Learning Objectives
- Identify the divisions of the lower limb and describe the bones of each region
- Describe the bones and bony landmarks that articulate at each joint of the lower limb
- Femur
- Patella
- Tibia
- Fibula
- Tarsal Bones
- Metatarsal Bones
- Phalanges
- Arches of the Foot
Like the upper limb, the lower limb is divided into three regions. The
thigh is that portion of the lower limb located between the hip joint and knee joint. The
leg is specifically the region between the knee joint and the ankle joint. Distal to the ankle is the
foot. The lower limb contains 30 bones. These are the femur, patella, tibia, fibula, tarsal bones, metatarsal bones, and phalanges (see Figure 6.51). The
femur is the single bone of the thigh. The
patella is the kneecap and articulates with the distal femur. The
tibia is the larger, weight-bearing bone located on the medial side of the leg, and the
fibula is the thin bone of the lateral leg. The bones of the foot are divided into three groups. The posterior portion of the foot is formed by a group of seven bones, each of which is known as a
tarsal bone, whereas the mid-foot contains five elongated bones, each of which is a
metatarsal bone. The toes contain 14 small bones, each of which is a
phalanx bone of the foot.
Femur
The femur, or thigh bone, is the single bone of the thigh region (Figure 6.51). It is the longest and strongest bone of the body, and accounts for approximately one-quarter of a person’s total height. The rounded, proximal end is the
head of the femur, which articulates with the acetabulum of the hip bone to form the
hip joint.
Figure 6.51. Femur and PatellaThe femur is the single bone of the thigh region. It articulates superiorly with the hip bone at the hip joint, and inferiorly with the tibia at the knee joint. The patella only articulates with the distal end of the femur.
The narrowed region below the head is the
neck of the femur. This is a common area for fractures of the femur. The
greater trochanter is the large, upward, bony projection located above the base of the neck. Multiple muscles that act across the hip joint attach to the greater trochanter, which, because of its projection from the femur, gives additional leverage to these muscles. The greater trochanter can be felt just under the skin on the lateral side of your upper thigh. The
lesser trochanter is a small, bony prominence that lies on the medial aspect of the femur, just below the neck.
The distal end of the femur has medial and lateral bony expansions. On the lateral side, the smooth portion that covers the distal and posterior aspects of the lateral expansion is the
lateral condyle of the femur. The roughened area on the outer, lateral side of the condyle is the
lateral epicondyle of the femur. Similarly, the smooth region of the distal and posterior medial femur is the
medial condyle of the femur, and the irregular outer, medial side of this is the
medial epicondyle of the femur. The lateral and medial condyles articulate with the tibia to form the knee joint. The epicondyles provide attachment for muscles and supporting ligaments of the knee. The
adductor tubercle is a small bump located at the superior margin of the medial epicondyle. Posteriorly, the medial and lateral condyles are separated by a deep depression called the
intercondylar fossa. Anteriorly, the smooth surfaces of the condyles join together to form a wide groove called the
patellar surface, which provides for articulation with the patella bone. The combination of the medial and lateral condyles with the patellar surface gives the distal end of the femur a horseshoe (U) shape.
Interactive Link
Watch this video to view how a fracture of the mid-femur is surgically repaired. How are the two portions of the broken femur stabilized during surgical repair of a fractured femur?
Patella
The patella (kneecap) is largest sesamoid bone of the body (see Figure 6.51). A sesamoid bone is a bone that is incorporated into the tendon of a muscle where that tendon crosses a joint. The sesamoid bone articulates with the underlying bones to prevent damage to the muscle tendon due to rubbing against the bones during movements of the joint. The patella is found in the tendon of the quadriceps femoris muscle, the large muscle of the anterior thigh that passes across the anterior knee to attach to the tibia. The patella articulates with the patellar surface of the femur and thus prevents rubbing of the muscle tendon against the distal femur. The patella also lifts the tendon away from the knee joint, which increases the leverage power of the quadriceps femoris muscle as it acts across the knee. The patella does not articulate with the tibia.
Interactive Link
Visit this site to perform a virtual knee replacement surgery. The prosthetic knee components must be properly aligned to function properly. How is this alignment ensured?
Tibia
The tibia (shin bone) is the medial bone of the leg and is larger than the fibula, with which it is paired (Figure 6.52). The tibia is the main weight-bearing bone of the lower leg and the second longest bone of the body, after the femur. The medial side of the tibia is located immediately under the skin, allowing it to be easily palpated down the entire length of the medial leg.
Figure 6.52. Tibia and FibulaThe tibia is the larger, weight-bearing bone located on the medial side of the leg. The fibula is the slender bone of the lateral side of the leg and does not bear weight.
The proximal end of the tibia is greatly expanded. The two sides of this expansion form the
medial condyle of the tibia and the
lateral condyle of the tibia. The tibia does not have epicondyles. The top surface of each condyle is smooth and flattened. These areas articulate with the medial and lateral condyles of the femur to form the
knee joint. Between the articulating surfaces of the tibial condyles is the
intercondylar eminence, an irregular, elevated area that serves as the inferior attachment point for two supporting ligaments of the knee.
The
tibial tuberosity is an elevated area on the anterior side of the tibia, near its proximal end. It is the final site of attachment for the muscle tendon associated with the patella. More inferiorly, the
shaft of the tibia becomes triangular in shape.
The large expansion found on the medial side of the distal tibia is the
medial malleolus (“little hammer”). This forms the large bony bump found on the medial side of the ankle region. Both the smooth surface on the inside of the medial malleolus and the smooth area at the distal end of the tibia articulate with the talus bone of the foot as part of the ankle joint. On the lateral side of the distal tibia is a wide groove called the
fibular notch. This area articulates with the distal end of the fibula, forming the
distal tibiofibular joint.
Fibula
The fibula is the slender bone located on the lateral side of the leg (see Figure 6.52). The fibula does not bear weight. It serves primarily for muscle attachments and thus is largely surrounded by muscles. Only the proximal and distal ends of the fibula can be palpated.
The
head of the fibula is the small, knob-like, proximal end of the fibula. It articulates with the inferior aspect of the lateral tibial condyle, forming the
proximal tibiofibular joint. The distal end of the fibula forms the
lateral malleolus, which forms the easily palpated bony bump on the lateral side of the ankle. The deep (medial) side of the lateral malleolus articulates with the talus bone of the foot as part of the ankle joint. The distal fibula also articulates with the fibular notch of the tibia.
Tarsal Bones
The posterior half of the foot is formed by seven tarsal bones (Figure 6.53). The most superior bone is the
talus. This has a relatively square-shaped, upper surface that articulates with the tibia and fibula to form the
ankle joint. Inferiorly, the talus articulates with the
calcaneus (heel bone), the largest bone of the foot, which forms the heel. Body weight is transferred from the tibia to the talus to the calcaneus, which rests on the ground. The medial calcaneus has a prominent bony extension called the
sustentaculum tali (“support for the talus”) that supports the medial side of the talus bone.
Figure 6.53. Bones of the FootThe bones of the foot are divided into three groups. The posterior foot is formed by the seven tarsal bones. The mid-foot has the five metatarsal bones. The toes contain the phalanges.
The
cuboid bone articulates with the anterior end of the calcaneus bone. The cuboid has a deep groove running across its inferior surface, which provides passage for a muscle tendon. The talus bone articulates anteriorly with the
navicular bone, which in turn articulates anteriorly with the three cuneiform (“wedge-shaped”) bones. These bones are the
medial cuneiform, the
intermediate cuneiform, and the
lateral cuneiform. Each of these bones has a broad superior surface and a narrow inferior surface, which together produce the transverse (medial-lateral) curvature of the foot. The navicular and lateral cuneiform bones also articulate with the medial side of the cuboid bone.
Interactive Link
Use this
tutorial to review the bones of the foot. Which tarsal bones are in the proximal, intermediate, and distal groups?
Metatarsal Bones
The anterior half of the foot is formed by the five metatarsal bones, which are located between the tarsal bones of the posterior foot and the phalanges of the toes (see Figure 6.53). These elongated bones are numbered 1–5, starting with the medial side of the foot.
Phalanges
The toes contain a total of 14 phalanx bones (phalanges), arranged in a similar manner as the phalanges of the fingers (see Figure 6.53). The toes are numbered 1–5, starting with the big toe (
hallux). The big toe has two phalanx bones, the proximal and distal phalanges. The remaining toes all have proximal, middle, and distal phalanges. A joint between adjacent phalanx bones is called an interphalangeal joint.
Interactive Link
View this link to learn about a bunion, a localized swelling on the medial side of the foot, next to the first metatarsophalangeal joint, at the base of the big toe. What is a bunion and what type of shoe is most likely to cause this to develop?
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