Which is the proximal bone of the lower limb

When the weight is removed, the elastic ligaments recoil and pull the ends of the arches closer together. This recovery of the arches releases the stored energy and improves the energy efficiency of walking. Stretching of the ligaments that support the longitudinal arches can lead to pain. This can occur in overweight individuals, with people who have jobs that involve standing for long periods of time such as a waitress , or walking or running long distances.

If stretching of the ligaments is prolonged, excessive, or repeated, it can result in a gradual lengthening of the supporting ligaments, with subsequent depression or collapse of the longitudinal arches, particularly on the medial side of the foot. The lower limb is divided into three regions. These are the thigh, located between the hip and knee joints; the leg, located between the knee and ankle joints; and distal to the ankle, the foot.

There are 30 bones in each lower limb. These are the femur, patella, tibia, fibula, seven tarsal bones, five metatarsal bones, and 14 phalanges. Its rounded head articulates with the acetabulum of the hip bone to form the hip joint.

The head has the fovea capitis for attachment of the ligament of the head of the femur. The narrow neck joins inferiorly with the greater and lesser trochanters. Passing between these bony expansions are the intertrochanteric line on the anterior femur and the larger intertrochanteric crest on the posterior femur. On the posterior shaft of the femur is the gluteal tuberosity proximally and the linea aspera in the mid-shaft region. The expanded distal end consists of three articulating surfaces: the medial and lateral condyles, and the patellar surface.

The outside margins of the condyles are the medial and lateral epicondyles. The adductor tubercle is on the superior aspect of the medial epicondyle. The patella is a sesamoid bone located within a muscle tendon.

It articulates with the patellar surface on the anterior side of the distal femur, thereby protecting the muscle tendon from rubbing against the femur. The leg contains the large tibia on the medial side and the slender fibula on the lateral side. The tibia bears the weight of the body, whereas the fibula does not bear weight.

The interosseous border of each bone is the attachment site for the interosseous membrane of the leg, the connective tissue sheet that unites the tibia and fibula. The proximal tibia consists of the expanded medial and lateral condyles, which articulate with the medial and lateral condyles of the femur to form the knee joint.

Between the tibial condyles is the intercondylar eminence. On the anterior side of the proximal tibia is the tibial tuberosity, which is continuous inferiorly with the anterior border of the tibia.

On the posterior side, the proximal tibia has the curved soleal line. The bony expansion on the medial side of the distal tibia is the medial malleolus.

The groove on the lateral side of the distal tibia is the fibular notch. The head of the fibula forms the proximal end and articulates with the underside of the lateral condyle of the tibia. The distal fibula articulates with the fibular notch of the tibia. The expanded distal end of the fibula is the lateral malleolus.

The posterior foot is formed by the seven tarsal bones. The talus articulates superiorly with the distal tibia, the medial malleolus of the tibia, and the lateral malleolus of the fibula to form the ankle joint. The talus articulates inferiorly with the calcaneus bone. The sustentaculum tali of the calcaneus helps to support the talus. Anterior to the talus is the navicular bone, and anterior to this are the medial, intermediate, and lateral cuneiform bones.

The cuboid bone is anterior to the calcaneus. The five metatarsal bones form the anterior foot. The base of these bones articulate with the cuboid or cuneiform bones. The metatarsal heads, at their distal ends, articulate with the proximal phalanges of the toes.

The big toe toe number 1 has proximal and distal phalanx bones. The remaining toes have proximal, middle, and distal phalanges. A hole is drilled into the greater trochanter, the bone marrow medullary space inside the femur is enlarged, and finally an intramedullary rod is inserted into the femur.

This rod is then anchored to the bone with screws. Metal cutting jigs are attached to the bones to ensure that the bones are cut properly prior to the attachment of prosthetic components. The proximal group of tarsal bones includes the calcaneus and talus bones, the navicular bone is intermediate, and the distal group consists of the cuboid bone plus the medial, intermediate, and lateral cuneiform bones.

A bunion results from the deviation of the big toe toward the second toe, which causes the distal end of the first metatarsal bone to stick out. A bunion may also be caused by prolonged pressure on the foot from pointed shoes with a narrow toe box that compresses the big toe and pushes it toward the second toe. Define the regions of the lower limb, name the bones found in each region, and describe the bony landmarks that articulate together to form the hip, knee, and ankle joints.

The thigh is the region located between the hip and knee joints. It contains the femur and the patella. The hip joint is formed by the articulation between the acetabulum of the hip bone and the head of the femur. The leg is the region between the knee and ankle joints, and contains the tibia medially and the fibula laterally. The knee joint is formed by the articulations between the medial and lateral condyles of the femur, and the medial and lateral condyles of the tibia.

Also associated with the knee is the patella, which articulates with the patellar surface of the distal femur. The foot is found distal to the ankle and contains 26 bones. The ankle joint is formed by the articulations between the talus bone of the foot and the distal end of the tibia, the medial malleolus of the tibia, and the lateral malleolus of the fibula.

The posterior foot contains the seven tarsal bones, which are the talus, calcaneus, navicular, cuboid, and the medial, intermediate, and lateral cuneiform bones. The anterior foot consists of the five metatarsal bones, which are numbered 1—5 starting on the medial side of the foot.

The toes contain 14 phalanx bones, with the big toe toe number 1 having a proximal and a distal phalanx, and the other toes having proximal, middle, and distal phalanges. The talus bone of the foot receives the weight of the body from the tibia. The talus bone then distributes this weight toward the ground in two directions: one-half of the body weight is passed in a posterior direction and one-half of the weight is passed in an anterior direction.

Describe the arrangement of the tarsal and metatarsal bones that are involved in both the posterior and anterior distribution of body weight. The talus bone articulates superiorly with the tibia and fibula at the ankle joint, with body weight passed from the tibia to the talus. Body weight from the talus is transmitted to the ground by both ends of the medial and lateral longitudinal foot arches.

Weight is passed posteriorly through both arches to the calcaneus bone, which forms the heel of the foot and is in contact with the ground. On the medial side of the foot, body weight is passed anteriorly from the talus bone to the navicular bone, and then to the medial, intermediate, and lateral cuneiform bones. The cuneiform bones pass the weight anteriorly to the first, second, and third metatarsal bones, whose heads distal ends are in contact with the ground.

On the lateral side, body weight is passed anteriorly from the talus through the calcaneus, cuboid, and fourth and fifth metatarsal bones. The talus bone thus transmits body weight posteriorly to the calcaneus and anteriorly through the navicular, cuneiform, and cuboid bones, and metatarsals one through five.

Skip to content The Appendicular Skeleton. Learning Objectives By the end of this section, you will be able to: 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 The femur, or thigh bone, is the single bone of the thigh region [link]. Femur and Patella. The 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. Patella The patella kneecap is largest sesamoid bone of the body see [link].

Homeostatic Imbalances. The Q-angle is a measure of the amount of lateral deviation of the femur from the vertical line of the tibia. Adult females have a larger Q-angle due to their wider pelvis than adult males. Tibia and Fibula. The 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.

Fibula The fibula is the slender bone located on the lateral side of the leg see [link]. The elongated shaft of the femur has a slight anterior bowing or curvature. At its proximal end, the posterior shaft has the gluteal tuberosity , a roughened area extending inferiorly from the greater trochanter.

This is the roughened ridge that passes distally along the posterior side of the mid-femur. Multiple muscles of the hip and thigh regions make long, thin attachments to the femur along the linea aspera. 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. 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?

The patella kneecap is largest sesamoid bone of the body see Figure 1. 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. Figure 2. The Q-Angle. The Q-angle is a measure of the amount of lateral deviation of the femur from the vertical line of the tibia. Adult females have a larger Q-angle due to their wider pelvis than adult males. It is most frequent in adolescents and young adults, and is more common in females. It often results from excessive running, particularly downhill, but may also occur in athletes who do a lot of knee bending, such as jumpers, skiers, cyclists, weight lifters, and soccer players.

It is felt as a dull, aching pain around the front of the knee and deep to the patella. The pain may be felt when walking or running, going up or down stairs, kneeling or squatting, or after sitting with the knee bent for an extended period.

Patellofemoral syndrome may be initiated by a variety of causes, including individual variations in the shape and movement of the patella, a direct blow to the patella, or flat feet or improper shoes that cause excessive turning in or out of the feet or leg. These factors may cause in an imbalance in the muscle pull that acts on the patella, resulting in an abnormal tracking of the patella that allows it to deviate too far toward the lateral side of the patellar surface on the distal femur.

Because the hips are wider than the knee region, the femur has a diagonal orientation within the thigh, in contrast to the vertically oriented tibia of the leg Figure 2. The Q-angle is a measure of how far the femur is angled laterally away from vertical.

The Q-angle is normally 10—15 degrees, with females typically having a larger Q-angle due to their wider pelvis. During extension of the knee, the quadriceps femoris muscle pulls the patella both superiorly and laterally, with the lateral pull greater in women due to their large Q-angle. This makes women more vulnerable to developing patellofemoral syndrome than men. Normally, the large lip on the lateral side of the patellar surface of the femur compensates for the lateral pull on the patella, and thus helps to maintain its proper tracking.

However, if the pull produced by the medial and lateral sides of the quadriceps femoris muscle is not properly balanced, abnormal tracking of the patella toward the lateral side may occur. With continued use, this produces pain and could result in damage to the articulating surfaces of the patella and femur, and the possible future development of arthritis. Treatment generally involves stopping the activity that produces knee pain for a period of time, followed by a gradual resumption of activity.

Proper strengthening of the quadriceps femoris muscle to correct for imbalances is also important to help prevent reoccurrence. The tibia shin bone is the medial bone of the leg and is larger than the fibula, with which it is paired Figure 3. 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 3. Tibia and Fibula. The 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 anterior apex of this triangle forms the anterior border of the tibia , which begins at the tibial tuberosity and runs inferiorly along the length of the tibia.

The femur is the longest, strongest and heaviest of the bones in the human body. The proximal end of the femur carries the greater and lesser trochanters. The greater trochanter is the insertion point of gluteus minimus and gluteus medius muscles, which help to abduct move away and medially inwardly rotate the thigh at the hip. The lesser trochanter is the insertion of the iliopsoas tendon, iliacus muscle and psoas major muscles which flex the thigh at the hip.

The head of the femur fits into the acetabulum of innominate bone of the pelvis. Proximal section of right femur showing an old intertrochanteric fracture of neck of femur which has been operatively repaired using a dynamic hip screw. The femoral neck is the most common site for fracture of the leg in older women. In living patients, lower extremity bowing can be due to several others factors, ranging from developmental bowing, to tibia vara Blount disease or achondroplasia, and clinical diagnosis alongside x-rays can differentiate between the diagnoses.

The epiphysis of the fibula shows erosion of the cortical bone, and a large mass of expansive calcification. The contours of the fibular head are completely destroyed. Possible chondrosarcoma. Anterior view of an adult fractured tibia and corresponding fibula. The tibia displays an oblique healed fracture in the distal third segment, with angulation and callus the new tissue formed during the healing process around the margins of the broken bone.

The process of bone remodelling in an adult can take several months. The two bones are articulated through the connecting ligaments. Skeletal specimen of an adult deformed foot which shows the effects of foot binding. The foot and the lower part of the leg bones fibula and tibia are present. The ligaments and tendons are also preserved. The practice was formally banned in This specimen allows the observation of the effects of the procedure- the very acute angle between the metatarsals and calcaneus, as well as the inward folding of the toes, under the sole of the foot.

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