patella is a prominent palpable feature at the knee. The quadriceps femoris tendon attaches superiorly to it and the patellar ligament connects the inferior surface of the patella to the tibial tuberosity (Fig. 6.131). The patellar ligament and the tibial tuberosity are easily palpable. A tap on the patellar ligament (tendon) tests reflex activity mainly at spinal cord levels L3 and L4. The head of the fibula is palpable as a protuberance on the lateral surface of the knee just inferior to the lateral condyle of the tibia. It can also be located by following the tendon of the biceps femoris inferiorly. The common fibular nerve passes around the lateral surface of the neck of the fibula just inferior to the head and can often be felt as a cord-like structure in this position. | [
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Anatomy_Gray_1538 | Anatomy_Gray | The common fibular nerve passes around the lateral surface of the neck of the fibula just inferior to the head and can often be felt as a cord-like structure in this position. Another structure that can usually be located on the lateral side of the knee is the iliotibial tract. This flat tendinous structure, which attaches to the lateral tibial condyle, is most prominent when the knee is fully extended. In this position, the anterior edge of the tract raises a sharp vertical fold of skin posterior to the lateral edge of the patella. Visualizing the contents of the popliteal fossa | Anatomy_Gray. The common fibular nerve passes around the lateral surface of the neck of the fibula just inferior to the head and can often be felt as a cord-like structure in this position. Another structure that can usually be located on the lateral side of the knee is the iliotibial tract. This flat tendinous structure, which attaches to the lateral tibial condyle, is most prominent when the knee is fully extended. In this position, the anterior edge of the tract raises a sharp vertical fold of skin posterior to the lateral edge of the patella. Visualizing the contents of the popliteal fossa | [
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Anatomy_Gray_1539 | Anatomy_Gray | Visualizing the contents of the popliteal fossa The popliteal fossa is a diamond-shaped depression formed between the hamstrings and gastrocnemius muscle posterior to the knee. The inferior margins of the diamond are formed by the medial and lateral heads of the gastrocnemius muscle. The superior margins are formed laterally by the biceps femoris muscle and medially by the semimembranosus and semitendinosus muscles. The tendons of the biceps femoris muscle and the semitendinosus muscle are palpable and often visible. The head of the fibula is palpable on the lateral side of the knee and can be used as a landmark for identifying the biceps femoris tendon and the common fibular nerve, which curves laterally out of the popliteal fossa and crosses the neck of the fibula just inferior to the head. | Anatomy_Gray. Visualizing the contents of the popliteal fossa The popliteal fossa is a diamond-shaped depression formed between the hamstrings and gastrocnemius muscle posterior to the knee. The inferior margins of the diamond are formed by the medial and lateral heads of the gastrocnemius muscle. The superior margins are formed laterally by the biceps femoris muscle and medially by the semimembranosus and semitendinosus muscles. The tendons of the biceps femoris muscle and the semitendinosus muscle are palpable and often visible. The head of the fibula is palpable on the lateral side of the knee and can be used as a landmark for identifying the biceps femoris tendon and the common fibular nerve, which curves laterally out of the popliteal fossa and crosses the neck of the fibula just inferior to the head. | [
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Anatomy_Gray_1540 | Anatomy_Gray | The popliteal fossa contains the popliteal artery, the popliteal vein, the tibial nerve, and the common fibular nerve (Fig. 6.132). The popliteal artery is the deepest of the structures in the fossa and descends through the region from the upper medial side. As a consequence of its position, the popliteal artery pulse is difficult to find, but usually can be detected on deep palpation just medial to the midline of the fossa. The small saphenous vein penetrates deep fascia in the upper part of the posterior leg and joins the popliteal vein. Finding the tarsal tunnel—the gateway to the foot The tarsal tunnel (Fig. 6.133) is formed on the medial side of the foot in the groove between the medial malleolus and the heel (calcaneal tuberosity) and by the overlying flexor retinaculum. | Anatomy_Gray. The popliteal fossa contains the popliteal artery, the popliteal vein, the tibial nerve, and the common fibular nerve (Fig. 6.132). The popliteal artery is the deepest of the structures in the fossa and descends through the region from the upper medial side. As a consequence of its position, the popliteal artery pulse is difficult to find, but usually can be detected on deep palpation just medial to the midline of the fossa. The small saphenous vein penetrates deep fascia in the upper part of the posterior leg and joins the popliteal vein. Finding the tarsal tunnel—the gateway to the foot The tarsal tunnel (Fig. 6.133) is formed on the medial side of the foot in the groove between the medial malleolus and the heel (calcaneal tuberosity) and by the overlying flexor retinaculum. | [
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Anatomy_Gray_1541 | Anatomy_Gray | The tarsal tunnel (Fig. 6.133) is formed on the medial side of the foot in the groove between the medial malleolus and the heel (calcaneal tuberosity) and by the overlying flexor retinaculum. The posterior tibial artery and tibial nerve enter the foot through the tarsal tunnel. The tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus also pass through the tarsal tunnel in compartments formed by septa of the flexor retinaculum. The order of structures passing through the tunnel from the anteromedial to posterolateral are the tendon of the tibialis posterior, the tendon of the flexor digitorum longus, the posterior tibial artery and associated veins, the tibial nerve, and the tendon of the flexor hallucis longus (“Tom, Dick, and a very nervous Harry”). The tibial artery is palpable just posteroinferior to the medial malleolus on the anterior face of the visible groove between the heel and medial malleolus. | Anatomy_Gray. The tarsal tunnel (Fig. 6.133) is formed on the medial side of the foot in the groove between the medial malleolus and the heel (calcaneal tuberosity) and by the overlying flexor retinaculum. The posterior tibial artery and tibial nerve enter the foot through the tarsal tunnel. The tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus also pass through the tarsal tunnel in compartments formed by septa of the flexor retinaculum. The order of structures passing through the tunnel from the anteromedial to posterolateral are the tendon of the tibialis posterior, the tendon of the flexor digitorum longus, the posterior tibial artery and associated veins, the tibial nerve, and the tendon of the flexor hallucis longus (“Tom, Dick, and a very nervous Harry”). The tibial artery is palpable just posteroinferior to the medial malleolus on the anterior face of the visible groove between the heel and medial malleolus. | [
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Anatomy_Gray_1542 | Anatomy_Gray | The tibial artery is palpable just posteroinferior to the medial malleolus on the anterior face of the visible groove between the heel and medial malleolus. Identifying tendons around the ankle and in the foot Numerous tendons can be identified around the ankle and in the foot (Fig. 6.134) and can be used as useful landmarks for locating vessels or testing spinal reflexes. The tibialis anterior tendon is visible on the medial side of the ankle anterior to the medial malleolus. The calcaneal tendon is the largest tendon entering the foot and is prominent on the posterior aspect of the foot as it descends from the leg to the heel. A tap with a tendon hammer on this tendon tests reflex activity of spinal cord levels S1 and S2. When the foot is everted, the tendons of the fibularis longus and fibularis brevis raise a linear fold of skin, which descends from the lower leg to the posterior edge of the lateral malleolus. | Anatomy_Gray. The tibial artery is palpable just posteroinferior to the medial malleolus on the anterior face of the visible groove between the heel and medial malleolus. Identifying tendons around the ankle and in the foot Numerous tendons can be identified around the ankle and in the foot (Fig. 6.134) and can be used as useful landmarks for locating vessels or testing spinal reflexes. The tibialis anterior tendon is visible on the medial side of the ankle anterior to the medial malleolus. The calcaneal tendon is the largest tendon entering the foot and is prominent on the posterior aspect of the foot as it descends from the leg to the heel. A tap with a tendon hammer on this tendon tests reflex activity of spinal cord levels S1 and S2. When the foot is everted, the tendons of the fibularis longus and fibularis brevis raise a linear fold of skin, which descends from the lower leg to the posterior edge of the lateral malleolus. | [
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Anatomy_Gray_1543 | Anatomy_Gray | When the foot is everted, the tendons of the fibularis longus and fibularis brevis raise a linear fold of skin, which descends from the lower leg to the posterior edge of the lateral malleolus. The tendon of the fibularis brevis is often evident on the lateral surface of the foot descending obliquely to the base of metatarsal V. The tendons of the fibularis tertius, extensor digitorum longus, and extensor hallucis longus are visible on the dorsal aspect of the foot from lateral to medial. Finding the dorsalis pedis artery The nature of the dorsalis pedis pulse (Fig. 6.135) is important for assessing peripheral circulation because the dorsalis pedis artery is the farthest palpable vessel from the heart. Also, it is the lowest palpable artery in the body when a person is standing. | Anatomy_Gray. When the foot is everted, the tendons of the fibularis longus and fibularis brevis raise a linear fold of skin, which descends from the lower leg to the posterior edge of the lateral malleolus. The tendon of the fibularis brevis is often evident on the lateral surface of the foot descending obliquely to the base of metatarsal V. The tendons of the fibularis tertius, extensor digitorum longus, and extensor hallucis longus are visible on the dorsal aspect of the foot from lateral to medial. Finding the dorsalis pedis artery The nature of the dorsalis pedis pulse (Fig. 6.135) is important for assessing peripheral circulation because the dorsalis pedis artery is the farthest palpable vessel from the heart. Also, it is the lowest palpable artery in the body when a person is standing. | [
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Anatomy_Gray_1544 | Anatomy_Gray | The dorsalis pedis artery passes onto the dorsal aspect of the foot and anteriorly over the tarsal bones where it lies between and is parallel to the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe. It is palpable in this position. The terminal branch of the dorsalis pedis artery passes into the plantar surface of the foot between the two heads of the first dorsal interosseous muscle. Approximating the position of the plantar arterial arch The blood supply of the foot is provided by branches of the posterior tibial and dorsalis pedis arteries. The posterior tibial artery enters the plantar surface of the foot through the tarsal tunnel and divides into a lateral and a medial plantar artery. | Anatomy_Gray. The dorsalis pedis artery passes onto the dorsal aspect of the foot and anteriorly over the tarsal bones where it lies between and is parallel to the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe. It is palpable in this position. The terminal branch of the dorsalis pedis artery passes into the plantar surface of the foot between the two heads of the first dorsal interosseous muscle. Approximating the position of the plantar arterial arch The blood supply of the foot is provided by branches of the posterior tibial and dorsalis pedis arteries. The posterior tibial artery enters the plantar surface of the foot through the tarsal tunnel and divides into a lateral and a medial plantar artery. | [
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Anatomy_Gray_1545 | Anatomy_Gray | The posterior tibial artery enters the plantar surface of the foot through the tarsal tunnel and divides into a lateral and a medial plantar artery. The lateral plantar artery curves laterally across the posterior half of the sole and then curves medially as the plantar arch (Fig. 6.136) through the anterior sole. Between the bases of metatarsals I and II, the plantar arch joins the terminal branch (deep plantar artery) of the dorsalis pedis artery. Most of the foot is supplied by the plantar arch. The medial plantar artery passes anteriorly through the sole, connects with branches of the plantar arch, and supplies the medial side of the great toe. Superficial veins in the lower limb often become enlarged. Also, because the veins are long, they can be removed and used elsewhere in the body as vascular grafts. | Anatomy_Gray. The posterior tibial artery enters the plantar surface of the foot through the tarsal tunnel and divides into a lateral and a medial plantar artery. The lateral plantar artery curves laterally across the posterior half of the sole and then curves medially as the plantar arch (Fig. 6.136) through the anterior sole. Between the bases of metatarsals I and II, the plantar arch joins the terminal branch (deep plantar artery) of the dorsalis pedis artery. Most of the foot is supplied by the plantar arch. The medial plantar artery passes anteriorly through the sole, connects with branches of the plantar arch, and supplies the medial side of the great toe. Superficial veins in the lower limb often become enlarged. Also, because the veins are long, they can be removed and used elsewhere in the body as vascular grafts. | [
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Anatomy_Gray_1546 | Anatomy_Gray | Superficial veins in the lower limb often become enlarged. Also, because the veins are long, they can be removed and used elsewhere in the body as vascular grafts. Superficial veins (Fig. 6.137) in the lower limb begin as a dorsal venous arch in the foot. The medial side of the arch curves superiorly anterior to the medial malleolus and passes up the leg and thigh as the great saphenous vein. This vein passes through an aperture in the fascia lata (saphenous ring) to join with the femoral vein in the femoral triangle. The lateral side of the dorsal venous arch in the foot passes posterior to the lateral malleolus and up the posterior surface of the leg as the small saphenous vein. This vessel passes through the deep fascia in the upper one-third of the leg and connects with the popliteal vein in the popliteal fossa posterior to the knee. | Anatomy_Gray. Superficial veins in the lower limb often become enlarged. Also, because the veins are long, they can be removed and used elsewhere in the body as vascular grafts. Superficial veins (Fig. 6.137) in the lower limb begin as a dorsal venous arch in the foot. The medial side of the arch curves superiorly anterior to the medial malleolus and passes up the leg and thigh as the great saphenous vein. This vein passes through an aperture in the fascia lata (saphenous ring) to join with the femoral vein in the femoral triangle. The lateral side of the dorsal venous arch in the foot passes posterior to the lateral malleolus and up the posterior surface of the leg as the small saphenous vein. This vessel passes through the deep fascia in the upper one-third of the leg and connects with the popliteal vein in the popliteal fossa posterior to the knee. | [
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Anatomy_Gray_1547 | Anatomy_Gray | Peripheral pulses can be felt at four locations in the lower limb (Fig. 6.138): femoral pulse in the femoral triangle—femoral artery inferior to the inguinal ligament and midway between the anterior superior iliac spine and the pubic symphysis; popliteal pulse in the popliteal fossa—popliteal artery deep in the popliteal fossa near the midline; posterior tibial pulse in the tarsal tunnel—posterior tibial artery posteroinferior to the medial malleolus in the groove between the medial malleolus and the heel (calcaneal tuberosity); dorsalis pedis pulse on the dorsal aspect of the foot—dorsalis pedis artery as it passes distally over the tarsal bones between the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe. Fig. 6.1 Upper margin of the lower limb. Fig. 6.2 Regions of the lower limb. Fig. 6.3 Areas of transition. Inguinal ligamentFemoral trianglePopliteal fossa(posterior to knee)Tarsal tunnel | Anatomy_Gray. Peripheral pulses can be felt at four locations in the lower limb (Fig. 6.138): femoral pulse in the femoral triangle—femoral artery inferior to the inguinal ligament and midway between the anterior superior iliac spine and the pubic symphysis; popliteal pulse in the popliteal fossa—popliteal artery deep in the popliteal fossa near the midline; posterior tibial pulse in the tarsal tunnel—posterior tibial artery posteroinferior to the medial malleolus in the groove between the medial malleolus and the heel (calcaneal tuberosity); dorsalis pedis pulse on the dorsal aspect of the foot—dorsalis pedis artery as it passes distally over the tarsal bones between the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe. Fig. 6.1 Upper margin of the lower limb. Fig. 6.2 Regions of the lower limb. Fig. 6.3 Areas of transition. Inguinal ligamentFemoral trianglePopliteal fossa(posterior to knee)Tarsal tunnel | [
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Anatomy_Gray_1548 | Anatomy_Gray | Fig. 6.1 Upper margin of the lower limb. Fig. 6.2 Regions of the lower limb. Fig. 6.3 Areas of transition. Inguinal ligamentFemoral trianglePopliteal fossa(posterior to knee)Tarsal tunnel Fig. 6.4 Center and line of gravity. Center ofgravityCenterof gravityposterior tohip jointLine of gravityAnterior to kneeAnterior to ankle Fig. 6.5 Movements of the hip joint. A. Flexion and extension. B. Abduction and adduction. C. External and internal rotation. D. Circumduction. Fig. 6.6 Movements of the knee and ankle. A. Knee flexion and extension. B. Ankle dorsiflexion and plantarflexion. Fig. 6.7 Some of the determinants of gait. | Anatomy_Gray. Fig. 6.1 Upper margin of the lower limb. Fig. 6.2 Regions of the lower limb. Fig. 6.3 Areas of transition. Inguinal ligamentFemoral trianglePopliteal fossa(posterior to knee)Tarsal tunnel Fig. 6.4 Center and line of gravity. Center ofgravityCenterof gravityposterior tohip jointLine of gravityAnterior to kneeAnterior to ankle Fig. 6.5 Movements of the hip joint. A. Flexion and extension. B. Abduction and adduction. C. External and internal rotation. D. Circumduction. Fig. 6.6 Movements of the knee and ankle. A. Knee flexion and extension. B. Ankle dorsiflexion and plantarflexion. Fig. 6.7 Some of the determinants of gait. | [
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Anatomy_Gray_1549 | Anatomy_Gray | D. Circumduction. Fig. 6.6 Movements of the knee and ankle. A. Knee flexion and extension. B. Ankle dorsiflexion and plantarflexion. Fig. 6.7 Some of the determinants of gait. Pelvic rotation in transverse planeminimizes drop in center of gravity byeffectively lengthening the limbsKnee flexion on full stance. Limb minimizes rise incenter of gravity by effectively shortening the limbPelvic tilt (drop) on swing side minimizes rise incenter of gravityMovement of knees toward midline(adduction of hip) minimizes lateralshift in center of gravityAbduction on stanceside controls andlimits the dropLateral shift incenter of gravityWith adductionof hip (kneesmove towardmidline)No adductionof hip (knees donot move towardmidline)Vertical shift incenter of gravityInternal rotationof hip jointExternal rotation of hip jointCenter of gravity with knee not flexedCenter of gravity with knee flexedFlexion Fig. 6.8 Bones and joints of the lower limb. Fig. 6.9 Bones of the foot. | Anatomy_Gray. D. Circumduction. Fig. 6.6 Movements of the knee and ankle. A. Knee flexion and extension. B. Ankle dorsiflexion and plantarflexion. Fig. 6.7 Some of the determinants of gait. Pelvic rotation in transverse planeminimizes drop in center of gravity byeffectively lengthening the limbsKnee flexion on full stance. Limb minimizes rise incenter of gravity by effectively shortening the limbPelvic tilt (drop) on swing side minimizes rise incenter of gravityMovement of knees toward midline(adduction of hip) minimizes lateralshift in center of gravityAbduction on stanceside controls andlimits the dropLateral shift incenter of gravityWith adductionof hip (kneesmove towardmidline)No adductionof hip (knees donot move towardmidline)Vertical shift incenter of gravityInternal rotationof hip jointExternal rotation of hip jointCenter of gravity with knee not flexedCenter of gravity with knee flexedFlexion Fig. 6.8 Bones and joints of the lower limb. Fig. 6.9 Bones of the foot. | [
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Anatomy_Gray_1550 | Anatomy_Gray | Fig. 6.8 Bones and joints of the lower limb. Fig. 6.9 Bones of the foot. Fig. 6.10 Longitudinal and transverse arches of the foot. Fig. 6.11 Muscles of the gluteal region. Extensor(gluteus maximus)Abductors(gluteus mediusand gluteus minimus)Rotators(piriformis, obturatorinternus, gemelli,quadratus femoris) Fig. 6.12 Major flexors of the hip. Fig. 6.13 Muscle compartments in the thigh and leg. Fig. 6.14 Apertures of communication between the lower limb and other regions. Fig. 6.15 Innervation of the lower limb. LumbarIliohypogastric (L1)Genitofemoral (L1, L2)Lateral cutaneous nerveof thigh (L2, L3)Obturator nerve (L2 to L4)Femoral nerve (L2 to L4)SacralSuperior gluteal nerve (L4 to S1)Sciatic nerve (L4 to S3)Inferior gluteal nerve (L5 to S2)Pudendal nerve (S2 to S4)Tibial nerve (branch of sciatic)(L4 to S3)Common fibular nerve (branch of sciatic)(L4 to S2)Sacrospinous ligamentIlio-inguinal (L1)LVLIVLIIILIILI | Anatomy_Gray. Fig. 6.8 Bones and joints of the lower limb. Fig. 6.9 Bones of the foot. Fig. 6.10 Longitudinal and transverse arches of the foot. Fig. 6.11 Muscles of the gluteal region. Extensor(gluteus maximus)Abductors(gluteus mediusand gluteus minimus)Rotators(piriformis, obturatorinternus, gemelli,quadratus femoris) Fig. 6.12 Major flexors of the hip. Fig. 6.13 Muscle compartments in the thigh and leg. Fig. 6.14 Apertures of communication between the lower limb and other regions. Fig. 6.15 Innervation of the lower limb. LumbarIliohypogastric (L1)Genitofemoral (L1, L2)Lateral cutaneous nerveof thigh (L2, L3)Obturator nerve (L2 to L4)Femoral nerve (L2 to L4)SacralSuperior gluteal nerve (L4 to S1)Sciatic nerve (L4 to S3)Inferior gluteal nerve (L5 to S2)Pudendal nerve (S2 to S4)Tibial nerve (branch of sciatic)(L4 to S3)Common fibular nerve (branch of sciatic)(L4 to S2)Sacrospinous ligamentIlio-inguinal (L1)LVLIVLIIILIILI | [
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Anatomy_Gray_1551 | Anatomy_Gray | Fig. 6.16 Dermatomes of the lower limb. Dots indicate autonomous zones (i.e., with minimal overlap). Fig. 6.17 Movements generated by myotomes. L1, L2L3, L4L5 to S2S1, S2Adduction of toes S2, S3 Fig. 6.18 Major nerves of the lower limb (colors indicate regions of motor innervation). Femoral nerve(anterior compartmentof thigh)Obturator(medial compartmentof thigh)Commonfibular nerveSuperficial branch(lateral compartment of leg)Deep branch(anterior compartment of leg)Sciatic nerve(posterior compartmentof thigh, leg, andsole of foot)Superior and inferiorgluteal nerves Fig. 6.19 Regions of skin innervated by peripheral nerves. | Anatomy_Gray. Fig. 6.16 Dermatomes of the lower limb. Dots indicate autonomous zones (i.e., with minimal overlap). Fig. 6.17 Movements generated by myotomes. L1, L2L3, L4L5 to S2S1, S2Adduction of toes S2, S3 Fig. 6.18 Major nerves of the lower limb (colors indicate regions of motor innervation). Femoral nerve(anterior compartmentof thigh)Obturator(medial compartmentof thigh)Commonfibular nerveSuperficial branch(lateral compartment of leg)Deep branch(anterior compartment of leg)Sciatic nerve(posterior compartmentof thigh, leg, andsole of foot)Superior and inferiorgluteal nerves Fig. 6.19 Regions of skin innervated by peripheral nerves. | [
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Anatomy_Gray_1552 | Anatomy_Gray | Fig. 6.19 Regions of skin innervated by peripheral nerves. Obturator nerveFemoral nerve (anteriorcutaneous nerves of thigh)Femoral nerve (saphenous nerve)Common fibular nerve(lateral cutaneous of calf)Common fibular nerve(superficial branch)Common fibular nerve(deep branch)Medial plantar nervePosterior cutaneous nerve of thigh(from sacral plexus)Posterior rami (L1 to L3)Posterior rami (S1 to S3)Obturator nerveFemoral nerve (saphenous nerve)Tibial nerve (sural nerve)Tibial nerve (sural nerve)Lateral plantar nerveTibial nerve (medial calcanealbranches)Lateral cutaneousnerve of thigh(from lumbar plexus) Fig. 6.20 Nerves related to bone. Deep branchCommon fibularnerve (neck of fibula)Superficial branch Fig. 6.21 Superficial veins. Fig. 6.22 External surface of the bony pelvis. Lateral view. | Anatomy_Gray. Fig. 6.19 Regions of skin innervated by peripheral nerves. Obturator nerveFemoral nerve (anteriorcutaneous nerves of thigh)Femoral nerve (saphenous nerve)Common fibular nerve(lateral cutaneous of calf)Common fibular nerve(superficial branch)Common fibular nerve(deep branch)Medial plantar nervePosterior cutaneous nerve of thigh(from sacral plexus)Posterior rami (L1 to L3)Posterior rami (S1 to S3)Obturator nerveFemoral nerve (saphenous nerve)Tibial nerve (sural nerve)Tibial nerve (sural nerve)Lateral plantar nerveTibial nerve (medial calcanealbranches)Lateral cutaneousnerve of thigh(from lumbar plexus) Fig. 6.20 Nerves related to bone. Deep branchCommon fibularnerve (neck of fibula)Superficial branch Fig. 6.21 Superficial veins. Fig. 6.22 External surface of the bony pelvis. Lateral view. | [
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Anatomy_Gray_1553 | Anatomy_Gray | Fig. 6.20 Nerves related to bone. Deep branchCommon fibularnerve (neck of fibula)Superficial branch Fig. 6.21 Superficial veins. Fig. 6.22 External surface of the bony pelvis. Lateral view. LIV spineHorizontal plane through top of iliac crestAnterior gluteal linePosterior gluteal linePosterior superior iliac spineSacrumSacrospinous ligamentIschial spineSacrotuberous ligamentPosterior inferior iliac spineAcetabulumIschial tuberosityIliumInferior gluteal lineIschiumPubisPubic tubercleIliopubic eminenceAnterior inferior iliac spineInguinal ligamentAnterior superior iliac spineAnterior abdominal wallIliac crestTuberculum of iliac crest Fig. 6.23 Ischial tuberosity. Posterolateral view. | Anatomy_Gray. Fig. 6.20 Nerves related to bone. Deep branchCommon fibularnerve (neck of fibula)Superficial branch Fig. 6.21 Superficial veins. Fig. 6.22 External surface of the bony pelvis. Lateral view. LIV spineHorizontal plane through top of iliac crestAnterior gluteal linePosterior gluteal linePosterior superior iliac spineSacrumSacrospinous ligamentIschial spineSacrotuberous ligamentPosterior inferior iliac spineAcetabulumIschial tuberosityIliumInferior gluteal lineIschiumPubisPubic tubercleIliopubic eminenceAnterior inferior iliac spineInguinal ligamentAnterior superior iliac spineAnterior abdominal wallIliac crestTuberculum of iliac crest Fig. 6.23 Ischial tuberosity. Posterolateral view. | [
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Anatomy_Gray_1554 | Anatomy_Gray | Fig. 6.23 Ischial tuberosity. Posterolateral view. AcetabulumIschial spineFor attachment of sacrotuberous ligamentFor attachment of semitendinosus andlong head of biceps femoris muscleCovered by connective tissue and bursaFor attachment of adductor magnus muscleFor attachment of semimembranosus muscleIschiopubic ramusObturator foramenBody of pubic bone Fig. 6.24 Acetabulum. Fig. 6.25 Multiple fractures of the pelvis. Radiograph with contrast in the bladder. A large accumulation of blood is deforming the bladder. Fig. 6.26 Proximal end of the femur (right). A. Anterior view. B. Medial view. C. Posterior view. D. Lateral view. | Anatomy_Gray. Fig. 6.23 Ischial tuberosity. Posterolateral view. AcetabulumIschial spineFor attachment of sacrotuberous ligamentFor attachment of semitendinosus andlong head of biceps femoris muscleCovered by connective tissue and bursaFor attachment of adductor magnus muscleFor attachment of semimembranosus muscleIschiopubic ramusObturator foramenBody of pubic bone Fig. 6.24 Acetabulum. Fig. 6.25 Multiple fractures of the pelvis. Radiograph with contrast in the bladder. A large accumulation of blood is deforming the bladder. Fig. 6.26 Proximal end of the femur (right). A. Anterior view. B. Medial view. C. Posterior view. D. Lateral view. | [
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Anatomy_Gray_1555 | Anatomy_Gray | Fig. 6.26 Proximal end of the femur (right). A. Anterior view. B. Medial view. C. Posterior view. D. Lateral view. ABTrochanteric fossaHeadNeckNeckAttachment site for piriformis muscleGreater trochanterAttachment site for gluteus minimusShaftLesser trochanterIntertrochanteric lineTubercleGreater trochanterPiriformisFoveaObturator internusTrochanteric fossaEnd of intertrochanteric linePectineal line (spiral line)Lesser trochanterOval depression forobturator externusAttachment ofgluteus mediusQuadrate tubercleGreater trochanterFoveaNeckQuadrate tubercleLesser trochanterPectineal line (spiral line)Medial margin of linea asperaLinea asperaLateral margin of linea asperaGluteal tuberosityAttachment site for gluteus mediusIntertrochanteric crestGluteus minimusGluteus mediusLesser trochanterCD Fig. 6.27 Shaft of the femur. On the right is a posterior view of proximal shaft of right femur. | Anatomy_Gray. Fig. 6.26 Proximal end of the femur (right). A. Anterior view. B. Medial view. C. Posterior view. D. Lateral view. ABTrochanteric fossaHeadNeckNeckAttachment site for piriformis muscleGreater trochanterAttachment site for gluteus minimusShaftLesser trochanterIntertrochanteric lineTubercleGreater trochanterPiriformisFoveaObturator internusTrochanteric fossaEnd of intertrochanteric linePectineal line (spiral line)Lesser trochanterOval depression forobturator externusAttachment ofgluteus mediusQuadrate tubercleGreater trochanterFoveaNeckQuadrate tubercleLesser trochanterPectineal line (spiral line)Medial margin of linea asperaLinea asperaLateral margin of linea asperaGluteal tuberosityAttachment site for gluteus mediusIntertrochanteric crestGluteus minimusGluteus mediusLesser trochanterCD Fig. 6.27 Shaft of the femur. On the right is a posterior view of proximal shaft of right femur. | [
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Anatomy_Gray_1556 | Anatomy_Gray | Fig. 6.27 Shaft of the femur. On the right is a posterior view of proximal shaft of right femur. Fig. 6.28 This radiograph of the pelvis, anteroposterior view, demonstrates a fracture of the neck of the femur. Fractured neck of femur Fig. 6.29 Anteroposterior radiograph showing an intertrochanteric fracture of proximal end of femur. Fig. 6.30 Hip joint. A. Articular surfaces. Anterior view. B. Movement of the neck of the femur during medial and lateral rotation. Superior view. Acetabulum of pelvic boneAcetabular labrumHead of femurSuperior viewLateral rotationMedial rotationAB Fig. 6.31 Hip joint. A. Transverse acetabular ligament. B. Ligament of the head of the femur. The head of the femur has been laterally rotated out of the acetabulum to show the ligament. | Anatomy_Gray. Fig. 6.27 Shaft of the femur. On the right is a posterior view of proximal shaft of right femur. Fig. 6.28 This radiograph of the pelvis, anteroposterior view, demonstrates a fracture of the neck of the femur. Fractured neck of femur Fig. 6.29 Anteroposterior radiograph showing an intertrochanteric fracture of proximal end of femur. Fig. 6.30 Hip joint. A. Articular surfaces. Anterior view. B. Movement of the neck of the femur during medial and lateral rotation. Superior view. Acetabulum of pelvic boneAcetabular labrumHead of femurSuperior viewLateral rotationMedial rotationAB Fig. 6.31 Hip joint. A. Transverse acetabular ligament. B. Ligament of the head of the femur. The head of the femur has been laterally rotated out of the acetabulum to show the ligament. | [
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Anatomy_Gray_1557 | Anatomy_Gray | Fig. 6.31 Hip joint. A. Transverse acetabular ligament. B. Ligament of the head of the femur. The head of the femur has been laterally rotated out of the acetabulum to show the ligament. ABAcetabular labrum Lunate surfaceTransverseacetabular ligamentAcetabularforamenObturator foramenAcetabular fossaArtery of ligament of headSynovial sleeve around ligamentLigament of head of femurIschial tuberosityObturator membranePubisPubic tubercleObturator arteryAcetabular branchof obturator arteryCut synovial membrane Fig. 6.32 Synovial membrane of the hip joint. Synovial membraneLine of attachment around head of femurMembrane reflects back to attach to margin ofacetabulum Fig. 6.33 Fibrous membrane and ligaments of the hip joint. A. Fibrous membrane of the joint capsule. Anterior view. B. Iliofemoral and pubofemoral ligaments. Anterior view. C. Ischiofemoral ligament. Posterior view. Fig. 6.34 Blood supply of the hip joint. | Anatomy_Gray. Fig. 6.31 Hip joint. A. Transverse acetabular ligament. B. Ligament of the head of the femur. The head of the femur has been laterally rotated out of the acetabulum to show the ligament. ABAcetabular labrum Lunate surfaceTransverseacetabular ligamentAcetabularforamenObturator foramenAcetabular fossaArtery of ligament of headSynovial sleeve around ligamentLigament of head of femurIschial tuberosityObturator membranePubisPubic tubercleObturator arteryAcetabular branchof obturator arteryCut synovial membrane Fig. 6.32 Synovial membrane of the hip joint. Synovial membraneLine of attachment around head of femurMembrane reflects back to attach to margin ofacetabulum Fig. 6.33 Fibrous membrane and ligaments of the hip joint. A. Fibrous membrane of the joint capsule. Anterior view. B. Iliofemoral and pubofemoral ligaments. Anterior view. C. Ischiofemoral ligament. Posterior view. Fig. 6.34 Blood supply of the hip joint. | [
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Anatomy_Gray_1558 | Anatomy_Gray | Fig. 6.34 Blood supply of the hip joint. Internal iliac arteryCommon iliac arteryExternal iliac arteryLateral circumflex femoral artery1st perforating arteryDeep artery of thighMedial circumflex femoral arteryFemoral arteryObturator arteryInferior gluteal arterySuperior gluteal artery Fig. 6.35 Gateways to the lower limb. | Anatomy_Gray. Fig. 6.34 Blood supply of the hip joint. Internal iliac arteryCommon iliac arteryExternal iliac arteryLateral circumflex femoral artery1st perforating arteryDeep artery of thighMedial circumflex femoral arteryFemoral arteryObturator arteryInferior gluteal arterySuperior gluteal artery Fig. 6.35 Gateways to the lower limb. | [
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Anatomy_Gray_1559 | Anatomy_Gray | Fig. 6.35 Gateways to the lower limb. Sacrospinous ligamentSacrotuberous ligamentPelvic cavityIlio-inguinal nerveAbdominal cavityGap between inguinal ligament and pelvic bone:• Psoas major, iliacus, pectineus muscles• Femoral artery• Femoral vein• Lymphatics• Femoral branch of genitofemoral nerve• Lateral cutaneous nerve of thigh• Femoral nerveObturator canal:• obturator nerve• obturator vesselsLesser sciatic foramen:• Obturator internus muscle tendon• Pudendal nerve and internal pudendal vessels pass into perineum from gluteal regionGreater sciatic foramen below piriformis muscle:• Sciatic nerve• Inferior gluteal nerve, artery, vein• Pudendal nerve• Internal pudendal artery and vein• Posterior femoral cutaneous nerve• Nerve to obturator internus and gemellus superior muscles• Nerve to quadratus femoris and gemellus inferior musclesGreater sciatic foramen abovepiriformis muscle:• Superior gluteal nerve, artery, veinPiriformis muscle | Anatomy_Gray. Fig. 6.35 Gateways to the lower limb. Sacrospinous ligamentSacrotuberous ligamentPelvic cavityIlio-inguinal nerveAbdominal cavityGap between inguinal ligament and pelvic bone:• Psoas major, iliacus, pectineus muscles• Femoral artery• Femoral vein• Lymphatics• Femoral branch of genitofemoral nerve• Lateral cutaneous nerve of thigh• Femoral nerveObturator canal:• obturator nerve• obturator vesselsLesser sciatic foramen:• Obturator internus muscle tendon• Pudendal nerve and internal pudendal vessels pass into perineum from gluteal regionGreater sciatic foramen below piriformis muscle:• Sciatic nerve• Inferior gluteal nerve, artery, vein• Pudendal nerve• Internal pudendal artery and vein• Posterior femoral cutaneous nerve• Nerve to obturator internus and gemellus superior muscles• Nerve to quadratus femoris and gemellus inferior musclesGreater sciatic foramen abovepiriformis muscle:• Superior gluteal nerve, artery, veinPiriformis muscle | [
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Anatomy_Gray_1560 | Anatomy_Gray | Fig. 6.36 Branches of the lumbosacral plexus. L3 anterior ramusPerforating cutaneous nerveLumbosacral trunkSuperior gluteal nerveNerves to quadratus femoris and obturator internusInguinal ligamentInferior gluteal nervePosterior cutaneous nerve of thighSciatic nerveS1S2Sacrotuberous ligamentSacrospinous ligamentObturator nerveFemoral branch of genitofemoral nerveFemoral nerveLateral cutaneous nerve of thighIlio-inguinal nerveL1 anterior ramusL2 anterior ramus Fig. 6.37 Arteries of the lower limb. Fig. 6.38 Veins of the lower limb. Fig. 6.39 Lymphatic drainage of the lower limb. Fig. 6.40 Fascia lata. A. Right limb. Anterior view. B. Lateral view. ABInguinal ligamentInguinal ligamentDeep fascia of legFascia lataSaphenous openingAnterior superior iliac spineAnterior superior iliac spineTuberculum of iliac crestFascia lataGluteus maximusTensor fascia lataIliotibial tractPubic tuberclePubic tubercle Fig. 6.41 Saphenous ring. Anterior view. | Anatomy_Gray. Fig. 6.36 Branches of the lumbosacral plexus. L3 anterior ramusPerforating cutaneous nerveLumbosacral trunkSuperior gluteal nerveNerves to quadratus femoris and obturator internusInguinal ligamentInferior gluteal nervePosterior cutaneous nerve of thighSciatic nerveS1S2Sacrotuberous ligamentSacrospinous ligamentObturator nerveFemoral branch of genitofemoral nerveFemoral nerveLateral cutaneous nerve of thighIlio-inguinal nerveL1 anterior ramusL2 anterior ramus Fig. 6.37 Arteries of the lower limb. Fig. 6.38 Veins of the lower limb. Fig. 6.39 Lymphatic drainage of the lower limb. Fig. 6.40 Fascia lata. A. Right limb. Anterior view. B. Lateral view. ABInguinal ligamentInguinal ligamentDeep fascia of legFascia lataSaphenous openingAnterior superior iliac spineAnterior superior iliac spineTuberculum of iliac crestFascia lataGluteus maximusTensor fascia lataIliotibial tractPubic tuberclePubic tubercle Fig. 6.41 Saphenous ring. Anterior view. | [
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Anatomy_Gray_1561 | Anatomy_Gray | Fig. 6.41 Saphenous ring. Anterior view. Fig. 6.42 Boundaries of the femoral triangle. Fig. 6.43 Contents of the femoral triangle. Fig. 6.44 Gluteal region. Posterior view. Fig. 6.45 Deep muscles in the gluteal region. A. Posterior view. B. Function. ABGemellus superior Gemellus inferiorObturator internusQuadratus femorisGluteus mediusGluteus minimusGreater sciatic foramen abovepiriformisPiriformis muscleGreater sciatic foramen belowpiriformisContraction of gluteus minimus and mediuson stance side prevents excessive pelvic tiltduring swing phase on opposite side Fig. 6.46 Gluteus maximus muscle. Posterior view. Gluteus mediusGluteus maximusAttachment of gluteus maximus to iliotibial tractIliotibial tractAttachment of deep fibers to gluteal tuberosity Fig. 6.47 Tensor fasciae latae. Left gluteal region, lateral view. Tensor fasciae lataeTubercle of crest of iliumGluteus mediusIliotibial tractGluteus minimusGluteus maximusFascia lataDeep fascia of legTibiaAttachment to tibia | Anatomy_Gray. Fig. 6.41 Saphenous ring. Anterior view. Fig. 6.42 Boundaries of the femoral triangle. Fig. 6.43 Contents of the femoral triangle. Fig. 6.44 Gluteal region. Posterior view. Fig. 6.45 Deep muscles in the gluteal region. A. Posterior view. B. Function. ABGemellus superior Gemellus inferiorObturator internusQuadratus femorisGluteus mediusGluteus minimusGreater sciatic foramen abovepiriformisPiriformis muscleGreater sciatic foramen belowpiriformisContraction of gluteus minimus and mediuson stance side prevents excessive pelvic tiltduring swing phase on opposite side Fig. 6.46 Gluteus maximus muscle. Posterior view. Gluteus mediusGluteus maximusAttachment of gluteus maximus to iliotibial tractIliotibial tractAttachment of deep fibers to gluteal tuberosity Fig. 6.47 Tensor fasciae latae. Left gluteal region, lateral view. Tensor fasciae lataeTubercle of crest of iliumGluteus mediusIliotibial tractGluteus minimusGluteus maximusFascia lataDeep fascia of legTibiaAttachment to tibia | [
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Anatomy_Gray_1562 | Anatomy_Gray | Tensor fasciae lataeTubercle of crest of iliumGluteus mediusIliotibial tractGluteus minimusGluteus maximusFascia lataDeep fascia of legTibiaAttachment to tibia Fig. 6.48 Nerves of the gluteal region. Posterior view. Superior gluteal nerveTensor fasciae latae muscleInferior gluteal nerveIliotibial tractPosterior cutaneous nerve of thighNerve to quadratus femorismuscle (deep to gemelli, obturator internus, and quadratus femoris)Gluteus maximusPerforating cutaneous nerveNerve to obturator internusPudendal nervePiriformis muscleSciatic nerve Fig. 6.49 Site for intramuscular injections in the gluteal region. Fig. 6.50 Arteries of the gluteal region. Deep branchLateral femoral circumflex arteryMedial femoral circumflex arteryFirst perforating artery fromdeep artery of thighInferior gluteal artery and veinSuperficial branchSuperior gluteal artery and veinPiriformis muscle | Anatomy_Gray. Tensor fasciae lataeTubercle of crest of iliumGluteus mediusIliotibial tractGluteus minimusGluteus maximusFascia lataDeep fascia of legTibiaAttachment to tibia Fig. 6.48 Nerves of the gluteal region. Posterior view. Superior gluteal nerveTensor fasciae latae muscleInferior gluteal nerveIliotibial tractPosterior cutaneous nerve of thighNerve to quadratus femorismuscle (deep to gemelli, obturator internus, and quadratus femoris)Gluteus maximusPerforating cutaneous nerveNerve to obturator internusPudendal nervePiriformis muscleSciatic nerve Fig. 6.49 Site for intramuscular injections in the gluteal region. Fig. 6.50 Arteries of the gluteal region. Deep branchLateral femoral circumflex arteryMedial femoral circumflex arteryFirst perforating artery fromdeep artery of thighInferior gluteal artery and veinSuperficial branchSuperior gluteal artery and veinPiriformis muscle | [
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Anatomy_Gray_1563 | Anatomy_Gray | Fig. 6.51 Anastomoses between gluteal arteries and vessels originating from the femoral artery in the thigh. Posterior view. Superior gluteal arteryFirst perforating arterySecond perforating arteryThird perforating arteryFemoral arteryDeep artery of thighMedial femoral circumflex arteryLateral femoralcircumflex arteryInferior gluteal artery Fig. 6.52 Thigh. A. Posterior view. B. Anterior view. C. Cross section through the midthigh. ABCInguinal ligamentAbdominal wallGap between inguinal ligament and pelvic boneObturator canalAnterior superior iliac spinePubic tubercleMedialAnteriorLateral Posterior Anterior compartmentPosterior compartmentMedial compartmentPopliteal fossa(posterior to knee)Popliteal fossaSciatic nerveQuadratus femorisInferior margin of gluteus maximusGluteal fold Fig. 6.53 Shaft and distal end of femur. A. Lateral view. B. Anterior view. C. Posterior view. D. Cross section through shaft of femur. | Anatomy_Gray. Fig. 6.51 Anastomoses between gluteal arteries and vessels originating from the femoral artery in the thigh. Posterior view. Superior gluteal arteryFirst perforating arterySecond perforating arteryThird perforating arteryFemoral arteryDeep artery of thighMedial femoral circumflex arteryLateral femoralcircumflex arteryInferior gluteal artery Fig. 6.52 Thigh. A. Posterior view. B. Anterior view. C. Cross section through the midthigh. ABCInguinal ligamentAbdominal wallGap between inguinal ligament and pelvic boneObturator canalAnterior superior iliac spinePubic tubercleMedialAnteriorLateral Posterior Anterior compartmentPosterior compartmentMedial compartmentPopliteal fossa(posterior to knee)Popliteal fossaSciatic nerveQuadratus femorisInferior margin of gluteus maximusGluteal fold Fig. 6.53 Shaft and distal end of femur. A. Lateral view. B. Anterior view. C. Posterior view. D. Cross section through shaft of femur. | [
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Anatomy_Gray_1564 | Anatomy_Gray | Fig. 6.53 Shaft and distal end of femur. A. Lateral view. B. Anterior view. C. Posterior view. D. Cross section through shaft of femur. Lateral epicondyleMedial epicondyleMedial condyleLateral borderLateral(posterolateral)surfaceMedial(posteromedial)surfaceMedialborderLateral condyleLateral epicondyleFacet for attachment of lateral head of gastrocnemiusFacet for attachment of the tendon of popliteus muscleFacet for attachmentof the tendon ofpopliteus muscleAdductor tubercleAdductor tuberclePatellar surfacePosterior surfaceMedial supracondylar lineLateral supracondylar lineIntercondylar fossaFacet for attachment of posterior cruciate ligamentFacet for attachment of anterior cruciate ligamentRoughened area for attachment of medial head of gastrocnemius muscleFacet for attachmentof lateral head ofgastrocnemius muscleLinea asperaLinea asperaAnterior surfaceABCD Fig. 6.54 Patella. A. Anterior view. B. Posterior view. C. Superior view. | Anatomy_Gray. Fig. 6.53 Shaft and distal end of femur. A. Lateral view. B. Anterior view. C. Posterior view. D. Cross section through shaft of femur. Lateral epicondyleMedial epicondyleMedial condyleLateral borderLateral(posterolateral)surfaceMedial(posteromedial)surfaceMedialborderLateral condyleLateral epicondyleFacet for attachment of lateral head of gastrocnemiusFacet for attachment of the tendon of popliteus muscleFacet for attachmentof the tendon ofpopliteus muscleAdductor tubercleAdductor tuberclePatellar surfacePosterior surfaceMedial supracondylar lineLateral supracondylar lineIntercondylar fossaFacet for attachment of posterior cruciate ligamentFacet for attachment of anterior cruciate ligamentRoughened area for attachment of medial head of gastrocnemius muscleFacet for attachmentof lateral head ofgastrocnemius muscleLinea asperaLinea asperaAnterior surfaceABCD Fig. 6.54 Patella. A. Anterior view. B. Posterior view. C. Superior view. | [
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Anatomy_Gray_1565 | Anatomy_Gray | Fig. 6.54 Patella. A. Anterior view. B. Posterior view. C. Superior view. Fig. 6.55 Proximal end of the tibia. A. Superior view, tibial plateau. B. Anterior view. C. Posterior view. D. Cross section through the shaft of tibia. AIntercondylar regionAttachment of posterior cruciate ligamentPosterior attachment of lateral meniscusArea of articulation with lateral meniscusAnterior attachment of lateral meniscusAttachment of anterior cruciate ligamentTuberosityTubercles of intercondylar eminenceRoughened and perforated areaAnterior attachment of medial meniscusArea of articulation with medial meniscusPosterior attachment of medial meniscus | Anatomy_Gray. Fig. 6.54 Patella. A. Anterior view. B. Posterior view. C. Superior view. Fig. 6.55 Proximal end of the tibia. A. Superior view, tibial plateau. B. Anterior view. C. Posterior view. D. Cross section through the shaft of tibia. AIntercondylar regionAttachment of posterior cruciate ligamentPosterior attachment of lateral meniscusArea of articulation with lateral meniscusAnterior attachment of lateral meniscusAttachment of anterior cruciate ligamentTuberosityTubercles of intercondylar eminenceRoughened and perforated areaAnterior attachment of medial meniscusArea of articulation with medial meniscusPosterior attachment of medial meniscus | [
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Anatomy_Gray_1566 | Anatomy_Gray | BCLateral condyleRoughened and perforated areaSite of attachment of sartorius, gracilis, and semitendinosus musclesShaft of tibiaGrooveTibial tuberosityMedial condyleAnterior attachment ofmedial meniscusTubercles of intercondylar eminenceAnterior Anterior borderLateral surfaceInterosseous borderPosterior surfacePosteriorMedial borderMedial surfaceAttachment of medial meniscusAttachment of posterior cruciate ligamentSoleal lineArticular facet for proximal head of fibulaD Fig. 6.56 Proximal end of the fibula. A. Anterior view. B. Cross section through the shaft of fibula. ABApexAttachment site for fibular collateral ligament of kneeAttachment site for tendon of biceps femoris muscleCommon fibular nerveLateral surfaceShaftMedial surfaceMedial part of posterior surfaceNeckFacet for articulationwith inferior surfaceof lateral condyle of tibiaHeadInterosseousborderPosterior borderLateral surfaceAnterior borderMedial surfacePosterior surfaceMedial crest onposterior surface | Anatomy_Gray. BCLateral condyleRoughened and perforated areaSite of attachment of sartorius, gracilis, and semitendinosus musclesShaft of tibiaGrooveTibial tuberosityMedial condyleAnterior attachment ofmedial meniscusTubercles of intercondylar eminenceAnterior Anterior borderLateral surfaceInterosseous borderPosterior surfacePosteriorMedial borderMedial surfaceAttachment of medial meniscusAttachment of posterior cruciate ligamentSoleal lineArticular facet for proximal head of fibulaD Fig. 6.56 Proximal end of the fibula. A. Anterior view. B. Cross section through the shaft of fibula. ABApexAttachment site for fibular collateral ligament of kneeAttachment site for tendon of biceps femoris muscleCommon fibular nerveLateral surfaceShaftMedial surfaceMedial part of posterior surfaceNeckFacet for articulationwith inferior surfaceof lateral condyle of tibiaHeadInterosseousborderPosterior borderLateral surfaceAnterior borderMedial surfacePosterior surfaceMedial crest onposterior surface | [
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Anatomy_Gray_1567 | Anatomy_Gray | Fig. 6.57 Transverse section through the midthigh. Fig. 6.58 Psoas major and iliacus muscles. Fig. 6.59 Muscles of the anterior compartment of thigh. SartoriusSartoriusStraight head of rectus femorisReflected head of rectus femorisVastus lateralisRectus femorisVastus medialisQuadriceps femoris tendonPatellaPatellar ligamentPes anserinusSartoriusGracilisSemitendinosusAttachment of pes anserinusTibial tuberosityPatellar ligamentQuadriceps femoris tendonSuprapatellar bursaArticularis genusVastus medialisRectus femorisVastus intermediusVastus lateralisSartoriusPosterior compartment of thighVastus lateralisVastus medialisVastus intermediusMedial compartment of thighAdductor canal Fig. 6.60 Muscles of the medial compartment of thigh. Anterior view. | Anatomy_Gray. Fig. 6.57 Transverse section through the midthigh. Fig. 6.58 Psoas major and iliacus muscles. Fig. 6.59 Muscles of the anterior compartment of thigh. SartoriusSartoriusStraight head of rectus femorisReflected head of rectus femorisVastus lateralisRectus femorisVastus medialisQuadriceps femoris tendonPatellaPatellar ligamentPes anserinusSartoriusGracilisSemitendinosusAttachment of pes anserinusTibial tuberosityPatellar ligamentQuadriceps femoris tendonSuprapatellar bursaArticularis genusVastus medialisRectus femorisVastus intermediusVastus lateralisSartoriusPosterior compartment of thighVastus lateralisVastus medialisVastus intermediusMedial compartment of thighAdductor canal Fig. 6.60 Muscles of the medial compartment of thigh. Anterior view. | [
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Anatomy_Gray_1568 | Anatomy_Gray | Fig. 6.60 Muscles of the medial compartment of thigh. Anterior view. Obturator externusAdductor magnusPectineusAdductor longusAdductor brevisAnterior compartment of thighSartorius attachmentGracilisGracilisSemitendinosus attachmentAdductor hiatusAdductor canalAdductor longusAdductor magnusPosterior compartment of thighPes anserinus Fig. 6.61 Pectineus, adductor longus, and adductor brevis muscles. Anterior view. Fig. 6.62 Adductor magnus and obturator externus muscles. Anterior view. Obturator externusAdductor magnus (adductor part)Adductor magnus (hamstring part)Adductor tubercleAdductor hiatusPerforations for branches of deep artery of thigh• Terminal end of deep artery of thigh Fig. 6.63 Muscles of the posterior compartment of thigh. Posterior view. | Anatomy_Gray. Fig. 6.60 Muscles of the medial compartment of thigh. Anterior view. Obturator externusAdductor magnusPectineusAdductor longusAdductor brevisAnterior compartment of thighSartorius attachmentGracilisGracilisSemitendinosus attachmentAdductor hiatusAdductor canalAdductor longusAdductor magnusPosterior compartment of thighPes anserinus Fig. 6.61 Pectineus, adductor longus, and adductor brevis muscles. Anterior view. Fig. 6.62 Adductor magnus and obturator externus muscles. Anterior view. Obturator externusAdductor magnus (adductor part)Adductor magnus (hamstring part)Adductor tubercleAdductor hiatusPerforations for branches of deep artery of thigh• Terminal end of deep artery of thigh Fig. 6.63 Muscles of the posterior compartment of thigh. Posterior view. | [
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Anatomy_Gray_1569 | Anatomy_Gray | Fig. 6.63 Muscles of the posterior compartment of thigh. Posterior view. Ischial tuberosityQuadratus femorisAdductor magnusHamstring part of adductor magnusLong head of biceps femorisShort head of biceps femorisPart of semimembranosus thatinserts into capsule around knee jointOn anterior aspect of tibia attaches to pes anserinusSemimembranosusSemitendinosus Fig. 6.64 Coronal MRI of the posterior pelvis and thigh showing a hamstring avulsion injury. Fig. 6.65 Femoral artery. | Anatomy_Gray. Fig. 6.63 Muscles of the posterior compartment of thigh. Posterior view. Ischial tuberosityQuadratus femorisAdductor magnusHamstring part of adductor magnusLong head of biceps femorisShort head of biceps femorisPart of semimembranosus thatinserts into capsule around knee jointOn anterior aspect of tibia attaches to pes anserinusSemimembranosusSemitendinosus Fig. 6.64 Coronal MRI of the posterior pelvis and thigh showing a hamstring avulsion injury. Fig. 6.65 Femoral artery. | [
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Anatomy_Gray_1570 | Anatomy_Gray | Fig. 6.64 Coronal MRI of the posterior pelvis and thigh showing a hamstring avulsion injury. Fig. 6.65 Femoral artery. Superficial epigastric arterySartorius muscleDeep artery of thighRectus femoris muscleVastus medialis muscleGracilis muscleDeep externalpudendal arterySuperficial externalpudendal arteryVastus lateralis muscleVastus medialis muscleSartorius muscleArtery passes posteriorlythrough adductor hiatus andbecomes popliteal arteryArtery in adductor canalFemoral artery • Midway between anterior superior iliac spine and pubic symphysis inferior to inguinal ligamentExternal iliac arterySuperficial externaliliac arteryPubic symphysis Fig. 6.66 Deep artery of thigh. A. Anterior view. B. Posterior view. | Anatomy_Gray. Fig. 6.64 Coronal MRI of the posterior pelvis and thigh showing a hamstring avulsion injury. Fig. 6.65 Femoral artery. Superficial epigastric arterySartorius muscleDeep artery of thighRectus femoris muscleVastus medialis muscleGracilis muscleDeep externalpudendal arterySuperficial externalpudendal arteryVastus lateralis muscleVastus medialis muscleSartorius muscleArtery passes posteriorlythrough adductor hiatus andbecomes popliteal arteryArtery in adductor canalFemoral artery • Midway between anterior superior iliac spine and pubic symphysis inferior to inguinal ligamentExternal iliac arterySuperficial externaliliac arteryPubic symphysis Fig. 6.66 Deep artery of thigh. A. Anterior view. B. Posterior view. | [
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Anatomy_Gray_1571 | Anatomy_Gray | Fig. 6.66 Deep artery of thigh. A. Anterior view. B. Posterior view. BSuperior gluteal arteryLateral femoral circumflex arteryCruciate anastomosesMedial circumflex femoral arteryFirst perforating arterySecond perforating arteryThird perforating arteryTerminal end of deepartery of thighPopliteal arteryAdductor magnus muscleAdductor hiatusInferior gluteal arteryPiriformis muscleAPsoas and iliacus musclesSartorius muscleRectus femoris muscleLateral circumflex femoral arteryAscending branchDescending branchVastus lateralis muscleVastus intermedius muscleCut vastus medialis muscleQuadriceps femoris tendonTerminal end of deepartery of thighGracilis muscleSartorius muscleAdductor magnus muscleFirst, second, and third perforating arteriesAdductor brevis muscleAdductor longus musclePectineus muscleMedial circumflex femoral arteryDeep artery of thigh Fig. 6.67 Obturator artery. | Anatomy_Gray. Fig. 6.66 Deep artery of thigh. A. Anterior view. B. Posterior view. BSuperior gluteal arteryLateral femoral circumflex arteryCruciate anastomosesMedial circumflex femoral arteryFirst perforating arterySecond perforating arteryThird perforating arteryTerminal end of deepartery of thighPopliteal arteryAdductor magnus muscleAdductor hiatusInferior gluteal arteryPiriformis muscleAPsoas and iliacus musclesSartorius muscleRectus femoris muscleLateral circumflex femoral arteryAscending branchDescending branchVastus lateralis muscleVastus intermedius muscleCut vastus medialis muscleQuadriceps femoris tendonTerminal end of deepartery of thighGracilis muscleSartorius muscleAdductor magnus muscleFirst, second, and third perforating arteriesAdductor brevis muscleAdductor longus musclePectineus muscleMedial circumflex femoral arteryDeep artery of thigh Fig. 6.67 Obturator artery. | [
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Anatomy_Gray_1572 | Anatomy_Gray | Fig. 6.67 Obturator artery. Ligament ofhead offemurObturatorarteryAnterior branchAcetabular branchPosterior branchObturatorexternus muscleArtery of ligament of head of femur Fig. 6.68 Femoral nerve. Nerve to pectineusAnterior branchNerves to iliacusNerve to sartoriusRectus femoris muscleVastus lateralis muscleVastus medialis muscleSaphenous nerveSaphenous nervePes anserinusSartorius muscleGracilis muscleAnterior cutaneous branchesAdductor magnus musclePectineus muscleAdductor longus musclePosterior branchFemoral nerve Fig. 6.69 Obturator nerve. Posterior branchObturator externus musclePsoas and iliacus musclesPectineus muscleAdductor brevis muscleAdductor longus muscleBranch to adductor magnus from posterior branchAdductor magnus muscleGracilis muscleCutaneous branchAnterior branchObturator nerve Fig. 6.70 Sciatic nerve. | Anatomy_Gray. Fig. 6.67 Obturator artery. Ligament ofhead offemurObturatorarteryAnterior branchAcetabular branchPosterior branchObturatorexternus muscleArtery of ligament of head of femur Fig. 6.68 Femoral nerve. Nerve to pectineusAnterior branchNerves to iliacusNerve to sartoriusRectus femoris muscleVastus lateralis muscleVastus medialis muscleSaphenous nerveSaphenous nervePes anserinusSartorius muscleGracilis muscleAnterior cutaneous branchesAdductor magnus musclePectineus muscleAdductor longus musclePosterior branchFemoral nerve Fig. 6.69 Obturator nerve. Posterior branchObturator externus musclePsoas and iliacus musclesPectineus muscleAdductor brevis muscleAdductor longus muscleBranch to adductor magnus from posterior branchAdductor magnus muscleGracilis muscleCutaneous branchAnterior branchObturator nerve Fig. 6.70 Sciatic nerve. | [
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Anatomy_Gray_1573 | Anatomy_Gray | Fig. 6.70 Sciatic nerve. Piriformis muscleQuadratus femoris muscleSciatic nerveAdductor magnus muscleLong head of biceps femoris muscleLong head of biceps femoris muscleShort head of biceps femoris muscleCommon fibular nerveTibial nervePopliteal artery and veinSemimembranosus muscleSemitendinosus muscleBranch to part of adductor magnus originatingfrom ischial tuberosity Fig. 6.71 Knee joint. Joint capsule is not shown. Fig. 6.72 Articular surfaces of the knee joint. A. Extended. B. Flexed. C. Anterior view (flexed). Fig. 6.73 Menisci of the knee joint. A. Superior view. Menisci of the knee joint. B. Normal knee joint showing the medial meniscus. T2-weighted magnetic resonance image in the sagittal plane. C. Normal knee joint showing the lateral meniscus. T2-weighted magnetic resonance image in the sagittal plane. APatellar ligamentJoint capsuleMedial meniscusPopliteus tendonLateral meniscusTransverse ligament of the kneeInfrapatellar fat | Anatomy_Gray. Fig. 6.70 Sciatic nerve. Piriformis muscleQuadratus femoris muscleSciatic nerveAdductor magnus muscleLong head of biceps femoris muscleLong head of biceps femoris muscleShort head of biceps femoris muscleCommon fibular nerveTibial nervePopliteal artery and veinSemimembranosus muscleSemitendinosus muscleBranch to part of adductor magnus originatingfrom ischial tuberosity Fig. 6.71 Knee joint. Joint capsule is not shown. Fig. 6.72 Articular surfaces of the knee joint. A. Extended. B. Flexed. C. Anterior view (flexed). Fig. 6.73 Menisci of the knee joint. A. Superior view. Menisci of the knee joint. B. Normal knee joint showing the medial meniscus. T2-weighted magnetic resonance image in the sagittal plane. C. Normal knee joint showing the lateral meniscus. T2-weighted magnetic resonance image in the sagittal plane. APatellar ligamentJoint capsuleMedial meniscusPopliteus tendonLateral meniscusTransverse ligament of the kneeInfrapatellar fat | [
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Anatomy_Gray_1574 | Anatomy_Gray | APatellar ligamentJoint capsuleMedial meniscusPopliteus tendonLateral meniscusTransverse ligament of the kneeInfrapatellar fat Fig. 6.74 Meniscal injury and repair. A. Sagittal MRI of a knee joint showing tear of the medial meniscus. B. Coronal MRI of a knee showing a truncated lateral meniscus after partial meniscectomy to treat a tear. Fig. 6.75 Synovial membrane of the knee joint and associated bursae. A. Superolateral view; patella and femur not shown. B. Paramedial sagittal section through the knee. Fig. 6.76 Fibrous membrane of the knee joint capsule. A. Anterior view. B. Posterior view. | Anatomy_Gray. APatellar ligamentJoint capsuleMedial meniscusPopliteus tendonLateral meniscusTransverse ligament of the kneeInfrapatellar fat Fig. 6.74 Meniscal injury and repair. A. Sagittal MRI of a knee joint showing tear of the medial meniscus. B. Coronal MRI of a knee showing a truncated lateral meniscus after partial meniscectomy to treat a tear. Fig. 6.75 Synovial membrane of the knee joint and associated bursae. A. Superolateral view; patella and femur not shown. B. Paramedial sagittal section through the knee. Fig. 6.76 Fibrous membrane of the knee joint capsule. A. Anterior view. B. Posterior view. | [
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Anatomy_Gray_1575 | Anatomy_Gray | Fig. 6.76 Fibrous membrane of the knee joint capsule. A. Anterior view. B. Posterior view. Fig. 6.77 Collateral ligaments of the knee joint. A. Lateral view. B. Medial view. C. Normal knee joint showing the patellar ligament and the fibular collateral ligament. T1-weighted magnetic resonance image in the sagittal plane. D. Normal knee joint showing the tibial collateral ligament, the medial and lateral menisci, and the anterior and posterior cruciate ligaments. T1-weighted magnetic resonance image in the coronal plane. Fig. 6.78 Cruciate ligaments of the knee joint. Superolateral view. Fig. 6.79 Knee “locking” mechanism. Medial rotation of femur on tibia tightens ligamentsFlat surface offemoral condylesis in contact withtibia and stabilizesjointLine of center of gravity isanterior to knee joint andmaintains extension Fig. 6.80 Anastomoses of arteries around the knee. Anterior view. | Anatomy_Gray. Fig. 6.76 Fibrous membrane of the knee joint capsule. A. Anterior view. B. Posterior view. Fig. 6.77 Collateral ligaments of the knee joint. A. Lateral view. B. Medial view. C. Normal knee joint showing the patellar ligament and the fibular collateral ligament. T1-weighted magnetic resonance image in the sagittal plane. D. Normal knee joint showing the tibial collateral ligament, the medial and lateral menisci, and the anterior and posterior cruciate ligaments. T1-weighted magnetic resonance image in the coronal plane. Fig. 6.78 Cruciate ligaments of the knee joint. Superolateral view. Fig. 6.79 Knee “locking” mechanism. Medial rotation of femur on tibia tightens ligamentsFlat surface offemoral condylesis in contact withtibia and stabilizesjointLine of center of gravity isanterior to knee joint andmaintains extension Fig. 6.80 Anastomoses of arteries around the knee. Anterior view. | [
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Anatomy_Gray_1576 | Anatomy_Gray | Fig. 6.80 Anastomoses of arteries around the knee. Anterior view. Femoral arteryAdductorhiatusDescendinggenicular arteryAdductormagnusSaphenousbranchSuperior medialgenicular arteryPoplitealarteryInferior medialgenicular arteryPosteriortibial arteryAnteriortibial arteryInterosseousmembraneRecurrent branchof anterior tibialCircumflexfibular arteryInferior lateralgenicular arterySuperior lateralgenicular arteryDescending branch of lateral circumflex femoral artery Fig. 6.81 Sagittal MRI of knee joint showing rupture of the anterior cruciate ligament. Fig. 6.82 Tibiofibular joint. Fig. 6.83 Popliteal fossa. A. Boundaries. B. Nerves and vessels. C. Superficial structures. | Anatomy_Gray. Fig. 6.80 Anastomoses of arteries around the knee. Anterior view. Femoral arteryAdductorhiatusDescendinggenicular arteryAdductormagnusSaphenousbranchSuperior medialgenicular arteryPoplitealarteryInferior medialgenicular arteryPosteriortibial arteryAnteriortibial arteryInterosseousmembraneRecurrent branchof anterior tibialCircumflexfibular arteryInferior lateralgenicular arterySuperior lateralgenicular arteryDescending branch of lateral circumflex femoral artery Fig. 6.81 Sagittal MRI of knee joint showing rupture of the anterior cruciate ligament. Fig. 6.82 Tibiofibular joint. Fig. 6.83 Popliteal fossa. A. Boundaries. B. Nerves and vessels. C. Superficial structures. | [
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Anatomy_Gray_1577 | Anatomy_Gray | Fig. 6.82 Tibiofibular joint. Fig. 6.83 Popliteal fossa. A. Boundaries. B. Nerves and vessels. C. Superficial structures. ABCLinea asperaBiceps femoris muscle(short head)Biceps femorismuscle(long head)PoplitealfossaPlantarismuscleLateral head ofgastrocnemiusmusclePopliteusmuscleMedial head ofgastrocnemiusmuscleSemitendinosusmuscleSemimembranosus muscleAdductorhiatusAdductor magnus muscleSciatic nerveTibial nerveSmallsaphenousveinSmallsaphenousveinCommonfibular nervePopliteal arteryPopliteal veinFemoral veinFemoral arteryPosteriorcutaneousnerve of thighPosteriorcutaneousnerve of thighLateralNerveVeinArteryMedial Fig. 6.84 Posterior view of leg; cross section through the left leg (inset). Fig. 6.85 Tibia and fibula. A. Anterior view. B. Posterior view. C. Cross section through shafts. D. Posteromedial view of distal ends. | Anatomy_Gray. Fig. 6.82 Tibiofibular joint. Fig. 6.83 Popliteal fossa. A. Boundaries. B. Nerves and vessels. C. Superficial structures. ABCLinea asperaBiceps femoris muscle(short head)Biceps femorismuscle(long head)PoplitealfossaPlantarismuscleLateral head ofgastrocnemiusmusclePopliteusmuscleMedial head ofgastrocnemiusmuscleSemitendinosusmuscleSemimembranosus muscleAdductorhiatusAdductor magnus muscleSciatic nerveTibial nerveSmallsaphenousveinSmallsaphenousveinCommonfibular nervePopliteal arteryPopliteal veinFemoral veinFemoral arteryPosteriorcutaneousnerve of thighPosteriorcutaneousnerve of thighLateralNerveVeinArteryMedial Fig. 6.84 Posterior view of leg; cross section through the left leg (inset). Fig. 6.85 Tibia and fibula. A. Anterior view. B. Posterior view. C. Cross section through shafts. D. Posteromedial view of distal ends. | [
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Anatomy_Gray_1578 | Anatomy_Gray | Fig. 6.85 Tibia and fibula. A. Anterior view. B. Posterior view. C. Cross section through shafts. D. Posteromedial view of distal ends. Lateral surfaceLateralsurfaceInterosseousmembraneInterosseousborderMedialsurfaceAnteriorborderMedialborderPosteriorborderPosterior surfacePosterior surfaceMedial crestInterosseous borderInterosseousborderMedialsurfaceAnteriorborderAnteriorborderGroove for fibularis longus and brevis musclesRoughened triangulararea that fits intofibular groove of tibiaABCDFibulaTibiaFibular grooveon tibiaSoleal lineArticular surfaces for talusMedial malleolusGroove for tendon oftibialis posterior muscleMalleolar fossaLateralmalleolusLateral malleolus Fig. 6.86 Interosseous membrane. A. Anterior view. B. Posteromedial view. Aperture for anterior tibial vesselsABAperture for perforating branch of fibular arteryAnterior tibiofibular ligamentInterosseous membraneInterosseous membranePosterior tibiofibular ligament | Anatomy_Gray. Fig. 6.85 Tibia and fibula. A. Anterior view. B. Posterior view. C. Cross section through shafts. D. Posteromedial view of distal ends. Lateral surfaceLateralsurfaceInterosseousmembraneInterosseousborderMedialsurfaceAnteriorborderMedialborderPosteriorborderPosterior surfacePosterior surfaceMedial crestInterosseous borderInterosseousborderMedialsurfaceAnteriorborderAnteriorborderGroove for fibularis longus and brevis musclesRoughened triangulararea that fits intofibular groove of tibiaABCDFibulaTibiaFibular grooveon tibiaSoleal lineArticular surfaces for talusMedial malleolusGroove for tendon oftibialis posterior muscleMalleolar fossaLateralmalleolusLateral malleolus Fig. 6.86 Interosseous membrane. A. Anterior view. B. Posteromedial view. Aperture for anterior tibial vesselsABAperture for perforating branch of fibular arteryAnterior tibiofibular ligamentInterosseous membraneInterosseous membranePosterior tibiofibular ligament | [
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Anatomy_Gray_1579 | Anatomy_Gray | Aperture for anterior tibial vesselsABAperture for perforating branch of fibular arteryAnterior tibiofibular ligamentInterosseous membraneInterosseous membranePosterior tibiofibular ligament Fig. 6.87 Superficial group of muscles in the posterior compartment of leg. A. Posterior view. B. Lateral view. APlantarisMedial head ofgastrocnemiusPopliteal vessels and tibial nerveLigament spanning distance betweenfibular and tibial origins of soleusTendon of plantarisCalcaneal (Achilles) tendonCalcaneusGastrocnemiusSoleusLateral head of gastrocnemiusMedialLateralBSoleusCalcaneal tendonGastrocnemiusCalcaneus Fig. 6.88 Deep group of muscles in the posterior compartment of leg. | Anatomy_Gray. Aperture for anterior tibial vesselsABAperture for perforating branch of fibular arteryAnterior tibiofibular ligamentInterosseous membraneInterosseous membranePosterior tibiofibular ligament Fig. 6.87 Superficial group of muscles in the posterior compartment of leg. A. Posterior view. B. Lateral view. APlantarisMedial head ofgastrocnemiusPopliteal vessels and tibial nerveLigament spanning distance betweenfibular and tibial origins of soleusTendon of plantarisCalcaneal (Achilles) tendonCalcaneusGastrocnemiusSoleusLateral head of gastrocnemiusMedialLateralBSoleusCalcaneal tendonGastrocnemiusCalcaneus Fig. 6.88 Deep group of muscles in the posterior compartment of leg. | [
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Anatomy_Gray_1580 | Anatomy_Gray | Fig. 6.88 Deep group of muscles in the posterior compartment of leg. PopliteusSoleal lineTibialisposteriorOrigin oftibialisposteriorVerticallineFlexordigitorumlongusOrigin of flexordigitorum longusOrigin of flexorhallucis longusGroove onmedialmalleolusMedialTuberosity ofnavicularMedialcuneiformGroove on inferiorsurface of sustentaculumtali of calcaneus boneGroove on posteriorsurface of talusFlexor hallucislongusLateral Fig. 6.89 Arteries in the posterior compartment of leg. Adductor hiatusSuperior medialgenicular arterySuperior lateralgenicular arteryAdductormagnus musclePopliteal arterySural arteriesMedial head ofgastrocnemiusmuscle Popliteus musclePosterior tibial arteryPosterior tibial arteryPerforating terminalbranch of fibular arteryBranches thatperforate intermuscularseptum to enter lateralcompartmentFibular arteryCircumflexfibular arteryAnterior tibial artery(passes throughaperture ininterosseousmembrane)Popliteal vein | Anatomy_Gray. Fig. 6.88 Deep group of muscles in the posterior compartment of leg. PopliteusSoleal lineTibialisposteriorOrigin oftibialisposteriorVerticallineFlexordigitorumlongusOrigin of flexordigitorum longusOrigin of flexorhallucis longusGroove onmedialmalleolusMedialTuberosity ofnavicularMedialcuneiformGroove on inferiorsurface of sustentaculumtali of calcaneus boneGroove on posteriorsurface of talusFlexor hallucislongusLateral Fig. 6.89 Arteries in the posterior compartment of leg. Adductor hiatusSuperior medialgenicular arterySuperior lateralgenicular arteryAdductormagnus musclePopliteal arterySural arteriesMedial head ofgastrocnemiusmuscle Popliteus musclePosterior tibial arteryPosterior tibial arteryPerforating terminalbranch of fibular arteryBranches thatperforate intermuscularseptum to enter lateralcompartmentFibular arteryCircumflexfibular arteryAnterior tibial artery(passes throughaperture ininterosseousmembrane)Popliteal vein | [
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Anatomy_Gray_1581 | Anatomy_Gray | Fig. 6.90 Tibial nerve. A. Posterior view. B. Sural nerve. Fig. 6.91 Muscles in the lateral compartment of leg. A. Lateral view. B. Inferior view of the right foot, with the foot plantarflexed at the ankle. ABCommon fibular nerveFibularislongusFibularisbrevisFibular trochleaof calcaneus boneAnteriorborder of fibulaInterosseousmembraneMedialcuneiformMetatarsal IGroove oninferior aspectof cuboidFibularisbrevistendonFibularislongustendon Fig. 6.92 Common fibular nerve, and nerves and arteries of the lateral compartment of leg. A. Posterior view, right leg. B. Lateral view, right leg. ABSural communicating nervePenetrates deep fasciaSural nervePenetrates deep fasciaLateral sural nerveCommon fibular nerveSuperficial fibular nervePerforating branches of fibular arteryin posterior compartment(vessels in and around fibula)Deep fibularnerve Fig. 6.93 Muscles of the anterior compartment of leg. | Anatomy_Gray. Fig. 6.90 Tibial nerve. A. Posterior view. B. Sural nerve. Fig. 6.91 Muscles in the lateral compartment of leg. A. Lateral view. B. Inferior view of the right foot, with the foot plantarflexed at the ankle. ABCommon fibular nerveFibularislongusFibularisbrevisFibular trochleaof calcaneus boneAnteriorborder of fibulaInterosseousmembraneMedialcuneiformMetatarsal IGroove oninferior aspectof cuboidFibularisbrevistendonFibularislongustendon Fig. 6.92 Common fibular nerve, and nerves and arteries of the lateral compartment of leg. A. Posterior view, right leg. B. Lateral view, right leg. ABSural communicating nervePenetrates deep fasciaSural nervePenetrates deep fasciaLateral sural nerveCommon fibular nerveSuperficial fibular nervePerforating branches of fibular arteryin posterior compartment(vessels in and around fibula)Deep fibularnerve Fig. 6.93 Muscles of the anterior compartment of leg. | [
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Anatomy_Gray_1582 | Anatomy_Gray | Fig. 6.93 Muscles of the anterior compartment of leg. Anterior surfaceof fibulaExtensordigitorumlongusOrigin of extensordigitorum longusLateral surfaceof fibulaExtensor hallucis longusOrigin of extensorhallucis longusFibularistertiusAttachment to inferior surface of medial cuneiform and metatarsal ISubcutaneoussurface of tibiaTibialisanteriorOrigin of tibialisanterior Fig. 6.94 Anterior tibial artery and deep fibular nerve. Fig. 6.95 Foot. A. Dorsal aspect, right foot. B. Plantar aspect, right foot, showing the surface in contact with the ground when standing. AbductionAdductionGreat toeDigit IDigit IIDigit IIIDigit IVDigit VPhalangesLittle toeMetatarsals (I–V)Tarsal bonesABCut surface of medialmalleolus (tibia)Cut surface of lateralmalleolus (fibula)Calcaneal tendonMedial malleolusLateral malleolusHeelSesamoid bones Fig. 6.96 Bones of the foot. A. Dorsal view, right foot. B. Lateral view, right foot. | Anatomy_Gray. Fig. 6.93 Muscles of the anterior compartment of leg. Anterior surfaceof fibulaExtensordigitorumlongusOrigin of extensordigitorum longusLateral surfaceof fibulaExtensor hallucis longusOrigin of extensorhallucis longusFibularistertiusAttachment to inferior surface of medial cuneiform and metatarsal ISubcutaneoussurface of tibiaTibialisanteriorOrigin of tibialisanterior Fig. 6.94 Anterior tibial artery and deep fibular nerve. Fig. 6.95 Foot. A. Dorsal aspect, right foot. B. Plantar aspect, right foot, showing the surface in contact with the ground when standing. AbductionAdductionGreat toeDigit IDigit IIDigit IIIDigit IVDigit VPhalangesLittle toeMetatarsals (I–V)Tarsal bonesABCut surface of medialmalleolus (tibia)Cut surface of lateralmalleolus (fibula)Calcaneal tendonMedial malleolusLateral malleolusHeelSesamoid bones Fig. 6.96 Bones of the foot. A. Dorsal view, right foot. B. Lateral view, right foot. | [
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Anatomy_Gray_1583 | Anatomy_Gray | Fig. 6.96 Bones of the foot. A. Dorsal view, right foot. B. Lateral view, right foot. TalusPosteriorprocessof the talusBCalcaneusFibular trochleaGrooveCuboidMedial tubercleCuneiformsNavicularPhalangesMetatarsalsNavicularIntermediatetarsal boneTuberosity (on undersurface)CalcaneusTalusLateral processLateraltubercleGroove for tendon offlexor hallucis longusProximal groupof tarsal bonesMedialIntermediateLateralCuneiformsDistal groupof tarsal bonesCuboidDistalMiddleProximalA Fig. 6.97 Talus. A. Medial view. B. Inferior view. ABPosterior AnteriorArticular surfacefor navicularArticular surfacefor navicularNeckHeadBodyAnteriorPosteriorArticular surface withmedial malleolusMedialtubercleLateraltubercleGroove for flexorhallucis longusGroove for flexorhallucis longusArticular surface withdistal end of tibiaAnterior calcanealsurfaceMiddle calcanealsurfaceSulcus taliPosterior processof talusPosteriorcalcaneal surfaceArticular surface forcalcaneonavicularligament | Anatomy_Gray. Fig. 6.96 Bones of the foot. A. Dorsal view, right foot. B. Lateral view, right foot. TalusPosteriorprocessof the talusBCalcaneusFibular trochleaGrooveCuboidMedial tubercleCuneiformsNavicularPhalangesMetatarsalsNavicularIntermediatetarsal boneTuberosity (on undersurface)CalcaneusTalusLateral processLateraltubercleGroove for tendon offlexor hallucis longusProximal groupof tarsal bonesMedialIntermediateLateralCuneiformsDistal groupof tarsal bonesCuboidDistalMiddleProximalA Fig. 6.97 Talus. A. Medial view. B. Inferior view. ABPosterior AnteriorArticular surfacefor navicularArticular surfacefor navicularNeckHeadBodyAnteriorPosteriorArticular surface withmedial malleolusMedialtubercleLateraltubercleGroove for flexorhallucis longusGroove for flexorhallucis longusArticular surface withdistal end of tibiaAnterior calcanealsurfaceMiddle calcanealsurfaceSulcus taliPosterior processof talusPosteriorcalcaneal surfaceArticular surface forcalcaneonavicularligament | [
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Anatomy_Gray_1584 | Anatomy_Gray | Fig. 6.98 Calcaneus. A. Superior view. B. Inferior view. C. Lateral view. ABCAnterior talar articular surfacePosterior talararticular surfacePosterior talararticular surfaceAnterior talararticular surfaceMiddle talararticular surfaceMiddle talararticular surfaceSustentaculum taliMedialMedialMiddle part of posterior surface(insertion of calcaneal tendon)Upper part ofposterior surfaceLateralCalcanealsulcusArticular surface with cuboid boneCalcanealtubercleLateralprocessNotchCalcaneal tuberosity(lower part of posterior surface)MedialprocessGroove for tendon offlexor hallucis longusAttachment of calcaneofibularpart of lateral collateral ligamentof ankle jointFibular trochleaCalcaneal sulcus Fig. 6.99 Tarsal sinus. Lateral view, right foot. Fig. 6.100 Metatarsals and phalanges. Dorsal view, right foot. Fig. 6.101 Radiograph of ankle showing talar beak. | Anatomy_Gray. Fig. 6.98 Calcaneus. A. Superior view. B. Inferior view. C. Lateral view. ABCAnterior talar articular surfacePosterior talararticular surfacePosterior talararticular surfaceAnterior talararticular surfaceMiddle talararticular surfaceMiddle talararticular surfaceSustentaculum taliMedialMedialMiddle part of posterior surface(insertion of calcaneal tendon)Upper part ofposterior surfaceLateralCalcanealsulcusArticular surface with cuboid boneCalcanealtubercleLateralprocessNotchCalcaneal tuberosity(lower part of posterior surface)MedialprocessGroove for tendon offlexor hallucis longusAttachment of calcaneofibularpart of lateral collateral ligamentof ankle jointFibular trochleaCalcaneal sulcus Fig. 6.99 Tarsal sinus. Lateral view, right foot. Fig. 6.100 Metatarsals and phalanges. Dorsal view, right foot. Fig. 6.101 Radiograph of ankle showing talar beak. | [
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Anatomy_Gray_1585 | Anatomy_Gray | Fig. 6.99 Tarsal sinus. Lateral view, right foot. Fig. 6.100 Metatarsals and phalanges. Dorsal view, right foot. Fig. 6.101 Radiograph of ankle showing talar beak. Fig. 6.102 Ankle joint. A. Anterior view with right foot plantarflexed. B. Schematic of joint, posterior view. C. Superior view of the talus to show the shape of the articular surface. ABCInterosseousligamentTibiaMedialmalleolusLateralmalleolusLateral malleolusTalusFibulaFibulaTibiaArticular surface of talusArticular surfacenarrow posteriorlyPosteriorMedial malleolusAnteriorArticular surface wide anteriorly Fig. 6.103 Medial ligament of the ankle joint, right foot. Medialtubercleof talusSustentaculum taliof calcaneus bonePlantar calcaneonavicular ligamentTuberosity ofnavicular bonePosteriortibiotalar partTibiocalcaneal partTibionavicular partAnterior tibiotalar partMedial ligament of the ankle joint Fig. 6.104 Lateral ligament of the ankle joint. A. Lateral view, right foot. B. Posterior view, right foot. | Anatomy_Gray. Fig. 6.99 Tarsal sinus. Lateral view, right foot. Fig. 6.100 Metatarsals and phalanges. Dorsal view, right foot. Fig. 6.101 Radiograph of ankle showing talar beak. Fig. 6.102 Ankle joint. A. Anterior view with right foot plantarflexed. B. Schematic of joint, posterior view. C. Superior view of the talus to show the shape of the articular surface. ABCInterosseousligamentTibiaMedialmalleolusLateralmalleolusLateral malleolusTalusFibulaFibulaTibiaArticular surface of talusArticular surfacenarrow posteriorlyPosteriorMedial malleolusAnteriorArticular surface wide anteriorly Fig. 6.103 Medial ligament of the ankle joint, right foot. Medialtubercleof talusSustentaculum taliof calcaneus bonePlantar calcaneonavicular ligamentTuberosity ofnavicular bonePosteriortibiotalar partTibiocalcaneal partTibionavicular partAnterior tibiotalar partMedial ligament of the ankle joint Fig. 6.104 Lateral ligament of the ankle joint. A. Lateral view, right foot. B. Posterior view, right foot. | [
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Anatomy_Gray_1586 | Anatomy_Gray | Fig. 6.104 Lateral ligament of the ankle joint. A. Lateral view, right foot. B. Posterior view, right foot. Malleolar fossaAnterior talofibular ligamentCalcaneofibular ligamentPosteriortalofibularligamentPosteriortalofibular ligamentPosteriorprocess of talusMalleolar fossaFibulaTibiaTalusAB Fig. 6.105 Intertarsal joints, right foot. Fig. 6.106 Interosseous talocalcaneal ligament. Lateral view, right foot. Fig. 6.107 Talocalcaneonavicular joint. A. Medial view, right foot. B. Superior view, right foot, talus removed. C. Ligaments, medial view, right foot. D. Ligaments, lateral view, right foot. Fig. 6.108 Plantar ligaments, right foot. A. Plantar calcaneocuboid ligament (short plantar ligament). B. Long plantar ligament. Fig. 6.109 Tarsometatarsal, metatarsophalangeal, and interphalangeal joints, and the deep transverse metatarsal ligaments, right foot. | Anatomy_Gray. Fig. 6.104 Lateral ligament of the ankle joint. A. Lateral view, right foot. B. Posterior view, right foot. Malleolar fossaAnterior talofibular ligamentCalcaneofibular ligamentPosteriortalofibularligamentPosteriortalofibular ligamentPosteriorprocess of talusMalleolar fossaFibulaTibiaTalusAB Fig. 6.105 Intertarsal joints, right foot. Fig. 6.106 Interosseous talocalcaneal ligament. Lateral view, right foot. Fig. 6.107 Talocalcaneonavicular joint. A. Medial view, right foot. B. Superior view, right foot, talus removed. C. Ligaments, medial view, right foot. D. Ligaments, lateral view, right foot. Fig. 6.108 Plantar ligaments, right foot. A. Plantar calcaneocuboid ligament (short plantar ligament). B. Long plantar ligament. Fig. 6.109 Tarsometatarsal, metatarsophalangeal, and interphalangeal joints, and the deep transverse metatarsal ligaments, right foot. | [
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Anatomy_Gray_1587 | Anatomy_Gray | Fig. 6.109 Tarsometatarsal, metatarsophalangeal, and interphalangeal joints, and the deep transverse metatarsal ligaments, right foot. Fig. 6.110 Tarsal tunnel and flexor retinaculum. Posteromedial view, right foot. A. Bones. B. Tarsal tunnel and flexor retinaculum. ABTibiaTalusCalcaneusFlexor retinaculumTarsaltunnelTendon of flexordigitorum longusTendon oftibialis posteriorPulse of post-tibial arterymidway between heeland medial malleolusTendon offlexorhallucislongusTibial nervePosteriortibial arteryTibialis posteriorFlexor digitorumlongusTibial arteryTibial veinTibial nerveFlexor hallucislongus Fig. 6.111 Extensor retinacula, right foot. Anterior tibial arteryTendon of extensorhallucis longusTendon oftibialis anteriorDorsalispedis arteryFirst dorsalinterosseousmuscleInferior extensorretinaculumSuperior extensorretinaculumExtensordigitorum longusFibularis tertius Fig. 6.112 Fibular retinacula. Lateral view, right foot. | Anatomy_Gray. Fig. 6.109 Tarsometatarsal, metatarsophalangeal, and interphalangeal joints, and the deep transverse metatarsal ligaments, right foot. Fig. 6.110 Tarsal tunnel and flexor retinaculum. Posteromedial view, right foot. A. Bones. B. Tarsal tunnel and flexor retinaculum. ABTibiaTalusCalcaneusFlexor retinaculumTarsaltunnelTendon of flexordigitorum longusTendon oftibialis posteriorPulse of post-tibial arterymidway between heeland medial malleolusTendon offlexorhallucislongusTibial nervePosteriortibial arteryTibialis posteriorFlexor digitorumlongusTibial arteryTibial veinTibial nerveFlexor hallucislongus Fig. 6.111 Extensor retinacula, right foot. Anterior tibial arteryTendon of extensorhallucis longusTendon oftibialis anteriorDorsalispedis arteryFirst dorsalinterosseousmuscleInferior extensorretinaculumSuperior extensorretinaculumExtensordigitorum longusFibularis tertius Fig. 6.112 Fibular retinacula. Lateral view, right foot. | [
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Anatomy_Gray_1588 | Anatomy_Gray | Fig. 6.112 Fibular retinacula. Lateral view, right foot. Tendons of fibularis longus andbrevis musclesSuperior fibular retinaculumInferior fibular retinaculum(at fibular trochlea on calcaneus) Fig. 6.113 Arches of the foot. A. Longitudinal arches, right foot. B. Transverse arch, left foot. Fig. 6.114 Support for arches of the foot. A. Ligaments. Medial view, right foot. B. Cross section through the foot to show tendons of muscles supporting the arches, left foot. Fig. 6.115 Plantar aponeurosis, right foot. Superficial transversemetatarsal ligamentsMedial process ofcalcaneal tuberosityPlantar aponeurosisAnterior arm of inferiorextensor retinaculum Fig. 6.116 Fibrous digital sheaths, right foot. Fig. 6.117 Extensor hoods. 1st dorsal interosseous muscleExtensor tendonsExtensor hoodDeep transverse metatarsal ligamentLumbricalFlexor digitorum longusExtension of PIP joints prevents overflexionFlexion of MTP jointprevents overextension | Anatomy_Gray. Fig. 6.112 Fibular retinacula. Lateral view, right foot. Tendons of fibularis longus andbrevis musclesSuperior fibular retinaculumInferior fibular retinaculum(at fibular trochlea on calcaneus) Fig. 6.113 Arches of the foot. A. Longitudinal arches, right foot. B. Transverse arch, left foot. Fig. 6.114 Support for arches of the foot. A. Ligaments. Medial view, right foot. B. Cross section through the foot to show tendons of muscles supporting the arches, left foot. Fig. 6.115 Plantar aponeurosis, right foot. Superficial transversemetatarsal ligamentsMedial process ofcalcaneal tuberosityPlantar aponeurosisAnterior arm of inferiorextensor retinaculum Fig. 6.116 Fibrous digital sheaths, right foot. Fig. 6.117 Extensor hoods. 1st dorsal interosseous muscleExtensor tendonsExtensor hoodDeep transverse metatarsal ligamentLumbricalFlexor digitorum longusExtension of PIP joints prevents overflexionFlexion of MTP jointprevents overextension | [
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Anatomy_Gray_1589 | Anatomy_Gray | Fig. 6.118 Extensor digitorum brevis muscle, right foot. Fig. 6.119 First layer of muscles in the sole of the right foot. Fig. 6.120 Second layer of muscles in the sole of the right foot. Fig. 6.121 MRI of posterior foot in a patient with plantar fasciitis shows thickening of the plantar aponeurosis at the calcaneal insertion and a calcaneal spur. Fig. 6.122 Third layer of muscles in the sole of the right foot. FlexorhallucisbrevisTransverse headOblique headAdductor hallucisFlexor digitiminimi brevisTendon of fibularislongus muscleTendon of tibialisposterior muscleTendon of flexorhallucis longus Fig. 6.123 Fourth layer of muscles in the sole of the right foot. Fig. 6.124 Arteries in the sole of the right foot. Digital branchesDeep plantar artery: terminal branchof dorsalis pedis arteryPlantar metatarsal arteriesPerforatingvesselsDeepplantar archLateral plantararteryPosterior tibial arteryMedial plantarartery Fig. 6.125 Dorsalis pedis artery right foot. | Anatomy_Gray. Fig. 6.118 Extensor digitorum brevis muscle, right foot. Fig. 6.119 First layer of muscles in the sole of the right foot. Fig. 6.120 Second layer of muscles in the sole of the right foot. Fig. 6.121 MRI of posterior foot in a patient with plantar fasciitis shows thickening of the plantar aponeurosis at the calcaneal insertion and a calcaneal spur. Fig. 6.122 Third layer of muscles in the sole of the right foot. FlexorhallucisbrevisTransverse headOblique headAdductor hallucisFlexor digitiminimi brevisTendon of fibularislongus muscleTendon of tibialisposterior muscleTendon of flexorhallucis longus Fig. 6.123 Fourth layer of muscles in the sole of the right foot. Fig. 6.124 Arteries in the sole of the right foot. Digital branchesDeep plantar artery: terminal branchof dorsalis pedis arteryPlantar metatarsal arteriesPerforatingvesselsDeepplantar archLateral plantararteryPosterior tibial arteryMedial plantarartery Fig. 6.125 Dorsalis pedis artery right foot. | [
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Anatomy_Gray_1590 | Anatomy_Gray | Fig. 6.125 Dorsalis pedis artery right foot. ExtensorhoodDorsaldigitalarteriesAnterior tibial arteryDorsalis pedisarteryAnterior medialmalleolar arteryAnterior lateralmalleolar arteryMedial and lateraltarsal branchesExtensorhallucislongusDorsalis pedisarteryDeep plantararteryFirst dorsalmetatarsalarteryFirst dorsalinterosseousmuscleArcuate arteryTendon of extensordigitorum longusto toe II Fig. 6.126 Superficial veins of the right foot. Fig. 6.127 Lateral and medial plantar nerves. A. Sole of the right foot. B. Cutaneous distribution of right foot. Fig. 6.128 A.Terminal branches of superficial and deep fibular nerves in the right foot. B. Cutaneous distribution right foot. Deep fibularnerveABBranches tofirst and seconddorsal interosseiExtensordigitorumbrevisBranch of deepfibular to extensordigitorum brevisSuperficialfibular nerveSaphenous nerveSuperficialfibular nerveDeep fibular nerveSural nerve | Anatomy_Gray. Fig. 6.125 Dorsalis pedis artery right foot. ExtensorhoodDorsaldigitalarteriesAnterior tibial arteryDorsalis pedisarteryAnterior medialmalleolar arteryAnterior lateralmalleolar arteryMedial and lateraltarsal branchesExtensorhallucislongusDorsalis pedisarteryDeep plantararteryFirst dorsalmetatarsalarteryFirst dorsalinterosseousmuscleArcuate arteryTendon of extensordigitorum longusto toe II Fig. 6.126 Superficial veins of the right foot. Fig. 6.127 Lateral and medial plantar nerves. A. Sole of the right foot. B. Cutaneous distribution of right foot. Fig. 6.128 A.Terminal branches of superficial and deep fibular nerves in the right foot. B. Cutaneous distribution right foot. Deep fibularnerveABBranches tofirst and seconddorsal interosseiExtensordigitorumbrevisBranch of deepfibular to extensordigitorum brevisSuperficialfibular nerveSaphenous nerveSuperficialfibular nerveDeep fibular nerveSural nerve | [
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Anatomy_Gray_1591 | Anatomy_Gray | Fig. 6.129 Avoiding the sciatic nerve. A. Posterior view of the gluteal region of a man with the position of the sciatic nerve indicated. B. Posterolateral view of the left gluteal region with gluteal quadrants and the position of the sciatic nerve indicated. Fig. 6.130 Position of the femoral artery in the femoral triangle. Anterior thigh. Inguinal ligamentAnterior superior iliac spineFemoral nerveFemoral arteryFemoral veinLymphatics passing through femoral canalMedial margin ofsartorius muscleMedial margin of adductor longus musclePubic tuberclePubic symphysis Fig. 6.131 Identifying structures around the knee. A. Anterior view of the right knee. B. Lateral view of the partially flexed right knee. C. Lateral view of the extended right knee, thigh, and gluteal region. | Anatomy_Gray. Fig. 6.129 Avoiding the sciatic nerve. A. Posterior view of the gluteal region of a man with the position of the sciatic nerve indicated. B. Posterolateral view of the left gluteal region with gluteal quadrants and the position of the sciatic nerve indicated. Fig. 6.130 Position of the femoral artery in the femoral triangle. Anterior thigh. Inguinal ligamentAnterior superior iliac spineFemoral nerveFemoral arteryFemoral veinLymphatics passing through femoral canalMedial margin ofsartorius muscleMedial margin of adductor longus musclePubic tuberclePubic symphysis Fig. 6.131 Identifying structures around the knee. A. Anterior view of the right knee. B. Lateral view of the partially flexed right knee. C. Lateral view of the extended right knee, thigh, and gluteal region. | [
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Anatomy_Gray_1592 | Anatomy_Gray | C. Lateral view of the extended right knee, thigh, and gluteal region. ABCVastus lateralisVastus medialisQuadriceps tendonQuadriceps femoris musclePatellaPatellaPatellarligamentPatellar ligamentTibial tuberosityTendon ofbiceps femorisHead of fibulaCommon fibular nerveTensor fasciae lataeIliotibial tractHamstring musclesGluteus maximus Fig. 6.132 Visualizing the contents of the popliteal fossa. Posterior view of the left knee. Popliteal fossaPopliteal arteryPopliteal veinCommon fibular nerveBiceps femoris muscle and tendonHead of fibulaPenetrates deep fasciaLateral head of gastrocnemius muscleMedial head of gastrocnemius muscleTibial nerveSemimembranosus muscleSemitendinosus tendonSmall saphenous vein Fig. 6.133 Finding the tarsal tunnel—the gateway to the foot. Fig. 6.134 Identifying tendons around the ankle and in the foot. A. Medial side of the right foot. B. Posterior aspect of the right foot. C. Lateral side of the right foot. D. Dorsal aspect of the right foot. | Anatomy_Gray. C. Lateral view of the extended right knee, thigh, and gluteal region. ABCVastus lateralisVastus medialisQuadriceps tendonQuadriceps femoris musclePatellaPatellaPatellarligamentPatellar ligamentTibial tuberosityTendon ofbiceps femorisHead of fibulaCommon fibular nerveTensor fasciae lataeIliotibial tractHamstring musclesGluteus maximus Fig. 6.132 Visualizing the contents of the popliteal fossa. Posterior view of the left knee. Popliteal fossaPopliteal arteryPopliteal veinCommon fibular nerveBiceps femoris muscle and tendonHead of fibulaPenetrates deep fasciaLateral head of gastrocnemius muscleMedial head of gastrocnemius muscleTibial nerveSemimembranosus muscleSemitendinosus tendonSmall saphenous vein Fig. 6.133 Finding the tarsal tunnel—the gateway to the foot. Fig. 6.134 Identifying tendons around the ankle and in the foot. A. Medial side of the right foot. B. Posterior aspect of the right foot. C. Lateral side of the right foot. D. Dorsal aspect of the right foot. | [
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Anatomy_Gray_1593 | Anatomy_Gray | Fig. 6.135 Finding the dorsalis pedis artery. Dorsalis pedis arteryExtensor digitorumlongus tendon to second toeExtensor hallucislongus tendon Fig. 6.136 Position of the plantar arch. Fig. 6.137 Major superficial veins. A. Dorsal aspect of the right foot. B. Anterior view of right lower limb. C. Posterior aspect of the left thigh, leg, and foot. Fig. 6.138 Where to feel peripheral arterial pulses in the lower limb. Fig. 6.139 A. Normal knee joint showing the tibial collateral ligament and the medial and lateral menisci. Proton density (PD)-weighted magnetic resonance image in the coronal plane. B. Knee joint showing a torn tibial collateral ligament. PD-weighted magnetic resonance image in the coronal plane. Fig. 6.140 A. Knee joint showing an intact anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. | Anatomy_Gray. Fig. 6.135 Finding the dorsalis pedis artery. Dorsalis pedis arteryExtensor digitorumlongus tendon to second toeExtensor hallucislongus tendon Fig. 6.136 Position of the plantar arch. Fig. 6.137 Major superficial veins. A. Dorsal aspect of the right foot. B. Anterior view of right lower limb. C. Posterior aspect of the left thigh, leg, and foot. Fig. 6.138 Where to feel peripheral arterial pulses in the lower limb. Fig. 6.139 A. Normal knee joint showing the tibial collateral ligament and the medial and lateral menisci. Proton density (PD)-weighted magnetic resonance image in the coronal plane. B. Knee joint showing a torn tibial collateral ligament. PD-weighted magnetic resonance image in the coronal plane. Fig. 6.140 A. Knee joint showing an intact anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. | [
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Anatomy_Gray_1594 | Anatomy_Gray | Fig. 6.140 A. Knee joint showing an intact anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. B. Knee joint showing a torn anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. C. Knee joint showing a torn medial meniscus (the broken off portion of the posterior horn has moved into the anterior aspect of the joint giving the impression of a ‘double meniscus’ in this location). Proton density-weighted magnetic resonance image in the sagittal plane. AFemurPatellaAnterior cruciate ligamentTibiaBFemurTorn anteriorcruciate ligamentTibiaAnterior cruciateligament fragmentPatellaCMedial femoral condyleTorn posterior “horn”of medial meniscusTibiaAnterior “horn” of medial meniscusDisplaced fragment of posterior hornof medial meniscus | Anatomy_Gray. Fig. 6.140 A. Knee joint showing an intact anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. B. Knee joint showing a torn anterior cruciate ligament. T2-weighted magnetic resonance image in the sagittal plane. C. Knee joint showing a torn medial meniscus (the broken off portion of the posterior horn has moved into the anterior aspect of the joint giving the impression of a ‘double meniscus’ in this location). Proton density-weighted magnetic resonance image in the sagittal plane. AFemurPatellaAnterior cruciate ligamentTibiaBFemurTorn anteriorcruciate ligamentTibiaAnterior cruciateligament fragmentPatellaCMedial femoral condyleTorn posterior “horn”of medial meniscusTibiaAnterior “horn” of medial meniscusDisplaced fragment of posterior hornof medial meniscus | [
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Anatomy_Gray_1595 | Anatomy_Gray | Fig. 6.141 Radiograph (A) and MRI (B) of soft tissue ulceration and erosion in the adjacent calcaneus. After debridement and placement of antibiotics beads in the wound there is progressive healing (C). eFig. 6.142 Popliteal fossa showing position of the popliteal artery and vein and sciatic nerve. T1-weighted magnetic resonance image in the axial plane. eFig. 6.143 Pulmonary embolus. Axial computed tomogram. Left atriumAortaRight inferior pulmonary artery with embolusEmbolus eFig. 6.144 Ankle showing a ruptured calcaneal tendon. T2-weighted magnetic resonance image in the sagittal plane. eFig. 6.145 A. Normal ankle joint showing an intact anterior talofibular ligament. T1-weighted magnetic resonance image in the axial plane. B. Ankle joint showing a torn anterior talofibular ligament. T2-weighted magnetic resonance image in the axial plane. Table 6.1 Branches of the lumbosacral plexus associated with the lower limb | Anatomy_Gray. Fig. 6.141 Radiograph (A) and MRI (B) of soft tissue ulceration and erosion in the adjacent calcaneus. After debridement and placement of antibiotics beads in the wound there is progressive healing (C). eFig. 6.142 Popliteal fossa showing position of the popliteal artery and vein and sciatic nerve. T1-weighted magnetic resonance image in the axial plane. eFig. 6.143 Pulmonary embolus. Axial computed tomogram. Left atriumAortaRight inferior pulmonary artery with embolusEmbolus eFig. 6.144 Ankle showing a ruptured calcaneal tendon. T2-weighted magnetic resonance image in the sagittal plane. eFig. 6.145 A. Normal ankle joint showing an intact anterior talofibular ligament. T1-weighted magnetic resonance image in the axial plane. B. Ankle joint showing a torn anterior talofibular ligament. T2-weighted magnetic resonance image in the axial plane. Table 6.1 Branches of the lumbosacral plexus associated with the lower limb | [
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Anatomy_Gray_1596 | Anatomy_Gray | Table 6.1 Branches of the lumbosacral plexus associated with the lower limb Table 6.2 Muscles of the gluteal region (spinal segments in bold are the major segments innervating the muscle) Table 6.3 Muscles of the anterior compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.4 Muscles of the medial compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.5 Muscles of the posterior compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.6 Superficial group of muscles in the posterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.7 Deep group of muscles in the posterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.8 Muscles of the lateral compartment of leg (spinal segments in bold are the major segments innervating the muscle) | Anatomy_Gray. Table 6.1 Branches of the lumbosacral plexus associated with the lower limb Table 6.2 Muscles of the gluteal region (spinal segments in bold are the major segments innervating the muscle) Table 6.3 Muscles of the anterior compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.4 Muscles of the medial compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.5 Muscles of the posterior compartment of thigh (spinal segments in bold are the major segments innervating the muscle) Table 6.6 Superficial group of muscles in the posterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.7 Deep group of muscles in the posterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.8 Muscles of the lateral compartment of leg (spinal segments in bold are the major segments innervating the muscle) | [
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Anatomy_Gray_1597 | Anatomy_Gray | Table 6.8 Muscles of the lateral compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.9 Muscles of the anterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.10 Muscles of the dorsal aspect of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.11 First layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.12 Second layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.13 Third layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.14 Fourth layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) In the clinic | Anatomy_Gray. Table 6.8 Muscles of the lateral compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.9 Muscles of the anterior compartment of leg (spinal segments in bold are the major segments innervating the muscle) Table 6.10 Muscles of the dorsal aspect of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.11 First layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.12 Second layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.13 Third layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) Table 6.14 Fourth layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) In the clinic | [
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Anatomy_Gray_1598 | Anatomy_Gray | Table 6.14 Fourth layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) In the clinic The pelvic bones, sacrum, and associated joints form a bony ring surrounding the pelvic cavity. Soft tissue and visceral organ damage must be suspected when the pelvis is fractured. Patients with multiple injuries and evidence of chest, abdominal, and lower limb trauma should also be investigated for pelvic trauma. Pelvic fractures can be associated with appreciable blood loss (concealed exsanguination) and blood transfusion is often required. In addition, this bleeding tends to form a significant pelvic hematoma, which can compress nerves, press on organs, and inhibit pelvic visceral function (Fig. 6.25). There are many ways of classifying pelvic fractures, which enable the surgeon to determine the appropriate treatment and the patient’s prognosis. Pelvic fractures are generally of four types. | Anatomy_Gray. Table 6.14 Fourth layer of muscles in the sole of the foot (spinal segments in bold are the major segments innervating the muscle) In the clinic The pelvic bones, sacrum, and associated joints form a bony ring surrounding the pelvic cavity. Soft tissue and visceral organ damage must be suspected when the pelvis is fractured. Patients with multiple injuries and evidence of chest, abdominal, and lower limb trauma should also be investigated for pelvic trauma. Pelvic fractures can be associated with appreciable blood loss (concealed exsanguination) and blood transfusion is often required. In addition, this bleeding tends to form a significant pelvic hematoma, which can compress nerves, press on organs, and inhibit pelvic visceral function (Fig. 6.25). There are many ways of classifying pelvic fractures, which enable the surgeon to determine the appropriate treatment and the patient’s prognosis. Pelvic fractures are generally of four types. | [
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Anatomy_Gray_1599 | Anatomy_Gray | There are many ways of classifying pelvic fractures, which enable the surgeon to determine the appropriate treatment and the patient’s prognosis. Pelvic fractures are generally of four types. Type 1 injuries occur without disruption of the bony pelvic ring (e.g., a fracture of the iliac crest). These types of injuries are unlikely to represent significant trauma, though in the case of a fracture of the iliac crest, blood loss needs to be assessed. Type 2 injuries occur with a single break in the bony pelvic ring. An example of this would be a single fracture with diastasis (separation) of the symphysis pubis. Again, these injuries are relatively benign in nature, but it may be appropriate to assess for blood loss. Type 3 injuries occur with double breaks in the bony pelvic ring. These include bilateral fractures of the pubic rami, which may produce urethral damage. Type 4 injuries occur at and around the acetabulum. | Anatomy_Gray. There are many ways of classifying pelvic fractures, which enable the surgeon to determine the appropriate treatment and the patient’s prognosis. Pelvic fractures are generally of four types. Type 1 injuries occur without disruption of the bony pelvic ring (e.g., a fracture of the iliac crest). These types of injuries are unlikely to represent significant trauma, though in the case of a fracture of the iliac crest, blood loss needs to be assessed. Type 2 injuries occur with a single break in the bony pelvic ring. An example of this would be a single fracture with diastasis (separation) of the symphysis pubis. Again, these injuries are relatively benign in nature, but it may be appropriate to assess for blood loss. Type 3 injuries occur with double breaks in the bony pelvic ring. These include bilateral fractures of the pubic rami, which may produce urethral damage. Type 4 injuries occur at and around the acetabulum. | [
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