1.-Topographical-anatomy-of-the-lower-limb_Lendvai_EM-9-17.pdf

lower limb

1. Topographicalanatomyof the
lowerlimb, gaitmechanism
Ph.D., Dr. Dávid Lendvai

2. Anatomicalaspects Clinical/ practicalaspects
Descriptive Topographic
Osteology,
Syndesmology,
Arthrology,
Myology
Angiology
Neurology
Glutealregion
~ subinguinalis
~ ant. femoral
FemoralTriagon
~ ~ posterior
~ genus anterior
~ ~ posterior
~ cruralisanterior
~ ~ posterior
~ malleolaris medialis
~ malleolaris lateralis
~ retromalleolaris medialis
~ retromalleolaris lateralis
~ calcanea
~ plantaris pedis
~ dorsalis pedis
~ digitorum pedis
Diseasesand injuries
(Symptoms, Syndroms, Diagnostics,
Interventionplanningand intervention)

3. Ventral regions

4. Footshapes

5. Epifascialstructures

6. Dermatomes,cutaneous nerves

7. Femoraltriangle

8. Subinguinalishiatus

9. Ant. femoralregion
Adductorian canal

10. Femoralartery

11. Arteries

12. Ant. and med. cruralregions

13. Cutaneous nerves, palpation

14. Nervesand blood vessels

15. Arteries

16. Dorsalregions

17. podogram

18. EpifascialStructures

19. Dermatomes, cutaneous nerves

20. Gluteal region

21. Gluteal region

22. Greater and lesser sciatic foramen

23. Blood vessels and nerves

24. IM injection

25. Ischio-analfossa
Pudendal canal (Alcock’s canal)

26. Pudendal canal

27. Pudendal region

28. Post. femoralregion

29. Popliteal region

30. Popliteal fossa

31. Arteries

32. Post. cruralregion

33. Compartments

34. Blood supply

35. Tarsal canal

36. Arteries
Most important pulse artery called
ATP in clinics.
Palpating: behind the medial
Malleolus

37. Plantar region

38. Plantar region

39. Clinical aspects

42. Dislocation
(Luxation)

44. Osteoporosis, fracture
pregnancy, substitution of Ca
++
!!!

45. Coxarthrosis, hip replacement

46. Venousdrenaige
Venousreflux conditionedby:
1. Anastomosisbetweene.g. skin-and deep
Veins(Perforanting)
2. Musclepumps
3. Valves
Perforating(e.g.):
1.Dodd
2.Hunter
3.Boyd
4.Sherman
5.Cocket

47. Veins

48. Varicosity

49. Lymphatic vessels
Deep(for Muscles, Tendonsand Joints)
and superficial (for subcutaneoustissuesand skin)
Lymphaticvessels
Below the knee: dorsolateraler and ventromedialer flow
To the sup. and deep popliteallymphnodes
Above theknee: dorsolateraler, dorsomedialer and ventro-
medialer flow
to thesup. and deep inguinallymphnodes

50. Lymphaticflow
Characteristic T-shapeof the inguinal lymphnodes:
Tractus horizontalis (drenaigefrom the outer
genitals,perineum, anal part of the rectum, lower
part of the rectus sheet , abdominal wall below the
navel!!!)
Tractus verticalis (beside the rectus sheetand the
outer genitals: lower limb)
By adults1,5-2 cm large lymph nodes

51. Lymphatic flow
Extreme Lymphoedema:
Elephantiasis

52. Compartment syndrome

53. Deep venomous thrombosis

54. Stenosis, diabetes

55. Innervation
Dermatoms

56. Innervation

57. Walking: ca. 5 million years ago
…
Gaitmechanism

58. The mechanism of walking
Walk Run
Human: bipeder
Quadrupets: quadrupedera) amble
b) cloister
Average walking speed: ~5 km/h = 1,4 m/s
Embrionaland learned elements must work automatically together
Syncroof the ipsi-and kontralateralmovements through the contractionthe
corresponding muscle groups::
Autochtone muclesof the back
Musclesof the upper and lower limbs

59. The mechanism of walking
Walking glides in cycles (gait cycle), which can be divided into phases.
A gait cycle means the repetitive sections of walking.
Phases of the gait cycle: Stance and Swing.

60. Stance phase (about 60% of the gait cycle) is divided into:
1. Weight transfer: from first contact to lifting the other leg
2. Medium stance phase: from standing on the whole foot to raising the heel
3. End phase: the other leg touches the ground
Standingleg: yellow
The mechanism of walking

61. The mechanism of walking
Swing phase (about 40% of the gait cycle) is divided into:
1. Start of swing: the swing leg passes the leg
2. Mid swing (mid swing): the lower leg is verticalabove the ground
3. Final swing: lasts until the heel is put on
Walking leg: yellow

62. The mechanism of walking
Phase of double support: both legs are on the floor
(Overlap between stance and swing phase)
ca. 10% of the walking cycle

63. The mechanism of walking
Muscle and joint activities while walking:
Standing leg:
extension (hip and knee), plantar flexion in the upper ankle joint (flexor hallucis longus muscle)
Swing leg:
Anteflexion in hip and flexion in the knee joint;
at the end dorsiflexion of the upperankle joint (tibialis anterior muscle)
Upper ankle joint is now stabilized by the geometry of the trochlea tali.

64. The mechanism of walking
further events:
1.The lumbar lordosis is strengthened (assisting the hip flexion)
2.Weight transfer from the side of the walking legto the supporting
leg(M. gluteus medius and minimus see „waddle gear")
3.Upper extremities make an opposite pendulum motion