Bones of the lower limbs

FEMUR
• The femur is the only bone in the thigh and
the longest bone in the body.
• It acts as the site of origin and attachment of
many muscles and ligaments, and can be
divided into three parts; proximal, shaft and
distal.
 Proximal
• The proximal aspect of the femur articulates with the acetabulum of
the pelvis to form the hip joint.
• It consists of a head and neck, and two bony processes – the greater
and lesser trochanters. There are also two bony ridges connecting the
two trochanters; the intertrochanteric line anteriorly and the
trochanteric crest posteriorly.
• Head – articulates with the acetabulum of the pelvis to form the hip
joint. It has a smooth surface, covered with articular cartilage (except
for a small depression – the fovea – where ligamentum teres attaches).
• Neck – connects the head of the femur with the shaft. It is cylindrical,
projecting in a superior and medial direction. It is set at an angle of
approximately 135 degrees to the shaft. This angle of projection allows
for an increased range of movement at the hip joint.
• Greater trochanter – the most lateral palpable
projection of bone that originates from the
anterior aspect, just lateral to the neck.It is the site
of attachment for many of the muscles in the
gluteal region, such as gluteus medius, gluteus
minimus and piriformis. The vastus lateralis
originates from this site.
• An avulsion fracture of the greater trochanter can
occur as a result of forceful contraction of the
gluteus medius.
• Lesser trochanter – smaller than the greater trochanter. It
projects from the posteromedial side of the femur, just
inferior to the neck-shaft junction.
– It is the site of attachment for iliopsoas (forceful contraction of
which can cause an avulsion fracture of the lesser trochanter).
• Intertrochanteric line – a ridge of bone that runs in an
inferomedial direction on the anterior surface of the femur,
spanning between the two trochanters. After it passes the
lesser trochanter on the posterior surface, it is known as
the pectineal line.
– It is the site of attachment for the iliofemoral ligament (the
strongest ligament of the hip joint).
 – It also serves as the anterior attachment of the hip
joint capsule.
• Intertrochanteric crest – like the
intertrochanteric line, this is a ridge of bone that
connects the two trochanters. It is located on the
posterior surface of the femur. There is a rounded
tubercle on its superior half called the quadrate
tubercle; where quadratus femoris attaches.
• The Shaft
• The shaft of the femur descends in a
slight medial direction. This brings the knees closer to
the body’s centre of gravity, increasing stability. A cross
section of the shaft in the middle is circular but flattened
posteriorly at the proximal and distal aspects.
• On the posterior surface of the femoral shaft, there are
roughened ridges of bone, called the linea aspera (Latin
for rough line). This splits distally to form the medial and
lateral supracondylar lines. The flat popliteal surface lies
between them.
• Proximally, the medial border of the linea aspera becomes
the pectineal line. The lateral border becomes the gluteal
tuberosity, where the gluteus maximus attaches.
• Distally, the linea aspera widens and forms the floor of
the popliteal fossa, the medial and lateral borders form
the medial and lateral supracondylar lines. The medial
supracondylar line ends at the adductor tubercle, where
the adductor magnus attaches.
• By TeachMeSeries Ltd (2021)
 Patella
• The patella (kneecap) is located at the front of the
knee joint, within the patellofemoral groove of the
femur. Its superior aspect is attached to the
quadriceps tendon and inferior aspect to the
patellar ligament.
• It is classified as a sesamoid type bone due to its
position within the quadriceps tendon, and is the
largest sesamoid bone in the body. In this article we
will look at the anatomy of the patella – its surface
features, functions and clinical relevance.
• Functions
• The patella has two main functions:
• Leg extension – Enhances the leverage that
the quadriceps tendon can exert on the femur,
increasing the efficiency of the muscle.
• Protection – Protects the anterior aspect of
the knee joint from physical trauma.
 Tibia
• The tibia is the main bone of the lower leg, forming what is
more commonly known as the shin.
• It expands at its proximal and distal ends; articulating at
the knee and ankle joints respectively. The tibia is the second
largest bone in the body and it is a key weight-
bearing structure.
• In this article, we shall look at anatomy of the tibia – its bony
landmarks, articulations and clinical correlations.
• By Anatomography [CC-BY-SA-2.1-jp], via Wikimedia Commons
 PROXIMAL
• The proximal tibia is widened by the medial and
lateral condyles, which aid in weight-bearing. The condyles
form a flat surface, known as the tibial plateau. This
structure articulates with the femoral condyles to form the
key articulation of the knee joint.
• Located between the condyles is a region called
the intercondylar eminence – this projects upwards on
either side as the medial and lateral intercondylar tubercles.
This area is the main site of attachment for the ligaments
and the menisci of the knee joint. The intercondylar
tubercles of the tibia articulate with the intercondylar
fossa of the femur
• The shaft of the tibia is prism-shaped, with three borders and three
surfaces; anterior, posterior and lateral. For brevity, only the anatomically
and clinically important borders/surfaces are mentioned here.
• Anterior border – palpable subcutaneously down the anterior surface of
the leg as the shin. The proximal aspect of the anterior border is marked
by the tibial tuberosity; the attachment site for the patella ligament.
• Posterior surface – marked by a ridge of bone known as soleal line. This
line is the site of origin for part of the soleus muscle, and extends
inferomedially, eventually blending with the medial border of the tibia.
There is usually a nutrient artery proximal to the soleal line.
• Lateral border – also known as the interosseous border. It gives
attachment to the interosseous membrane that binds the tibia and the
fibula together.
• The distal end of the tibia widens to assist with weight-
bearing.
• The medial malleolus is a bony projection continuing
inferiorly on the medial aspect of the tibia. It
articulates with the tarsal bones to form part of the
ankle joint. On the posterior surface of the tibia, there
is a groove through which the tendon of tibialis
posterior passes.
• Laterally is the fibular notch, where the fibula is bound
to the tibia – forming the distal tibiofibular joint.
 Fibula
• The fibula is a bone located within the lateral aspect
of the leg. Its main function is to act as an
attachment for muscles, and not as a weight-bearer.
• It has three main articulations:
• Proximal tibiofibular joint – articulates with the
lateral condyle of the tibia.
• Distal tibiofibular joint – articulates with the fibular
notch of the tibia.
• Ankle joint – articulates with the talus bone of the
foot.
 Bones of the foot
• The bones of the foot provide mechanical support for the soft tissues;
helping the foot withstand the weight of the body whilst standing and
in motion.
• They can be divided into three groups:
• Tarsals – a set of seven irregularly shaped bones. They are situated
proximally in the foot in the ankle area.
• Metatarsals – connect the phalanges to the tarsals. There are five in
number – one for each digit.
• Phalanges – the bones of the toes. Each toe has three phalanges –
proximal, intermediate, and distal (except the big toe, which only has
two phalanges). The foot can also be divided up into three regions: (i)
Hindfoot – talus and calcaneus; (ii) Midfoot – navicular, cuboid, and
cuneiforms; and (iii) Forefoot – metatarsals and phalanges.
 Tarsals
• The tarsal bones of the foot are organised into three rows: proximal,
intermediate, and distal.
• Proximal Group (Hindfoot)
• The proximal tarsal bones are the talus and the calcaneus. These
comprise the hindfoot, forming the bony framework around the
proximal ankle and heel.
• Talus
• The talus is the most superior of the tarsal bones. It transmits the
weight of the entire body to the foot. It has three articulations:
• Superiorly – ankle joint – between the talus and the bones of the leg
(the tibia and fibula).
• Inferiorly – subtalar joint – between the talus and calcaneus.
• Anteriorly – talonavicular joint – between the talus and the navicular.
• The main function of the talus is to transmit
forces from the tibia to the heel bone (known as
the calcaneus). It is wider anteriorly compared to
posteriorly which provides additional stability to
the ankle.
• Whilst numerous ligaments attach to the talus, no
muscles originate from or insert onto it. This
means there is a high risk of avascular necrosis as
the vascular supply is dependent on fascial
structures.
• Calcaneus
• The calcaneus is the largest tarsal bone
and lies underneath the talus where it constitutes the heel. It
has two articulations:
• Superiorly – subtalar (talocalcaneal) joint – between the
calcaneus and the talus.
• Anteriorly – calcaneocuboid joint – between the calcaneus
and the cuboid.
• It protrudes posteriorly and takes the weight of the body as
the heel hits the ground when walking. The posterior aspect of
the calcaneus is marked by calcaneal tuberosity, to which the
Achilles tendon attaches.
• The intermediate row of tarsal bones contains one bone, the navicular (given its name
because it is shaped like a boat).
• Positioned medially, it articulates with the talus posteriorly, all three cuneiform bones
anteriorly, and the cuboid bone laterally. On the plantar surface of the navicular, there is
a tuberosity for the attachment of part of the tibialis posterior tendon.
• Distal Group (Midfoot)
• In the distal row, there are four tarsal bones – the cuboid and the three cuneiforms.
These bones articulate with the metatarsals of the foot
• The cuboid is furthest lateral, lying anterior to the calcaneus and behind the fourth and
fifth metatarsals. As its name suggests, it is cuboidal in shape. The inferior (plantar)
surface of the cuboid is marked by a groove for the tendon of fibularis longus.
• The three cuneiforms (lateral, intermediate (or middle) and medial) are wedge shaped
bones. They articulate with the navicular posteriorly, and the metatarsals anteriorly. The
shape of the bones helps form a transverse arch across the foot. They are also the
attachment point for several muscles:
• Medial cuneiform – tibialis anterior, (part of) tibialis posterior and fibularis longus
• Lateral cuneiform – flexor hallucis brevis