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.
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
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.
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.
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.