SUMMARY: HIP: Flex: Iliopsoas, rectus femoris, sartorius Extend: hamstring, gluteus maximus Abduct: gluteus medius and

and minimus Rotate laterally: obturator internus, gemelli, piriformis Adduct: adductor muscles of medial thigh KNEE Flex: hamstrings, gracilis, Sartorius Extend: quadriceps femoris Rotate medially: semitendinosus, semimembranosus Rotate laterally: biceps femoris ANKLE Plantarflex: gastrocnemius, soleus, tibialis posterior, flexor digitorum longus, flexor hallucis longus Dorsiflex: tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius INTERTARSAL Evert: fibularis longus, fibularis brevis, fibularis tertius Invert: tibialis anterior, tibialis posterior METATARSOPHALANGEAL Flex: Interossei, lumbricals Extend: extensor digitorum longus, extensor digitorum brevis Abduct: dorsal interossei Adduct: plantar interossei INTERPHALANGEAL Flex: flexor digitorum longus, flexor digitorum brevis Extend: extensor digitorum longus, extensor digitorum brevis

Muscle Iliacus: large triangular muscle Psoas

Proximal attachment Upper 2/3 of concavity of iliac fossa and iliac crest Transverse processes of lumbar vertebrae, sides of bodies of T12-L5 vertebrate

Distal attachment Lateral side of tendon of psoas major, lesser trochanter of femur Lesser trochanter of femur

Nerve supply Branches of femoral nerve Lumbar plexus via ventral branches of L2-L4 nerves (ventral rami of lumbar nerves L1-L3)

Action Flex thigh at hip joint

Flex thigh at hip joint

Iliopsoas

Passes under inguinal ligament to attach to lesser trochanter of femur

Flexes thigh at hip joint

Muscles of gluteal region: Muscle Gluteus maximus: large quadrilateral muscles which forms prominence of buttock and covers Proximal attachment Ilu posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, and Distal attachment Iliotibial tract, gluteal tuberosity of femur Nerve supply Inferior gluteal nerve Action Extends thigh at hip LABS 1

ischial tuberosity Gluteus medius: triangular muscles between maximus and minimus Gluteus minimus: - deep to gluteus medius Tensor fasciae latae

sacrotuberous ligament Gluteal surface of ala of ilium

Greater trochanter

Superior gluteal nerve

Abducts thigh at hip

Bone of ala of ilium ASIS and anterior iliac crest

Obturator internus

Piriformis: triangular muscle passes through greater sciatic foramen; separates inferior and superior gluteal vessels and nerves Quadratus femoris: 4 sided muscles just inferior to tendon of obturator inters

Pelvic surface of obturator membrane and surrounding bones Anterior surface of sacrum (pelvic surface)

Greater trochanter Iliotibial tract that attaches to lateral condyle of tibia Greater trochanter Greater trochanter

Superior gluteal nerve Superior gluteal nerve

Abducts thigh at hip Abducts thigh at hip; Stabilizes knee in extension Laterally rotates thigh at hip joint Laterally rotates thigh

Don't need to know Don't need to know

Lateral border of ischial tuberosity

Intertrochanter ic crest

Don't need to know

Laterally rotates thigh at hip joint

Iliotibial band: thickened band of fascia lata extending from the tubercle of ilia crest to the lateral condyle of the tibia. Serves as tendon fro the gluteus maximus and TFL. Attaches inferiorly to the lateral plateau of the tibia Vascularization of gluteal region: Descending aorta bifurcates into the common iliac artery which provides blood to lower extremities Common iliac bifurcates into the internal and external iliac arteries External iliac artery: becomes femoral Internal iliac artery is major blood supply to pelvis and gluteal regions Internal iliac splits into superior and inferior gluteal arteries o Superior gluteal artery: Supplies blood to obturator internus and piriformis muscles Supplies blood to muscles and skin in gluteal region, including TFL o Inferior gluteal artery: terminal branch of internal iliac artery Supplies blood to muscles of gluteal region and forms anastomoses with blood vessels around hip joint Major branches of sacral plexus: Anterior: 1. Pudendal 2. Tibial: innervates posterior thigh muscles, posterior leg muscles, and foot, forms the sciatic nerve with common fibular nerve Posterior 1. Superior gluteal: innervate gluteus medius and minimus (L4-S1) 2. Inferior gluteal: innervates gluteus maximus (L5-S2) 3. Common fibular: portion of sciatic nerve that innervates lateral and anterior muscles compartments of leg

Posterior compartment of thigh

Refereed to as hamstrings, can also rotate the knee and attached proximally to ischial tuberosity (except short head) Supplied by deep (femoral) artery of thigh and the femoral artery Proximal Attach Ischial tuberosity Lateral supracondylar line of femur Ischial tuberosity Ischial tuberosity Distal attachment Head of fibula Head of fibula Nerve supply Tibial division of sciatic nerve Common fibular division of sciatic nerve Tibial nerve Action Extends thigh at hip; flexes leg at knee Flexes leg at knee joint Labs 1 1

Muscle Biceps femoris, long head Biceps femoris, short head Semimembranosus: flat tendon extending length of proximal half Semitendinosus: has a cord like tendon on its distal half

Posterior part of medial condyle of tibia Medial surface of superior part of tibia

Extends thigh at hip, flexes leg at knee Extends thigh at hip, flexes leg at knee

Tibial nerve

Anterior compartment of the thigh Include the quadriceps which attach to the patella by the quadriceps femoris tendon and to the tibia by the patellar ligament Primarily extensors the leg at the knee 2 secondarily flex the thigh at hip Innervated by femoral nerve Supplied by femoral artery and deep artery of the thigh Iliopsoas: starts as 2 muscles from posterior abdominal wall, fuses into one muscle at about level of inguinal ligament and attaches the lesser trochanter of femur. Deepest muscle of femoral triangle Femoral triangle: o Boundaries: Inguinal ligament: base of triangle Sartorius: lateral boundary Adductor longus muscle: medial boundary o Inferiorly, fascial sleeve extends rom apex of triangle and continuous with adductor canal o Contains Femoral nerve and Femoral artery, vein, lymphatics at they pass beneath inguinal ligament and to the anterior thigh o Contains: (from lateral to medial) N - femoral nerve: originates as branch from lumbar plexus A- femoral artery: continuation of external iliac artery V - Femoral vein: continues at the external iliac vein E - empty space (femoral canal) L - Lymphatics o Femoral sheath: contains femoral vessels, femoral branch of genitofemoral nerve and lymphatics Femoral nerve is outside this sheath Muscle Sartorius: longest muscles, upper 1/3 forms lateral boundary of femoral triangle Rectus femoris Vastus lateralis: head of quads on lateral side of ant Proximal attachment ASIS Distal attachment Superior part of medial surface of tibia Quadriceps femoris tendon Quadriceps femoris tendon Nerve Femoral nerve Femoral nerve Femoral nerve Action Flexes and laterally rotates thigh, flexes leg Extends leg, flex thigh Extends leg Labs 2

ASIS, ilium superior to acetabulum Greater trochanter and lateral lip of linea

2 2

thigh Vastus medialis: head of quads on medial side of ant thigh Vastus intermedius: deep head of quads

aspera of femur Intertrochanteric line and medial lip of linea aspera of femur Femoral shaft, upper 2/3 of anterior and lateral surfaces

Quadriceps femoris tendon Quadriceps femoris tendon

Femoral nerve Femoral nerve

Extends leg

Extends leg

Medial compartment of thigh Primarily adductors the thigh at hip Most innervated by obturator nerve Supplied by obturator artery and dep artery o thigh Muscle Pectineus: forms part of posterior wall of femoral triangle. Located on floor of femoral triangle lateral to adductor longus and medial to Iliopsoas. Femoral vessels and greater saphenous vein lie anteriorly. Adductor brevis: triangular muscle deep to adductor longus, Adductor longus: triangular muscle, most anterior of adductors in same plane as pectineus Adductor magnus: fan shaped muscle Proximal attachment Superior ramus of pubis Distal attachment Pectineal line of femur inferior to less trochanter Nerve Femoral nerve, may receive branch from obturator nerve Action Adducts and flexes thigh Labs 2

Body and inferior ramus of pubis Body of pubis inferior in pubic crest Adductor: ischiopubic ramus Hamstring: ischial tuberosity Body and inferior ramus of pubis External surface of obturator membrane

Linea aspera of femur

Obturator

Adducts thigh at hip Adducts and medially rotates thigh Adducts thigh Hamstring: extends thigh Adducts thigh; flexes leg Lateral rotates thigh

Linea aspera

Obturator

Gracilis: long strap like, superficial muscle on medial side of thigh Obturator externus: seen between superior part of adductor magnus and superior pubic ramus

Adductor: linea aspera, femoral shaft Hamstring: adductor tubercle of femur Medial surface of proximal tibia Trochanteric fossa of femur

Adductor: obturator Hamstring: tibial Obturator

Don't need to know

Major arteries of thigh: Obturator: arises fro internal iliac artery has anterior and posterior branches, passes through obturator foramen Femoral: continuation of external iliac artery with numerous branches to perineum, hip, thigh and knee Deep artery of thigh: arises from femoral artery; supplies hip and thigh

Ligaments: Sacrotuberous ligament (Lab 1): stout ligament spanning from ischial tuberosity and dorsum of the sacrum Posterior (flexor) compartment of leg Primarily flexors of foot at ankle (plantarflexion) and flexors of toes Several can flex the leg at knee or invert the foot Innervated by tibial nerve Posterior tibial artery (popliteal artery divides in to anterior and posterior tibial arteries) Muscle Gastrocnemius: large superficial muscle of calf region Proximal attachment Lateral head: lateral condyle of femur Medial head: popliteal surface of femur, superior to medial condyle of femur Posterior aspect of fibular head and shaft, posterior aspect of tibia Superior to lateral femoral condyle Distal attachment Posterior surface of calcaneus bone via calcaneal tendon Nerve Tibial Action Plantar flexes foot at ankle, flexes leg at knee Labs 3

Soleus: large muscle of calf deep to gastrocnemius Plantaris: very small muscle, long tendon and small muscle belly Deep Popliteus: triangular muscle of posterior compartment just below knee and deeply position, apex of muscle points laterally Flexor hallucis longus: tendon passes behind medial malleolus posterior to FDL Flexor digitorum longus: tendon lies between Tibialis posterior and FHL tendons at medial malleolus Tibialis posterior: tendon is first to pass posterior to medial malleolus

Posterior surface of calcaneus bone via calcaneal tendon

Tibial

Plantar flexes foot at ankle

Posterior surface of calcaneus bone via calcaneal tendon

Tibial

Identify only

Lateral condyle of femur and lateral meniscus

Posterior surface of tibia

Tibial

Unlocks knee at beginning of flexion = laterally rotate femur on fixed tibia, or medially rotate tibia on fixed femur Flexes big toe

Posterior surface of fibula and interosseous membrane

Distal phalanx of big toe

Tibial

Posterior surface of Tibia

Distal phalanges of lateral 4 digits (digits 2-5)

Tibial

Flexes lateral 4 toes

Interosseous membrane, posterior surface of tibia and fibula

Navicular, cuneiform bones, metatarsals 2-4

Tibial

Plantar flexes foot at ankle and inverts foot at subtalar joints

Anterior (extensor) compartment of leg Primarily extensors of foot at the ankle (dorsiflexion) and extensors of toes Several can invert foot, and fibularis tertius can weakly evert the foot

 Muscle

Innervated the by the deep fibular nerve (common fibular nerve divides into superficial and deep branches) Supplied by anterior tibial artery Proximal attachment Lateral condyle and surface of tibia, interosseous membrane Fibula and lateral tibial condyle Anterior surface of fibula and interosseous membrane Distal part of fibula Distal attachment Medial cuneiform and base of metatarsal 1 Nerve Deep fibular nerve Action Dorsiflexes foot at ankle and inverts foot at subtalar joint Labs 3

Tibialis anterior: large muscle, its tendon passes on medial side of dorsum of foot to insert in tarsal bone Extensor digitorum longus: 4 tendons attaching to phalanges 2-6 Extensor hallucis longus: tendon lies between tibialis anterior (medial) and EDL (lateral) Fibularis (peroneus) tertius: lowest arising part of EDL that sends tendon to tuberosity of 5th metatarsal

Middle and distal phalanges of digits 2-5 (lateral 4 digits) Distal phalanx of great toe

Deep fibular nerve Deep fibular nerve

Extends lateral 4 toes

Extends great toe and dorsiflexes at ankle

Base of 5th metatarsal

Deep fibular nerve

Everts foot at ankle

Lateral (fibular) compartment of leg Primarily able to evert the foot (supination -plantar surface faces laterally) and weakly plantar flex foot at ankle Innervated by superficial fibular nerve Supplied by fibular artery (branch of posterior tibial artery) Muscle Fibularis (peroneus) longus: lies superficial to FB muscles, tendon wraps around sole of foot from lateral to medial to insert on tarsal bone Fibularis (peroneus) brevis: lies deep to fibularis longus, attaches to tuberosity on base of 5th metatarsal Proximal attachment Head and superior 2/3 of lateral surface of fibula Inferior 2/3 of lateral surface of fibula Distal attachment Base of 1st metatarsal and medial cuneiform Nerve Superficial fibular nerve Action Everts foot at subtalar joints and plantar flexes foot at ankle Labs 3

Dorsal surface of tuberosity on lateral side of 5th metatarsal

Superficial fibular nerve

Everts foot at subtalar joints and plantar flexes foot at ankle

Dorsum (extensor) surface of foot Muscle Extensor digitorum brevis: dorsum of foot under long tendons, arise from lateral side 4 tendons for digits 2-5 Extensor hallucis brevis: medial head of EDB with tendon going to big toe Plantar (flexor) surface of foot

Proximal attachment Lateral calcaneus Lateral calcaneus

Distal attachment Digits 2-4

Nerve Deep fibular nerve Deep fibular nerve

Action Extends digits 2-4 (extension of middle 3 toes) Extension of big toe

Labs 3

Digit 1

Muscle Flexor digitorum brevis: deep to plantar aponeurosis arising from calcaneus and giving rise to 4 tendons Quadratus plantae: muscle parallel and dep to FDB, inserts into tendon of FDL, lateral plantar artery and nerve pass obliquely between FDB and QP Abductor hallucis: Abductor digiti minimi Flexor hallucis brevis Flexor digiti minimi brevis Adductor hallucis Lumbricals (4 muscles) Dorsal interossei Plantar interossei

Proximal Distal attachment attachment Calcaneus Middle phalanges tuberosity of lateral 4 digits

Nerve Tibial nerve

Action Flexes lateral 4 digits

Labs 4

Plantar surface of calcaneus

Tendon of flexor digitorum longus

Tibial nerve

Assist FDL in flexing digits 25

Large muscle on medial side of the sole, visible and palpable as prominent bulge. Belongs to most superficial layer of muscles of foot Relatively slender muscles in lateral part of the sole of foot. First layer of muscle of foot Layer 3, medial side of foot, plantar surface s of cuboid and lateral cuneiforms to proximal phalanx of first digit Layer 3, attaches proximally to base of metatarsal 5 and distally to base of proximal phalanx 5, lateral side of foot Layer 3, between FHB and FDMB, 2 heads: transvers and oblique 4 slender muscles, 2 layer. Name is sequence from the medial aspect of the foot. First lumbricals is most medial of the 4. 4 muscles arranged around 2nd toe as central axis of foot, layer 4 3 muscles arranged around 2nd toe at central axis of foot, layer 4

Gait

Involves swing phase and stance phase (when foot is weight bearing) Walking produces pelvic tilt and rotation, hip and knee flexion/extension and a smoothly coordinated interaction btwn pelvis, hip, knee, ankle, and foot Swing phase o Occurs rom pre-swing toe-off (TO) position, with acceleration though the initial swing the mid-sing (MSW) and terminal swing phase o Limb decelerates to the heel strike (HS) phase when foot meets the ground Stance phase o Occurs from the heel strike position to the flat foot (FF) position, to the mid-stance (MST) phase, and then the heel off (HO) o Forward thrust to toe-off position and the heels trike position for the opposite foot

Gait cycle Toe off (TO) to Mid swing (MSW)

MSW to heel strike (HS) HS to flat foot (FF)

Muscle actions Hip flexors accelerate thigh Knee is flexed Foot dorsiflexed to clear ground Knee extended rapidly Foot dorsiflexed Hip flexed Knee extended Ankle is neutral position but foot plantarflexes flat on ground Limb extensors stabilize weight bearing joints

Phase Swing

Swing Stance

FF to mid stance (MST)

MST to heel-off (HO)

HO to Toe-Off

Body moves forward Extensors support limb while other limb is in swing phase Hip abductors control pelvic tilt Body continues forward Planar flexors contract as weight moves from heel to metatarsal heads Hip abductors control pelvic tilt Push off as opposite heel strikes ground Plantarflexors exert thrust Knee flexes Foot goes into dorsiflexed position at beginning of HO to plantarflexed as toes push off at TO Hip abductors relax while hip flexors ready for swing face

Stance

Stance

Stance