Lower Limbs




  • greater/false pelvis (abdominal cavity)
  • pelvic brim/inlet (linea terminalis; 50-60°)
  • innominate line = linea terminalis (iliopectineal line, sacral promontory)
  • iliopectineal line = arcuate line + pectineal line
  • lesser/true pelvis
  • pelvic outlet (coccyx, ischial tuberosities, pubic arch; 15°)
  • male narrower pelvic inlet, sacrum; prominent ischial spines, sacral promontory; smaller subpubic angle; deeper true pelvic cavity)
  • innominate bone (ilium, ischium, pubis)


  • triradiate cartilage (oss 2 centres at puberty, fuse 20y)
  • anterior/iliopubic column
  • posterior/ilioischial column
  • quadrilateral plate (med wall) with acetabular/cotyloid fossa (non-articular)
  • dome (sup weight-bearing aspect)


  • iliac crest (inner lip, intermediate zone, outer lip; oss puberty, fuse 20y)
  • ant and posterior superior iliac spines (ASIS, PSIS)
  • ant (oss puberty) and posterior inferior iliac spines (AIIS, PIIS)
  • paraglenoid/auricular sulcus (sup branch gluteal a)
  • wing/ala = iliac fossa
  • arcuate line
  • greater sciatic notch


  • ischial spine (post)
  • lesser sciatic notch
  • ischial tuberosity (inf; oss puberty, fuse 20y)
  • body of ischium
  • ischial ramus (synchondrosis with inferior pubic ramus fuses at 7y)


  • superior pubic ramus
  • pecten pubis = pectineal line = pubic crest
  • obturator groove
  • obturator crest
  • body
  • pubic tubercle
  • body of pubis
  • symphyseal surface
  • inferior pubic ramus
  • pubic arch
  • subpubic angle (ischial > inferior pubic rami)
  • obturator foramen
  • symphysis pubis
  • fibrocartilaginous disc


  • 5 fused sacral vertebrae
  • superior articular process/facets (post-med)
  • sacral promontory
  • base
  • sacral ala/wings
  • auricular surface (post-lat; > ilium)
  • transverse ridges (betw sacral foramina)
  • anterior/pelvic sacral/neural foramina (4 pairs)
  • sacral canal
  • median sacral crest (post) with sacral tubercles (4)
  • intermediate sacral crest (facets; between median crest and posterior foramina)
  • posterior sacral foramina (4 pairs)
  • lateral sacral crest with transverse tubercles (vestigial transverse processes)
  • sacral hiatus (inf; unfused S4-S5 laminae; 5th sacral n)
  • sacral cornu/horns
  • medial sacrum fuse 5y, with other side 8y; lateral fuse below up at puberty
  • width of S1 body<ala in females; body>ala in males
  • ant surface flat superior and concave inferior in females; uniformly concave in males


  • 4 fused coccygeal vertebrae (1st often separate)
  • 3 or 5 coccygeal vertebrae (V)

Sacroiliac Joints

  • several elevations and depressions that fit for increased stablility; allows minimal rotation
  • 25°to sagittal plane (converge A > P), perpendicular to ipsilateral facet joints
  • iliac hyaline cartilage, sacral fibrocartilage
  • ventral and dorsal (thickened; strongest lig in body) sacroiliac ligaments
  • interosseous sacroiliac ligament (sup-post to joint = syndesmotic portion of SIJ)

Ligaments and Membranes

  • greater sciatic foramen (post-sup; piriformis)
  • sacrospinous ligament (ischial spine > sacrum, coccyx)
  • lesser sciatic foramen (ant-inf; obturator internus)
  • sacrotuberous ligament (ischial tuberosity >sacrum, coccyx, PIIL)
  • iliolumbar ligament (transverse L5 > iliac crest)
  • inguinal ligament (pubic tubercle > ASIS; thickening anterior abdo wall mm aponeurosis)
  • obturator membrane (>pubic and ischial rami and bodies)
  • obturator canal (sup-ant; obturator a+v+n)


  • gluteus maximus (sup-post ilium, crest, sacrum, coccyx, sacrotuberous lig >iliotibial tract, gluteal tuberosity; accessory ossicle [V])
  • gluteus medius (sup ilium > lateral greater trochanter)
  • gluteus minimus (inf ilum > anterior greater trochanter)
  • piriformis (ant sacrum, gluteal ilium > greater sciatic foramen > superior greater trochanter)
  • obturator internus (med pelvic obturator membrane, ischium, pubis > lesser sciatic foramen > medial greater trochanter)
  • gemellus superior and inferior (ischial spine and tuberosity > obturator internus tendon)
  • quadratus femoris (ischial tuberosity > quadrate tubercle of trochanteric crest)
  • obturator externus (lat obturator membrane, pubic rami > trochanteric fossa)
  • iliopsoas (psoas major&minor, iliacus > under inguinal lig > lesser trochanter)


  • articular surface/lunate of the acetabulum (deficient inferior and centrally)
  • acetabular notch
  • floor of the acetabulum = acetabular/cotyloid fossa (central, fibrofatty pad)
  • acetabular labrum (fibrocartilage; vairants in shape)
  • joint capsule (rim acetabulum, transverse acetabular lig > anterior intertrochanteric line, posterior 10mm above trochanteric crest)
  • capsular retinaculum (longitudinal reflection at neck with retinacular branches of medial femoral circumflex a to head)
  • os acetabuli (V, upper outer lip acetabulum)
  • obturator, medial circumflex femoral, superior and inferior gluteal arteries and nerves


  • ligament of the femoral head = ligamentum teres (fovea capitis > acetabular fossa)
  • transverse acetabular lig (labrum over acetabular notch)
  • iliofemoral ligament = Y-shaped ligament of Bigelow (AIIS > trochanteric line, capsule)
  • pubofemoral ligament (iliopectineal line, superior pubic ramus, obturator membrane >base femoral neck, capsule)
  • ishiofemoral ligament (ischium > greater trochanter, capsule
  • iliacus/iliopectineal bursa (ant; <deficiency in capsule between pubofemoral and iliofemoral ligs)


  • A = pectineus, femoral v, ilipsoas tendon, iliacus bursa, femoral a+n, rectus femoris, iliotibial tract
  • S = rectus femoris head, gluteus minimus
  • P = piriformis, obturator internus, gemelli tendons, sciatic n, obturator externus tendon, quadratus femoris
  • I = pectineus, obturator externus


  • flexion: iliacus, psoas, pectineus, rectus femoris, sartorius
  • extension: gluteus maximus, hamstrings
  • abduction: gluteus medius/minimus, tensor fascia lata, sartorius
  • adduction: adductor longus/brevis/magnus, pectineus, gracilis
  • medial rotation: anterior gluteus medius/minimus, tensor fascia lata
  • lateral rotation: obturator, gemelli mm, quadratus femoris, piriformis, gluteus maximus, sartorius



  • fovea capitis
  • head (sup-med-ant)
  • neck (5cm long, 125-135° to shaft, 8° anterior (up to 50° in children)
  • greater (sup-lat) and lesser (post-med) trochanter
  • intertrochanteric line (ant)
  • intertrochateric crest (post)
  • trochanteric fossa (med to greater trochanter)
  • pectineal/spiral line (inf to lesser trochanter)
  • gluteal tuberosity (post-inf to greater trochanter)
  • shaft (angled med, anterior convexivity; lower shaft angled 17° posterior from upper)
  • linea aspera (post, medial and lateral lips join in middle then divide as supracondylar lines)
  • nutrient foramen (‘flee from knee’)
  • medial and lateral supracondylar lines
  • popliteal surface (betw supracondylar lines)
  • adductor tubercle (sup medial epicondyle, end of medial supracondylar line)
  • lateral and medial epicondyles
  • popliteus tendon groove (post-lat lateral epicondyle)
  • lateral and medal (larger, more post-inf) condyles
  • intercondylar fossa
  • patellar surface (mostly lateral condyle)
  • femur valgus with tibia 10° men, 14° women
  • fabella (lat head gastrocnemius)
  • 2° oss in head (appear 6/12), greater trochanter (appear 4y), lesser trochanter (appear 8y), lower femur (appear 9miu) and fuse at 18y


  • 1° compressive trabeculae (sup head>med neck)
  • 1° tensile trabeculae (tip head >lat shaft)
  • 2° compressive trabeculae (gr trochanter > medial shaft)
  • Ward’s triangle (betw above trabeculae)

arterial supply to femoral head

  • retinacular aa beneath synovium (<vascular ring from transverse/ascending branches of the medial and lateral circumflex femoral aa[< profunda femoris], branches of superior and inferior gluteal aa)
  • terminal medullary branches of the shaft
  • artery of the ligamentum teres (<obturator and medial circumflex femoral aa)


anterior compartment

  • tensor fascia lata (ASIS > iliotibial tract)
  • iliotibial tract = fascia lata (thickened deep fascia of lateral thigh > lateral tibial condyle)
  • sartorius (ASIS > aponeurosis > medial tibial condyle)
  • quadriceps femoris
    • rectus femoris (straight head AIIS and reflected head superior acetabulum, capsule > superior patella)
    • vastus lateralis (greater trochanter, lateral linea aspera > lateral patella, iliotibial tract)
    • vastus intermedius (ant-lat femur > base patella)
    • vastus medialis (med lesser trochanter, spiral line, medial linea aspera, medial supracondylar line > medial patella)

adductor compartment

  • gracilis (body, inferior pubic ramus > medial tibia)
  • pectineus (pectin pubis > between lesser trochanter and linea aspera)
  • adductor longus (ant body pubis > aponeurosis > inferior medial linea aspera
  • adductor brevis (body, inferior pubis > between lesser trochanter and linea aspera)
  • adductor magnus (inf pubis, ramus, ischium > linea aspera, adductor tubercle)
  • adductor minimus (upper part adductor magnus)
  • adductor hiatus (betw adductor magnus tendons, femoral>popliteal vessels)

posterior compartment

  • hamstrings
    • semimembranosus (ischial tuberosity > medial tibial condyle, over politeus > lateral femoral condyle)
    • semitendinosis (ischial tuberosity > pes anserinus)
    • biceps femoris (long head ischial tuberosity, short head lateral linea aspera > head fibula)
  • pes anserinus (attachments of sartorius, gracilis, semitendinosus to ant-med tibia)


  • tibial (2 components) and femoral (3) articular surfaces (concave) and deep surface patella
  • tibiofemoral joint space (3-8mm)
  • patellofemoral joint space (3mm)
  • patella tendon (>tibial tuberosity; = length of patella)
  • capsule > intercondylar fossa, margins of condyles, lateral patella, tibial condyles, head fibula, tibial tuberosity, menisci; perforated by popliteus


  • lateral patellar retinaculae (expanded vastus medialis&lateralis, iliotibial tract ligaments)
  • ligamentum patellae (paptella > tibial tuberosity)
  • medial/tibial collateral ligament (med epicondyle >band>med tibial condyle, meniscus, capsule)
  • lateral/fibular collateral ligament (lat epicondyle >cord>head fibular separate from capsule by popliteus tendon)
    • outer (ant iliotibial band and posterior biceps femoris tendon), middle (fibular collat lig) and deep (popliteus tendon) layers
  • oblique popliteal ligament = posterior lig (med tibia/semimembranosus tendon > intercondylar fossa; floor popliteal fossa)
  • anterior cruciate lig (ACL; medial anterior intercondylar tibia > posterior lateral femoral condyle)
    • anteromedial and posterolateral bands
  • posterior cruciate lig (PCL; lateral posterior intercondylar tibia > anterior medial femoral condyle; stronger& shorter than ACL)
  • cruciate ligaments are intracapsular but extrasynovial
  • infrapatellar/Hoffa’s fat pad (deep to patella ligament)

Menisci = Semilunar Fibrocartilage

  • 2/3 of knee surface
  • outer circumferential and inner transverse zones
  • medial menisci larger, less curved and thinner
  • anterior and posterior horns (>intercondylar tibia)
  • meniscofemoral lig (post horn lateral meniscus > anterior [lig of Humphrey] and posterior [lig of Wrisberg] to PCL >medial condyle femur)
  • transverse ligament of the knee (ant medial > lateral menisci > tibia)
  • coronary ligament = meniscotibial lig (part of capsule; inferior menisci > tibial plateau)
  • discoid meniscus (V3%, usually lat, thicker and fuller crescenteric shaped)

Synovium and Bursae

  • synovial membrane (not over menisci, infolding posteriorly to cross anterior ACL)
  • alar folds (two infoldings of synovium under infrapatellar fat pad)
  • central infrapatellar fold (union of alar folds anterior to intercondylar fossa)
  • subpopliteal recess (around popliteus tendon)
  • suprapatellar bursa (< joint; deep to suprapatellar fat pad and quadriceps tendon)
    • oblique septum of the suprapatellar bursa (V)
  • prepatellar bursa (subcutaneous)
  • deep infrapatella bursa (deep to patellar tendon)
  • subcutaneous infrapatellar bursa
  • biceps femoris bursa (betw tendon and LCL)
  • iliotibial tract bursa
  • politeus bursa = bursa of the popliteus tendon (< joint; between tendon and lateral fem condyle)
  • lateral gastrocnemius bursa (<joint [V])
  • medial gastrocnemius-semimembranosus bursa (<joint in 50%; popliteal/Baker’s cyst if inflammed)
  • bursae deep to medial collat lig, between semimembranosus and semitentinosus tendons (V)


  • A = quadriceps, patellar retinacula, suprapatellar bursa
  • P/med = sartorius, gracilis tendons
  • P = oblique popliteal lig, popliteus, pop a+v, tibial n, LN, gastrocnemius, semimembranosus, semitendinosus
  • P/lat = common peroneal n, biceps femoris


  • flexion: unlocked by popliteus (rotates femur lat), hamstrings
  • extension: quadriceps
  • medial rotation: popliteus, semimembranosus, semitendinosus
  • lateral rotation: biceps femoris


  • apex (inf; 1cm above knee)
  • base (sup; lateral and medial facets post)
  • Wiberg shapes type 1 (med and lateral articular facets equal), type 2 (lat>med), type 3 (med atretic/redundant)
  • bipartite or tripartite/multipartite patella (V, failed union sup-lat segments, usually bilat)
  • oss of patella (1-3 centres appear 3y, fuse puberty)



  • tibial plateau
  • ant and posterior intercondylar areas
  • intercondylar eminence = tibial spine
  • medial and lateral intercondylar tubercle
  • medial and lateral facets/articular surfaces
  • medial (larger, ovoid) and lateral (circular) condyles
  • Gerdy’s tubercle (ant-lat, <iliotibial tract)
  • oblique line (ant-lat)
  • tibial tuberosity
  • soleal line (post, lat>med)
  • nutrient foramen
  • anterior, medial and lateral/interossieous borders
  • inferior articular surface
  • fibular notch
  • groove for tibialis posterior tendon (post-med)
  • medial malleolus
  • facet of medial malleolus
  • 2° oss in upper tib (appear birth, fuse 18y), lower tib (appear 2y, fuse 18y), medial malleolus (extend/appear 7y), tibial tuberosity (extend/appear 10y ± fuse 12y)


  • apex, head, neck
  • lateral malleolus (post-inf to medial mall)
  • malleolar fossa with facet
  • 2° oss upper fib (appear 3y, fuse 18y), lower fib (appear 1y, fuse 18y)

Tibiofibular Joints

  • superior tibiofibular joint (synovial with capsule)
  • ant and posterior ligaments of the fibular head = superior tibiofibular ligs
  • inferior tibiofibular joint (syndesmosis, interosseous lig cont with interosseus membrane)
  • ant and posterior inferior tibiofibular ligaments
  • interosseous ligament/membrane (deficient superior and inf)


anterior compartment

  • mm, anterior tibial a&v, deep peroneal/fibular n
  • tibialis anterior (ant tibia, membrane > medial cuneiform, inf/med base 1st MC)
  • extensor hallucis longus (EHL; anterior mid fibula, membrane > dorsum base distal 1st phalanx)
  • extensor digitorum longus (ant superior fibula, membrane > 4 tendons > dorsum mid and distal 2nd-4th phalanges)
  • peroneus/fibularis tertius (ant inferior fibula > dorsum base 5th MT)
  • superior extensor retinaculum (fibula > tibia)
  • inferior extensor retinaculum (calcaneus > navicular)
  • Tendons anterior to ankle from medial -> lateral (Tom, Harry and Dick): tibialis anteroir, extensor hallucis longus, extensor digitorum longus, peroneus tertius. Confined by anterior extensor retinaculum.

lateral/peroneal compartment

  • separated by anterior intermuscular septum; mm, superficial peroneal/fibular n
  • peroneus/fibularis longus (sup-lat fibula > groove lateral mall and cuboid> deep to plantar lig > medial cuneiform, base 1st MT)
    • postmed to peroneus brevis
    • hiatus in superior perneus longus attachment (common peroneal n)
  • peroneus/fibularis brevis (inf-lat fibula > tuberosity base 5th MT)
  • superior fibular/peroneal retinaculum (lat malleolus > calcaneus)
  • inferior fibular/peroneal retinaculum (calcaneus>calcaneus)
  • peroneus quartus (V, muscular peroneus brevis/longus or fibula -> peroneal tubercle of calcaneus)

superficial posterior compartment

  • separated by posterior intermuscular septum; mm
  • gastrocnemius (medial head medial femoral condyle, lateral head lateral fem condyle > Achille’s/calcaneal tendon > calcaneus)
  • plantaris (vestigial, abset [V7-10%]; lateral supracondylar line, oblique popliteal lig > post-med calcaneus)
  • soleus (head, sup-post fibula, soleal line, medial tibia > Achille’s tendon)

deep posterior compartment

  • separated by transverse intermuscular septum; mm, posterior tibial a&v, tibial n, peroneal/fibular a&v
  • popliteus (sup-post-med tibia > pieces capsule > groove lateral fem condyle, lateral meniscus)
  • flexor hallucis longus (FHL; mid posterior fibula > 1st distal phalanx). musculotendinous junction more distal than other flexors, at level of ankle joint line.
  • flexor digitorum longus (FDL; medial to FHL; mid posterior tibia > 4 slips > 2nd-5th distal phalanges)
  • tibialis posterior – posterior tibia, membrane, fibula > medial to flexor digitorum longus tendon > navicular tuberosity, slips to cuneiforms, cuboid, 2nd-4th MT. Principle inverter of foot and helps to maintain longitudinal arch. Should be no thicker than twice other tendons.
  • flexor retinaculum (med malleolus > calcaneus)
  • Flexor tendons pass posteromedial to medial malleolus in tarsal tunnel, confined by flexor retinaculum. Medial -> lateral (Tom, Dick, And Harry): tibialis posterior, flexor digitorum longus, a&v&n (post tibial nerve, posterior tibial a&v, lymphatics), flexor hallucis longus.


tibial plafond, fibula and talar dome (broader ant) with 3-4mm joint space

deltoid/medial collateral/complex ligament much stronger than lateral ligaments. Deep to flexor tendons.

  • superficial component from anterior medial malleolus
    • tibionavicular part -> navicular tuberosity, weakest of medial ligaments.
    • tibiospring part ->spring lig
    • tibiocalcaneal part -> sustentaculum tali
  • deep component from posterior medial malleolus
    • anterior tibiotalar part
    • posterior tibiotalar part -> posterior process

lateral collateral ligament

  • anterior talofibular lig – anterior fibula -> lateral talar neck.
  • calcaneofibular lig – tip of lateral malleolus -> peroneal/fibular trochlea on lateral calcaneus
  • posterior talofibular lig – fan shaped from distal lateral malleolar fossa -> distallater tubercle of posterior talar process

syndesmosis (inf tibiofibular articulation

  • anterior tibiofibular lig (ATIF)
  • posterior tibiofibular lig (PTIF)
  • interosseous membrane


  • A = great saphenous v, tibialis ant, EHL, anterior tibial a&v, deep peroneal n, EDL, peroneus tertius
  • P = tibialis post, FDL, posterior tibial a&v, tibial n, FHL
  • lat = peroneus longus/brevis, short saphenous v


  • dorsiflexion: tibialis ant, EDL, EHL, peroneus tertius
  • plantarflexion: gastrocnemius, soleus, tibialis post, FDL, FHL
  • eversion: peroneus tertius, peroneus longus and brevis


Hindfoot (calcaneus and talus), midfoot (navicular, cuboid and cuneiforms) and forefoot (metatarsals and phalanges). Chopart’s joint – hindfoot-midfoot articulation; Lisfranc’s joint – midfoot-forefoot articulation.


  • body (w trochlear surface)
  • neck (150° inf-med to body, 130-140° in infants)
  • head (inf-med-ant, navicular facet)
  • posterior process
  • lateral process
  • plantar/inferior surface
    • anterior calcaneal facet
    • facet for spring ligament (med)
    • middle (for sustentaculum tali) calcaneal facet
    • sulcus tali (inf groove in neck)
    • posterior calcaneal facet
    • facets for medial and lateral malleoli
  • 1° oss in utero


  • articular surface for cuboid
  • anterior talar facet
  • sustentaculum tali with middle talar facet (med)
  • sulcus calcanei
  • posterior talar facet
  • body (ant-sup-lat)
  • anterior tubercle (<short plantar lig)
  • peroneal/fibular tubercle/trochlea (lat)
  • calcaneal tuberosity (lateral and medial processes)
  • 1° oss in utero
  • 2° oss posterior calcaneus (appear 5y, fuse puberty)

Other Tasral Bones

  • navicular (facets for talus, cuneiforms [3], cuboid)
    • navicular tuberosity (med)
    • 1° oss 3y in several centres
  • medial/1st cuneiform (>1st MT; 1° oss 1-3y)
  • intermediate/2nd cuneiform (>2nd MT; 1° oss 1-3y)
  • lateral/3rd cuneiform (>3rd MT, medial 4th MT, medial cuboid); 1° oss 1-3y)
  • cuboid (groove for peroneus longus tendon lat-inf, tubicle/tuberosity, 1° oss birth)

Metatarsals and Phalanges

  • base, body/shaft, head
  • metatarsals (2nd-5th epiphyses ossify 3-4y, fuse 18y). 2nd MT base is the most proximal and dorsal, acts to ensure position of other MTs, held to medial cuneiform with strong Lisfranc’s ligamet.
  • MT bases articulate with each other
  • facets for sesamoid bones (1st MT head)
  • styloid process (base 5th MT; the apophyseal line is sagittal, appears 10-15yo, fuses 25yo)
  • hallux (2 phalanges, slight valgus)
  • metatarsus adductus (V, adduction of hallux in infancy corrects with weightbearing)
  • phalanges (epiphyses ossify 2-8y, fuse 18y

Sesamoid/Accessory Ossicles

  • sesamoid bones (2 in FHB base 1st MTP, bipartite [V])
  • sesamoid bones at other MTPs or 1st/2nd IPJs
  • os peroneum (peroneus longus lateral to cuboid)
  • os vesalianum pedis (peroneus brevis tendon proximal to base 5th MT)
  • os trigonum (unfused apophysis posterior process talus)
  • os tibiale externum/os naviculare/accessory navicular (separate oss of navicular tuberosity or in tibialis posterior, medial to proximal navicula)

Subtalar Joints

  • posterior talocalcaneal joint
    • medial (>sustentaculum) and lateral talocalcaneal ligaments
  • sinus tarsi (lat; sinus tali and calcanei)
    • interosseous talocalcaneal ligament (lat; sulcus tali > sulcus calcanei)
  • talocalcaneonavicular joint (post navicular, head talus, anterior calcaneus, spring ligament, mid talocalcaneal joint)
    • plantar calcaneonavicular = spring ligament (ant sustentaculum tali > plantar navicular bone)
    • (dorsal) talonavicular ligament (neck talus > dorsum navicular)
    • bifurcate ligament (lat; calcaneonavicular and calcaneocuboid ligaments)

Calcaneocuboid Joint

  • long plantar/calcaneocuboid ligament (plantar calcaneum > cuboid tuberosity, base 2nd-4th MT)
  • short plantar/calcaneocuboid ligament (anterior tubercle calcaneum > plantar cuboid)

Arches of the Foot

  • longitudinal arch
    • medial arch (calcaneus, talus, cuneiforms, 1st-3rd metatarsals
    • lateral arch (calcaneus, cuboid, 4th-5th metatasrsals
  • transverse arches (each foot has ½ of full arch)


  • inversion: tibialis anterior/posterior (limited by peronei, interosseous talocalcaneal lig)
  • eversion: peroneus longus/brevis (limited by tibialis ant/post, deltoid lig)


  • bipartite navicular
  • bipartite medial cuneiform
  • bipartite base 1st proximal phalanx
  • tarsal coalition (fibrous, cartilaginous or osseous bridging)
    • calcaneonavicular coalition/fusion
    • talocalcaneal coalition
    • bony bridge between calcaneum and cuboid
    • fusion of cuboid and lateral cuneiform


  • common iliac arteries (CIAs; R 5cm, L 4cm)> internal and external iliac arteries (at SIJ)
  • A = ureter, superior rectal a (L), preaortic autonomic plexus (L)
  • P = CIVs (R), lumbosacral trunk, obturator n, iliolumbar a, sympathetic trunk, L4-5
  • P/med = CIVs

External Iliac Artery

  • pelvic brim > medial to psoas > inguinal ligament/midinguinal point > femoral a
  • A = ureter, vas deferens, testicular/ovarian vessels, round ligament
  • P/med = EIV
  • inferior epigastric artery (>med to deep inguinal ring > posterior surface anterior abdominal wall > rectus sheath [>rectus abdominis] > superior epigastric a;)
    • pubic branch of inferior epigastric a (>periosteum of superior pubic ramus, anast with pubic branch obturator a)
  • deep circumflex iliac artery (>iliac crest mm)
  • abnormal obturator a (V30%, opened pubic branch anast when obturator a absent)

(Common) Femoral Artery

  • superficial (inferior) epigastric artery (>rectus sheath, anast with inferior and superior epigastric aa)
  • superficial circumflex iliac a (>parallel to inguinal lig >ASIS)
  • superficial external pudendal artery (>skin and superficial tissues external genitalia)
  • deep external pudendal artery (>skin of external genitalia, medial to superficial a)
  • relations
    • surr: femoral sheath (diverticulum of transversalis fascia)
    • P = psoas
    • med = CFV
    • lat = femoral n

profunda femoris (PFA; 3.5cm distal to inguinal lig)

  • between anterior and adductor compartments, in post-lat thigh
  • lateral femoral circumflex a (ascending and transverse branches > trochanteric anast; > descending geniculate branch > knee)
  • medial femoral circumflex a (betw psoas and pectineus > posterior thigh >transverse and ascending branches >trochanteric anast; >hip joint and adductors)
  • 4 perforating arteries (> mm; 4th = terminal branch PFA)
  • trochanteric anastomosis ( ascending br medial and lateral fem circumflex aa, superior and inferior gluteal aa branches)
  • cruciate anastomosis (at lesser trochanter; medial femoral circumflex a, transverse br lateral fem circumflex, ascending br 1st perforating a, descending br inferior gluteal a)
  • lateral and medial circumflex arise from PFA in only 50%

(Superficial) Femoral Artery

  • CFA bifurcation >adductor canal > adductor hiatus (covered by anteromedial intermuscular septum)
  • adductor/subsartorial/Hunter’s canal (betw vastus medialis, adductor mm, sartorius)
  • superficial between anterior and adductor compartments running from posterior to lat
  • descending genicular artery (>knee, anast with medial superior genicular a)

Popliteal Artery

  • adductor hiatus > bifurcation below lower border popliteus
  • P = popliteal v
  • cutaneous branches
  • superficial muscular branches
  • sup and inferior sural arteries (>gastroctemeus and soleus)
  • superior medial and lateral genicular branches
  • middle genicular branch
  • inferior medial and lateral genicular branches
  • anterior tibial a and tibioperoneal trunk
  • crural vessels (ant and posterior tibial, peroneal aa)


  • tibioperoneal trunk > anterior tibial and peroneal aa
  • trifurcation of popliteal a
  • anastomosis of anterior tibial a and tibioperoneal trunk
  • long tibioperoneal trunk

Anterior Tibial Artery

  • lower border popliteus > through interosseous membrane > below extensor retilaculum midway between malleoli > dorsalis pedis
  • A = tibialis anterior
  • P = fibula, interossesous membrane, extensor hallucis longus
  • R&L = paired anterior tibial v
  • post tibial recurrent a
  • muscular branches
  • medial and lateral malleolar aa

dorsalis pedis

  • extensor retinaculum > arcuate artery
  • med and lateral tarsal aa
  • 1st dorsal metatarsal artery (>great toe)
  • > deep plantar artery (>plantar arch)
  • arcuate artery = dorsal arch (anast with lateral tarsal a and lateral plantar aa)
  • > 2nd-4th dorsal metatarsal aa >2 dorsal digital aa with 4th MT a > lateral branch to 5th toe


  • enlarged to compensate for deficient plantar artery (supplying plantar arch)
  • absent terminal branches in toes (then supplied from medial plantar a)
  • absent dorsalis pedis (supply from large perforating branch of peroneal a)
  • lateral tarsal dominant supply of dorsal arch

Posterior Tibial Artery

  • tibioperoneal trunk = proximal posterior tibial a
  • betw soleus and tibialis posterior > medial to Achilles tendon > under flexor retinaculum inferior to medial malleolus
  • branches around fibular to genicular anastomosis
  • muscular branches
  • nutrient artery to the tibia
  • posterior medial malleolar branch
  • lateral calcaneal branch
  • medial plantar artery (anast with deep plantar a)
  • lateral plantar artery (>base 5th MT anast with lateral tarsal a> plantar arch > base 1st/2nd MT > anast with medial plantar and deep plantar aa)
  • plantar arch >4 plantar MT arteries > 2 plantar digital aa

peroneal/fibular artery

  • 2.5cm from posterior tib a origin, upper fibula > posterior to distal tibiofibular joint
  • muscular branches to peroneal and posterior compartments
  • nutrient artery to the fibula
  • perforating branch > interosseous membrane > anterior lateral malleolar branches and anast with anterior tibial/dorsalis pedis
  • communicating branch > anast with posterior tibial a
  • posterior lateral malleolar branch
  • lateral calcaneal branch


  • high take-off of posterior tibial artery
  • absent/hypoplastic posterior tibial (supply from large peroneal communicating branch or deep plantar a supplying arch)

Knee Anastomoses

  • medial sup, medial inferior and descending (<SFA) genicular aa
  • lat superior and lateral inferior and descending (<lat circumflex femoral) genicular aa
  • lat inf, medial inferior genicular and posterior tibial recurrent a (<ant tibial a)
  • patellar anastomosis (med sup/inf and lateral sup/inf genicular aa)


  • superficial (saphenous vv)> intercommunicating/ perforating vv > deep veins
  • valves and soleal pump
  • short/small saphenous vein (lat dorsal venous arch >post to lateral malleolus > posterior calf >pieces pop fossa fascia > popliteal v [saphenopopliteal junction]; communicating vv > long saphenous, profunda femoris vv)
  • long saphenous vein (medial dorsal venous arch > anterior to medial malleolus > medial leg/thigh > saphenous opening in lower inguinal triangle > femoral v; communicating vv > femoral vv)
  • deep veins (paired venae comitantes: medial and lateral plantar vv> posterior and anterior tibial vv> popliteal v > SFV> CFV> inguinal lig > external iliac v; profunda femoris v > common femoral v)
  • interal and external iliac vv (post-med to arteries > common iliac vv anterior to SIJ, post-R of arteries > IVC at L5)
  • Cockett’s point (V, compression of LCIV from RCIA)


  • LN < 10mm; retrocrural < 6mm, paraaortic/subcarinal </= 12mm
  • superficial vessels (follow long saphenous v > superficial inguinal LNs, short saphenous v > popliteal LNs)
  • abdominal wall below umbilicus, gluteal region, anal canal, external genitalia, perineum > upper inguinal LNs > lower superficial inguinal LNs
  • superficial inguinal LNs > deep inguinal group (1-3 nodes; via saphenous opening) > external iliac group
  • deep vessels > deep inguinal LNs
  • deep buttock > internal iliac nodes
  • internal and external iliac nodes > common iliac nodes > paraaortic nodes > right and left lumbar trunks > cisterna chyli
  • preaortic nodes (coeliac, SMA, IMA)
  • lymph from paired branches aorta >right and left paraaortic nodes (ant-lat to psoas; > right and left lumbar lymph
  • retroaortic nodes (behind aorta)
  • R&L lumbar trunks, intestinal trunk, descending intercostal trunks > cisterna chyli (5 x 40-60mm; behind right crus diaphragm, L1-2) > aortic hiatus > thoracic duct

Femoral Canal

  • lat > medial (NAVY): ilipsoas, femoral nerve, artery, vein, femoral canal, pectineus
  • femoral sheath (lateral compartment [fem a], intermediate [fem v], medial [fem canal]; <transversalis fascia and fascia iliacus)
  • femoral canal (fat, lymphatics)