Muscle Origin Insertion Action Innervation Vascular Supply Relations Notes / Function

Pelvic Region, Gluteal Region & Hip Joint

Muscles of the Iliac Region

Upper part - lumbar  Roots of lumber plexus Muscle descends along the pelvic
arteries are lodged within brim, continues posterior to the
PSOAS Major & inguinal ligament and anterior to
Mid part by the branches emerge from the capsule of the hip joint, and
its borders and
Lateral surface of bodies anterior branch of the converges to a tendon (along with
surfaces
of T12 and L1-L5
Flexion of thigh at hip
iliolumbar artery  Upper limit posterior to iliacus)
vertebrae, transverse (the main artery to diaphragm in its lowest
Lesser trochanter of joint (Psoas major acts Ventral rami of the  Long muscle that lies on either
processes of the lumbar part
the femur (via a together with iliacus; the the muscle; branch side of the lumbar vertebral
vertebrae, and the lumbar spinal nerves,  Anteriorly, right psoas is
tendon, which, having combination is referred of posterior trunk of overlapped by inferior column and the pelvic brim
PSOAS Major intervertebral discs mainly L1 and 2 with
received on its lateral to as iliopsoas) internal iliac artery) vena cava & crossed by  Intervertebral foramina lie
between T12 and L1-L5 some contribution
side nearly all the with contributions end of ileum anterior to transverse processes
vertebrae (5 digitations from L3.
fibres of iliacus) Active in balancing the & posterior to attachment to
each from bodies of from the deep
trunk while sitting vertebral bodies, discs, and
adjoining vertebrae and circumflex and
interposed disc) external iliac arteries tendinous arches

- distal part - femoral

artery and its
branches

Ends in a long, flat Lies anterior to psoas major, Absent in almost 40% of subjects
Arises from the sides of tendon which is Potential a weak flexor entirely within the abdomen
the bodies of the T12
attached to the Pecten of the trunk (lumbar Lumbar arteries (with
pubis (Pectineal line vertebral column) minor contribution from
PSOAS Minor and L1 vertebrae and Anterior Rami of L1
of pelvic brim) and other vessels of network
from the intervertebral iliopubic ramus and, Acts on spine and supply psoas muscle)
disc between them laterally, to the iliac sacroiliac joint
fascia.

Iliacus Superior two-thirds of Most of its fibres Flexion of thigh at hip Br. of Femoral Nerve Iliac branches of the Anterior surface – fascia In Thigh, anterior surface in
concavity of iliac fossa, converge into the joint (Psoas major acts (L2, L3) iliolumbar artery (which seperates the contact with fascia lata, rectus
anterior sacroiliac and lateral side of the together with iliacus; the (main supply), with
iliolumbar ligaments, and muscle from femoris, Sartorius, & profunda
strong tendon of psoas combination is referred contributions from the
upper lateral surface of extraperitoneal tissue and femoris artery; posterior surface
sacrum major, then insert to as iliopsoas) deep circumflex iliac &
peritoneum), lateral in contact with hip joint
together into the obturator arteries, and
Flexes thigh upon the femoral cutaneous nerve,
lesser trochanter branches of the femoral
caecum (on right) & iliac
 part of descending colon
(on left)
artery
Posterior surface – iliac
pelvis Same arterial network fossa
as psoas major
Medial border - Psoas
major and femoral nerve

Muscles of the Gluteal Region

Deep Group

Muscle passes out of Occupies central position in the

pelvis through greater buttock, where it lies in same
sciatic foramen (which it plane as gluteus medius
Anterior surface of subsequently fills)
In Buttock - Constitutes an important
sacrum by three Medial side of Superior gluteal Anterior surface of surgical landmark for
digitations between superior border of artery (mainly), with piriformis is related to the structures that emerge above
anterior pelvic sacral greater trochanter contributions from rectum (especially on the and below it within sciatic
foramina (middle three of femur (via Laterally rotates the gemellar branches of left), the sacral plexus of foramen
pieces of the sacrum) rounded tendon extended femur at hip internal pudendal; nerves and branches of
Piriformis can occasionally cause
Gluteal surface of ilium lying above and joint Nerve to Piriformis May be a separate the internal iliac vessels
Piriformis entrapment of the sciatic nerve
near PIIS (at margin of below it, but is often ((L5), S1, S2) branch from the
Abducts flexed femur at
greater sciatic notch), partially blended inferior gluteal artery Variable relation to sciatic in the buttock, giving rise to the
hip joint nerve; (the most common so-called ‘piriformis syndrome’
from capsule of adjacent with, the common
tendon of obturator In Pelvis – Lateral variant) one division
sacroiliac joint and
internus and the sacral artery, with passes between the heads In the embryo the inferior
sometimes from upper gluteal artery supplied the main
contributions from of a divided muscle and
part of pelvic surface of gemelli)
both gluteal vessels one division either above axial artery of the limb, which is
sacrotuberous ligament represented in the adult by the
or below.
arteria comitans nervi
ischiadici (artery to the sciatic
nerve)

Obturator Arises from the Tendon ends in the Lateral rotator of the Posterior branch of the Obturator artery & The short rotators cannot be
Externus anteromedial two-thirds trochanteric fossa extended thigh and an obturator nerve (L3, L4) medial circumflex tested individually, but external
of the external surface of abductor of the flexed rotation of the extended hip and
the obturator membrane,

and from the adjacent
bone of the pubic and
ischial rami, extending for
a short distance onto their
of the femur
pelvic surfaces between the
margin of the obturator
foramen and the obturator
membrane
Anterolateral wall of true
pelvis; deep surface of
obturator membrane and
surrounding bone (inferior
ramus of the pubis, the
ischial ramus, and the
pelvic surface of the hip
bone below and behind
the pelvic brim, to the
upper part of the greater
sciatic foramen above and
Obturator
behind, to the obturator
Internus
foramen below and in front
& the medial part of the
pelvic surface of the
obturator membrane,
from the tendinous arch
that completes the
obturator canal, and, to a
small extent, from the
obturator fascia that covers
the muscle)
Gemellus Gemellus superior, the
Superior smaller of the two gemelli,
arises from the dorsal
surface of the ischial
spine, blends with the
thigh abduction of the flexed hip
against resistance tests them as
Short muscles around
a group.
the hip joint, pectineus,
piriformis, obturators,
gemelli and quadratus
femoral artery
femoris, are more
important as postural
muscles than as prime
movers
Fibres converge towards the
lesser sciatic foramen and
end in four or five tendinous
bands on the deep surface of
the muscle. These bands
make a lateral right-angled
turn around the grooved
surface of the ischium
Gemelli fuse with this
Extrapelvic part - between its spine and
tendon before it inserts
Gemellar branches of tuberosity. The grooved
into an anterior Nerve to obturator
Lateral rotator of the the internal pudendal surface is covered with a
impression on the internus, (L5, S1)
extended thigh artery smooth layer of hyaline
medial surface of the
cartilage and is separated
greater trochanter Abducts of the flexed Iintrapelvic part - from the tendon by a bursa:
anterosuperior to the thigh obturator artery ridges on the surface
trochanteric fossa
correspond to furrows
between the tendinous
bands
 Crossed posteriorly by
the sciatic nerve and
passes behind the hip
joint
Inserts with it into Lateral rotator of the Nerve to obturator Internal pudendal  It is sometimes absent.
the medial surface of extended thigh and an internus, (L5, S1, S2) artery and its  The two gemelli can be
the greater abductor of the flexed gemellar branches; regarded as accessory
trochanter. thigh to obturator internus
inferior gluteal and
sometimes also by the
 superior gluteal
upper border of the tendon artery.
of obturator internus

It blends with the

Arises from the upper part
lower border of
of the lateral surface of
obturator internus
the ischial tuberosity, Nerve to quadratus Medial circumflex
Gemellus tendon, and inserts
Inferior immediately below the femoris (L4-5, S1) femoral artery
with it into the
groove for the tendon of
medial surface of the
obturator internus.
greater trochanter.

Inserts into a small Inferior gluteal Flat, quadrilateral muscle It may be absent
tubercle a little artery (superficial lying between Gemellus
above the middle of inferior and the upper
Upper part of the surface) & medial
margin of adductor magnus,
the trochanteric Lateral rotation of Nerve to quadratus circumflex femoral
Quadratus external aspect of the from which it is separated by
Femoris crest of the femur the thigh femoris, L5 and S1 artery (superficial
ischial tuberosity the transverse branch of the
and into the bone for and deep surface) medial circumflex femoral
a short distance artery
below

Superficial Group

Tensor Fasciae Anterior 5 cm of the It descends Acting through the Superior gluteal Large ascending Fascia surrounding the Iliotibial tract - upper end of
Latae outer lip of the iliac between, and is iliotibial tract, extends nerve, L4, 5 and S1 branch of the lateral muscle is supplied on its the tract splits to enclose tensor
crest, from the lateral attached to, the two the knee with lateral circumflex femoral superficial aspect by the fasciae latae and the superficial
surface of the anterior layers of the rotation of the leg artery superficial circumflex iliac layer is attached to the iliac
superior iliac spine and iliotibial tract of the artery and on its deep crest. Three-quarters of gluteus
part of the border of fascia lata and surface by the lateral maximus is inserted into it. The
the notch below it, usually ends Superior part of the circumflex femoral artery. tract passes vertically down and
between gluteus medius approximately one- muscle receives is inserted into Gerdy’s
and sartorius, and from third of the way branches from the tubercle, a smooth circular
the deep surface of the down the thigh, superior gluteal facet on the lateral condyle of
fascia lata. Proximal although it may artery the tibia. When the knee is
attachments may extend occasionally extend straight the tract passes in front
to the aponeurotic fascia as far as the lateral of the axis of flexion. Thus it
superficial to gluteus femoral condyle maintains the knee in the
medius hyperextended position while
 the quadriceps is relaxed and the
patella freely mobile.

(3/4 of muscle) Bilaminar muscle with Largest & most superficial

Ends in a thick overlying adipose fascia – muscle of gluteal region
Posterior gluteal line of tendinous lamina forms familiar
the ilium, and the which passes lateral prominence of the
rough area of bone, to the greater buttock Test - Extension of the hip
including the crest, trochanter and is against resistance, in the supine
immediately above and attached to the Powerful extensor of
Inferior gluteal or prone position
behind it; from the posterior aspect of artery (dominant
flexed femur at hip
aponeurosis of erector iliotibial tract of the vascular pedicle) –
joint;
spinae; the dorsal fascia lata Inferior gluteal nerve, two-thirds of the
Gluteus muscle
surface of the lower Lateral stabilizer of (L5 & S1, S2)
Maximus (¼ of muscle)
part of the sacrum and Deeper fibres of the hip joint and knee
Superior gluteal
the side of the coccyx; joint; laterally rotates
lower part of the artery – one-third of
the sacrotuberous and abducts thigh
muscle are attached muscle
ligament; and the to the gluteal
fascia (gluteal tuberosity of
aponeurosis) which proximal femur
covers gluteus medius between vastus
lateralis and
adductor magnus

Rises from the outer Fibres converge to a Acting from the pelvis - Superior gluteal
surface of the ilium flat tendon that abduct the thigh, and Deep branch of the
nerve (L4-5 S1)
between the iliac crest attaches to a ridge their anterior fibres superior gluteal
and posterior gluteal that slants rotate it medially. artery
Gluteus Medius line above, and the downwards and
Acting from the femur -
anterior gluteal line forwards on the Distal part –
below, and also from the lateral surface of play an essential part trochanteric
strong fascia superficial the greater in maintaining the anastomosis
to its upper part. trochanter. trunk upright when
the foot of the
opposite side is
Gluteus Arises from the outer Fibres converge Main trunk and the Lies deep to Gluteus Trendelenburg's sign - in
raised from the
Minimus surface of the ilium below to the deep deep branch of the medius paralysis of the glutei, congenital
ground in walking
between the anterior surface of an superior gluteal dislocation of the hip, or coxa
 aponeurosis that vara, the supporting mechanism
ends in a tendon is upset and the pelvis sinks on
which is attached to the unsupported side when the
an anterolateral patient tries to stand on the
artery, with a
and inferior gluteal ridge (elongate affected limb
contribution at its
lines and, behind, from facet on lateral
femoral attachment
the margin of the surface) on the
and running from the trochanteric
greater sciatic notch greater trochanter
anastomosis
and contributes an
expansion to the
capsule of the hip
joint

Muscle Origin Insertion Action Innervation Vascular Supply Relations Notes / Function

Thigh & Knee

FEMORAL SHEATH - femoral vessels, passing beneath the inguinal ligament, draw around themselves a funnel-shaped prolongation of the transversalis fascia in front and the psoas fascia behind. This
prolongation of fascia, the femoral sheath, fuses with the adventitia of the artery and vein about 3 cm distal to the inguinal ligament

The femoral canal is widest at its abdominal end, where its opening, the FEMORAL RING, has four boundaries. Anteriorly lies the medial part of the inguinal ligament, medially the crescentic edge of the
lacunar ligament, posteriorly the pectineal ligament and laterally the femoral vein

Saphenous opening - aperture (oblique space) in the deep fascia, inferolateral to the medial end of the inguinal ligament, which allows passage to the long saphenous vein and other smaller vessels.

 Cribriform fascia, which is pierced by these structures, fills in the aperture and must be removed to reveal it. Adjacent subsidiary openings may exist to transmit venous tributaries
 Covered in by a loose fascia attached laterally to the falciform edge and medially to the fascia lata where it lies over adductor longus

FASCIA LATA - wide deep fascia of the thigh, is thicker in the proximal and lateral parts of the thigh

Over the flattened lateral surface of the thigh, the fascia lata thickens to form a strong band, the ILIOTIBIAL TRACT. The upper end of the tract splits into two layers, where it encloses and anchors tensor
Fasciae Latae and receives, posteriorly, most of the tendon of Gluteus Maximus. Distally, the iliotibial tract is attached to a smooth, triangular facet (Gerdy's tubercle) on the anterolateral aspect of the
lateral condyle of the tibia where it is superficial to, and blends with, an aponeurotic expansion from Vastus Lateralis.
Anterior (Extensor) Compartment
Sartorius is a narrow strap muscle; longest muscle in the
body

Femoral Triangle – depressed, intermuscular space in the

Draws lower limb anteromedial aspect of the proximal thigh, lying immediately
Muscle fibres into the sitting distal to the inguinal ligament
terminate at the Taylor’s position
- (Laterally) medial border of Sartorius crossing thigh
medial side of the (thigh flexed,
obliquely, medial border of adductor longus (on
knee, and a thin, laterally rotated and
medial side) and the inguinal ligament;
flattened tendon abducted, knee - Floor of the triangle is gutter-shaped and the hollow
Arises by
curves obliquely flexed) can be seen when the thigh is flexed. The femoral
tendinous fibres
forwards and nerve and vessels lie in the gutter. The muscles lying
from the Anterior Flexes and laterally
expands into a Branch from anterior in the floor of the femoral triangle are the iliacus &
Superior Iliac rotates the hip joint Muscular branches
Sartorius broad aponeurosis division of Femoral psoas major (laterally), and pectineus and adductor
Spine (ASIS) and and flexes the knee of femoral artery
which is attached to nerve (L2-4) longus (medially)
the upper half of
the proximal part - Roof is overlying fascia lata
the notch below
of the medial - Femoral vessels passing from midbase to apex
it.
surface of the tibia Together with - Femoral nerve lies laterally to femoral artery and
in front of gracilis inversion of the foot, outside femoral sheath; fat and lymph nodes also
and semitendinosus, these movements present
together forming the bring the sole of the
Sartorius crosses thigh obliquely on fascial roof of
‘pes anserinus' foot into direct view
adductor canal
Act on both hip and
In some cases sartorius is absent, while in others the muscle
knee joints
may possess an extra head

Quadriceps Femoris – Rectus Femoris, Vastus Medialis, Lateralis & Intermedius

- Great extensor muscle of the leg, covers almost all of the front and sides of the femur. It can be divided into four parts, each named individually
- Tendons of the four components of quadriceps unite in the lower part of the thigh to form a single strong tendon attached to the base of the patella, and some fibres continue over it to blend with the
patellar tendon
- Patellar tendon, which extends from the patellar apex to the tuberosity of the tibia, is the continuation of the main tendon. The medial and lateral patellar retinacula are expansions from its borders
- Suprapatellar bursa & deep infrapatellar bursa
- Single branch of either the profunda femoris or of the lateral circumflex femoral, the ‘artery of the quadriceps'
- Quadriceps femoris extends the knee.
 Straight Head: Helps to flex the thigh Capsule of the hip joint, Fusiform
straight tendon on the pelvis vastus intermedius, the
anterior borders of vasti Bipennate superficial fibres and
arises from the
Assists iliopsoas in lateralis and medius, the parallel deep fibres
upper half of
flexing the pelvis on lateral circumflex femoral
anterior inferior 2 heads unite at an angle to form
the thigh. Rectus can artery and some branches
iliac spine (AIIS) anterior lamina of quadriceps
flex the hip and 2 main pedicles: of the femoral nerve all lie
above the and spread into an aponeurosis
Base of patella to extend the knee superior and inferior deep to rectus femoris.
iliofemoral that is prolonged downwards on
form superficial simultaneously both arising from the
ligament Femoral nerve, ‘artery of quadriceps’ the anterior surface of the
Rectus Femoris central portion of Pulls the patella muscle: the muscular fibres arise
Reflected Head: a quadriceps femoris along the line of the (L2-4) lateral circumflex from this aponeurosis; fibres
thinner, flatter tendon mechanical axis of femoral artery end in a broad, thick
reflected tendon
the lower limb (i.e. (ascending branch) aponeurosis that forms over the
from a groove
the line connecting the lower two-thirds of its posterior
above the
centres of the hip, surface
acetabulum and
knee, and ankle)
from the fibrous
capsule of the hip Act on both hip and
joint knee joints

Vastus Medialis Arises from the Medial base and Extends the leg at the Femoral nerve, (Superficial) Vastus Medialis Obliquus – distinction by some authors of the fibres that
originate largely from the tendon of adductor magnus and insert into the
lower part of the border of patella; knee and draws the Femoral artery,
intertrochanteric also forms the medial patella medially (L2-4) profunda femoris
medial border of the patella. It plays an important role in the function of
patellofemoral joint
line, spiral line, patellar retinaculum artery, and superior
medial lip of the and medial side of medial genicular - Counters lateral vector during knee motion
linea aspera, quadriceps femoris branch of popliteal
proximal part of tendon artery Adductor (Subsartorial & Hunter’s) canal - gutter-shaped
the medial groove between vastus medialis and the front of the
supracondylar adductor muscles, below the apex of the femoral triangle
line, the tendons - Femoral artery & vein
of adductor - Saphenous nerve
longus and - Nerve to Vastus Medialis
magnus below the - Adductor longus & magnus form floor
hiatus for the
femoral vessels, Factors preventing lateral displacement of the patella -
and the medial Forward prominence of the lateral condyle of the femur, the
intermuscular tension of the medial patellar retinaculum, most importantly
septum the lowest fibres of vastus medialis, inserted into the
 border of the bone, hold the patella medially when the
quadriceps contracts

Arises by broad Separated from vastus Largest component of

Attached to the
aponeurosis from intermedius by branches Quadriceps femoris
base and lateral
the upper part of of the femoral nerve and
border of the
the the lateral circumflex
patella and blends
intertrochanteric femoral artery. Posteriorly lateral intermuscular septum
into the compound
line, the anterior it is separated from is a strong layer extending from
quadriceps femoris Extends the leg at the Lateral circumflex
and inferior biceps femoris by the the deep surface of the iliotibial
tendon. It femoral, ‘artery of the
borders of the knee and draws the Femoral nerve, lateral intermuscular tract to the linea aspera of the
Vastus Lateralis contributes an patella laterally quadriceps’, 1st
greater trochanter, (L2-4) septum. femur. Vastus Lateralis lies in
expansion to the perforating branch
the lateral lip of front and the short head of
capsule of the knee of profunda femoris
the gluteal biceps femoris behind it
joint which descends
tuberosity, and
to the lateral condyle
the proximal half
of the tibia and
of the lateral lip
blends with the
of the linea
iliotibial tract.
aspera

Anterior and Fibres end on the anterior

lateral surfaces of Lateral artery of surface of the muscle in
the upper two- Attached to the supply, which arises an aponeurosis which
thirds of the lateral border of from the ‘artery of the forms the deep part of the
Extends the leg at the Femoral nerve,
Vastus Intermedius femoral shaft and the patella and the quadriceps', and a quadriceps tendon
knee (L2-4)
from the lower lateral condyle of medial artery that
part of the the tibia arises directly from
intermuscular the profunda femoris
septum

Articularis Genu Anterior surface of Upper convexity of Retracts the synovial Femoral nerve,
the lower femoral the Suprapatellar suprapatellar bursa
shaft deep to V. bursa proximally during (L2-4)
Intermedius extension of the leg,
presumably to prevent
interposition of
redundant synovial
 folds between patella
and femur

Posterior (Flexor) Compartment

Hamstring Muscles – all arise from the ischial tuberosity and inserted into the tibia or fibula

Profunda femoris (and its perforating branches) mainly & blood supply of the upper part of the hamstrings is derived from the inferior gluteal artery and that of the lower part from the popliteal artery,;
These and the perforating branches of the profunda femoris form a series of anastomoses along the back of the thigh. The highest is the cruciate anastomosis.

Biceps Femoris Long Head - Via Lateral Flexes the knee, and Sciatic Nerve (L5, S1, Long Head - Long head forms a Occupies a posterolateral
inferomedial Hamstring tendon also rotates the tibia S2); long head through Profunda femoris fusiform belly that position in the thigh
impression on the whose main part laterally when knee is tibial division & short (1st & 2nd descends laterally across
upper area of the splits round the semi-flexed; long head head by common fibular perforating the sciatic nerve. The
ischial tuberosity fibular collateral also extends the hip division branches) fibres end in an Tendon of biceps can be felt at
via a shared tendon ligament and is joint aponeurosis, which popliteal fossa when the knee is
with inserted into the covers the posterior flexed against resistance
semitendinosus, head of the fibula When the hip is surface of the muscle.
extended, biceps is a Short head
and from the lower -superiorly by the 2nd This aponeurosis receives
part of the lateral rotator of the on its deep surface the
thigh or 3rd perforating
sacrotuberous artery and inferiorly fibres of the short head,
ligament. by the lateral and gradually narrows to
superior genicular a tendon (the lateral
Short Head - hamstring)
lateral lip of the artery.
linea aspera,
between adductor
magnus and vastus
lateralis. This
attachment extends
proximally almost
to gluteus maximus
and distally along
the lateral
supracondylar line
to within 5 cm of
the lateral femoral
condyle, and from
 the lateral
intermuscular
septum.

Extends the thigh, Superior - Medial Semitendinosus lies on Lies Posterormedial in the thigh
Tendon of flexes the knee, and circumflex femoral semimembranosus
semitendinosus also rotates the tibia or 1st perforating throughout its length
passes behind the medially, especially artery At its termination it is united
medial condyle of the when the knee is flexed with the tendon of gracilis and
Inferomedial femur, then passes gives off a prolongation to the
impression on the over medial Inferior – 1st deep fascia of the leg and to the
upper area of the collateral ligament of perforator distal to medial head of gastrocnemius
Sciatic Nerve (L5, S1,
ischial tuberosity, the knee joint to be origin of the superior
Semitendinosus inserted behind When the hip is S2) through its tibial
by a tendon it branch
gracilis into the extended, division
shares with the
long head of upper part of the semitendinosus &
biceps femoris medial surface of semimembranosus are
the shaft of the tibia lateral rotators of the Accessory supply –
distal to insertion thigh inferior gluteal artery
of gracilis (ischial attachment)
and medial inferior
genicular artery
(tibial attachment)

Semimembranosus Arises from a long, 2nd Aponeurosis Sciatic Nerve (L5, S1, Perforating Arteries From its insertion three
flat tendon from a tapers to the heavy, S2) through its tibial (Usually from all) expansions diverge. One
superolateral rounded tendon of division passes forwards along the
impression on the the distal attachment medial surface of the
ischial tuberosity that divides at the Branch of femoral or condyle deep to the tibial
(above the part level of the knee into popliteal arties collateral ligament of
that bears weight) five components. The supplies distal part of the knee, separated from
main one is attached muscle it by a bursa. A second
to a horizontal expansion passes
concavity obliquely upwards to the
(sometimes called lateral femoral condyle as
the tuberculum the oblique popliteal
tendinis) on the ligament, while the third
posterior aspect of forms a strong fascia
 the medial tibial overlying popliteus and
condyle. The others reaches the soleal line of
are: a series of slips the tibia.
to the medial
margin of the tibia,
directly behind the
medial collateral
ligament

Medial (Adductor) Compartment

All five muscles cross the hip joint, but only gracilis reaches beyond the knee

Collectively as the adductors of the thigh, although their actions are more complex than this, e.g. acting from below they have important roles in balancing the trunk on the lower limb during walking

The adductor mass of muscles, though large, is less important in the prime movement of adduction than in synergic activities associated with posture and gait.
Arises from the Flat quadrangular muscle in the
pectin pubis, from femoral triangle
Fibres descend,
narrow area of
initially Pectineus may be bilaminar, in
bone in front of it
posteromedially and which case the two layers
between the Pectineus adducts Femoral nerve (L2-3)
then posterolaterally Medial circumflex receive separate nerve supplies.
Pectineus iliopubic ramus the thigh and flexes and accessory obturator
to be attached along femoral artery Proximally it may be partially or
and the pubic it on the pelvis nerve, L3, when present
a line from the wholly attached to the capsule of
tubercle, and from
lesser trochanter to the hip joint.
the fascia on its
the linea aspera
own anterior
surface

Gracilis Arises by a thin Upper part of the Flexes the leg and Anterior division of Segmental blood Most superficial of the adductor
aponeurosis from medial surface of rotates it medially; Obturator Nerve supply from the group
the medial the shaft of the tibia may also act as an medial circumflex,
margins of the just below the adductor (L2-3) profunda and fibres descend vertically into a
lower half of the condyle (proximal to femoral arteries in rounded tendon, often harvested
body of the pubis, insertion of When the foot is fixed, succession distally. as a knee ligament graft
the edge of the semitendinosus, gracilis rotates the
femur and pelvis A gracilis muscular flap based on
inferior pubic forming part of the the profunda pedicle is used in
laterally on the tibia,
 ramus, and the perineal reconstructive surgery.
and helps balance the
adjoining ischial pes anserinus)
trunk during walking.
ramus.

Inserted via an Extensive or

aponeurosis into the
Arises by a narrow forcible
femur, along a line
attachment from adduction of the
from the lesser Profunda femoris
the external
trochanter to the femur is not often distally and Artery to
aspect of the body Anterior division of
linea aspera, and required. the adductors',
Adductor Brevis and inferior the obturator nerve,
on the upper part assisted proximally by
ramus of the
of the linea
Although the (L2-3)
the obturator artery
pubis, between adductors can act
immediately behind (deep surface)
gracilis and
obturator externus
pectineus and the in this way, they
upper part of
more commonly
adductor longus
act as synergists
Narrow tendon in the complex
Descends
with a flattened
posterolaterally and patterns of gait
(sometimes C-
inserts by an activity, and to
shaped) cross- ‘Artery to the
section, which is
aponeurosis into some degree as Anterior division of adductors' of the
the linea aspera in
Adductor Longus attached to the controllers of the obturator nerve, profunda femoris, Most anterior of the adductors
the middle third of
front of the pubis posture. They are (L2-3) assisted distally by
the femur, between
in the angle the femoral artery
Vastus Medialis and active during
between the crest
adductors magnus flexion and
and the
and brevis
symphysis extension of the
knee and during
Adductor Magnus Hamstring Part - Hamstring part Hamstring part – Anteriorly - obturator,The long, linear
Arises from a small -fibres descend
flexion (longus) tibial part of sciatic profunda femoris and attachment of the muscle
part of the inferior vertically to a and extension nerve (L4-5) (superficial) femoral is interrupted by a series Near the top of the medial
supracondylar line there is a
ramus of the tendinous (magnus) of the arteries contribute of osseo-aponeurotic
pubis, from the attachment to the Adductor part - openings, bridged by gap in the muscle attachment
thigh at the hip posterior division of Posteriorly – branches tendinous arches attached (adductor hiatus) through
conjoined ischial adductor tubercle
ramus, and from of the femur, with an joint. In the obturator nerve from the medial to the bone. The upper which the femoral vessels
the inferolateral expansion to the symmetrical easy (L2-4) circumflex femoral, four are small and pass, changing their name to
the first and second popliteal as they do so
aspect of the medial supracondylar standing their transmit the perforating
 line branches and the
termination of the
Adductor part - profunda femoris artery.
fibres are inserted The lowest is large
ischial tuberosity. progressively (adductor hiatus) and
higher along the allows the femoral vessels
medial to cross to the popliteal
supracondylar line, perforating and the fossa.
Adductor part –
the linea aspera popliteal vessels.
ischipubic ramus
(in continuity
and up to the activity is
medial margin of minimal.
with ischial
the gluteal
origin)
tuberosity

Muscle Origin Insertion Action Innervation Vascular Supply Relations Notes / Function
Leg
Anterior (Extensor) Compartment
Produces dorsiflexion of ankle
Anterior Tibial Artery supplies the muscles of the extensor compartment and gives malleolar branches to both malleolar regions. The deep peroneal nerve reaches it from the lateral side, runs in front of
it in the crowded space of the middle of the leg and returns to its lateral side below. The accompanying anterior tibial veins run, one on each side of the artery (vena comitantes), in close contact with it
and anastomose by cross channels at frequent intervals.

Tibialis Arises from the lateral Medial and inferior Dorsiflexor of the Deep peroneal Series of medial and Muscle descends vertically and ends in a tendon on its
Anterior condyle and proximal surfaces of the ankle joint and (fibular) nerve (L4, anterior branches of anterior surface in the lower third of the leg; tendon is
half to two-thirds of the medial cuneiform invertor of the foot L5) the Anterior Tibial enclosed in a synovial sheath & passes through the medial
lateral surface of the and the adjoining (most active when Artery compartments of the superior and inferior retinacula,
tibial shaft; the part of the base of movements are inclines medially
adjoining anterior the 1st metatarsal combined, as in
 surface of the Extensor digitorum longus and extensor hallucis longus lie
interosseous walking) laterally
membrane; the deep
bone via tendon on Elevates the first Tendon of tibialis anterior is the only extensor tendon that
surface of the deep
its anterior surface in metatarsal base and possesses a synovial sheath at the level of the superior
fascia; and the
the lower third of the medial cuneiform and extensor retinaculum
intermuscular septum
leg. rotates their dorsal
between itself and
extensor digitorum aspects laterally
longus

Fibres form tendon Extensor hallucis longus is

on anterior border of sometimes united with extensor
muscle which passes Anterior Tibial Extensor hallucis longus digitorum longus and may send
deep to the Artery & variable lies between, and partly a slip into the second toe.
superior extensor contribution from overlapped by, tibialis
Arises from the middle perforating branch of anterior and extensor
retinaculum and is
two-fourths of the fibular artery digitorum longus
slung by the
medial surface of the
inferior extensor Anterior tibial vessels and
fibula, medial to
retinaculum, Extends the phalanges deep fibular nerve lie
Extensor extensor digitorum Deep peroneal
Hallucis crosses anterior to of the hallux and More distally - between extensor hallucis
longus, and from the (fibular) nerve, L5
Longus the anterior tibial dorsiflexes the foot anterior medial longus and tibialis
adjacent anterior
vessels to lie on their malleolar artery and anterior. Extensor hallucis
surface of the
medial side near the network, the dorsalis longus lies lateral to the
interosseous
ankle, and is pedis artery, and the artery proximally, crosses
membrane
inserted into the plantar arteries of the it in the lower third of the
dorsal aspect of the first ray via leg, and is medial to it on
base of the distal perforating branches. the foot.
phalanx of the
hallux

Extensor Arises from the inferior Splits into 4 tendon Dorsiflex the lateral Deep peroneal Anteriorly and Origins form the walls ofAt the metatarsophalangeal
Digitorum surface of the lateral slips after inferior four toes. (fibular) nerve, L5, S1 laterally placed an osseo-aponeurotic joints the tendons to the second,
Longus condyle of the tibia, extensor branches of the tunnel third and fourth toes are each
proximal three- retinaculum, each of Acting synergistically Anterior Tibial joined on the lateral side by a
quarters of the medial which insert on with tibialis anterior, Artery, supplemented Becomes tendinous in the tendon of extensor digitorum
surface of the fibula, dorsum of middle extensor hallucis distally from the lower third of the leg; brevis
adjacent anterior and distal longus and fibularis perforating branch of Tendon passes deep to
surface of the phalanges as part (Peroneous) tertius, it the superior extensor
 retinaculum and within a Dorsal digital expansions
loop of the inferior formed on dorsal aspect of
extensor retinaculum proximal receive contributions
with fibularis Tertius; from the appropriate lumbrical
interosseous divides into four slips and interosseous muscles;
membrane, deep of dorsal digital is a dorsiflexor of the which run forward on the Expansion narrows as it
surface of the deep expansions ankle. Acting with dorsum of the foot and approaches a proximal
fascia, anterior crural (extensor extensor hallucis are attached in the same interphalangeal joint, and
expansion the fibular artery
intermuscular septum, longus it helps tighten way as the tendons of divides into three slips. These
and from the fascial complex) the plantar extensor digitorum in the are a central (axial) slip,
septum between itself aponeurosis. hand attached to the base of the
and tibialis anterior. middle phalanx, and two
collateral (coaxial) slips, which
reunite on the dorsum of the
middle phalanx and are attached
to the base of the distal phalanx.

Muscle unique to humans Action levels the foot and helps

the toes to clear the ground, an
Tendon inserted into Tendon passes deep to action that improves the
the medial part of the superior extensor
Arise from the distal Dorsiflexes foot (acts efficiency and enhances the
the dorsal surface retinaculum and within
third or more of the with Ext. Digitorum economy of bipedal locomotion
of the base of the the stem of the inferior
medial surface of the Longus & Tibialis
fifth metatarsal extensor retinaculum
Fibularis fibula, the adjoining anterior) and everts Deep peroneal Same as ext.
(Peroneous) bone; a thin alongside the extensor Not active during stance phase
anterior surface of the the foot (acts with (fibular) nerve, L5, S1 digitorum longus
Tertius expansion usually digitorum longus
interosseous membrane, Peroneous Longus &
extends forwards
and the anterior crural Brevis) during swing Shares the synovial
along the medial
intermuscular septum phase of gait sheath of extensor
border of the shaft of
the bone digitorum longus

Lateral (Fibular or Peroneal) Compartment

Both muscles evert the foot and are weak plantar flexors of the ankle, and both probably play a part in balancing the leg on the foot in standing and walking

Fibularis Arises from the head Tendon crosses the Both muscles evert, Superficial Peroneal Superior and Muscle belly of peroneous longus ends in a long tendon that
(Peroneous) and proximal two- sole of the foot and weakly (Superficial Fibular) inferior branches runs distally behind the lateral malleolus in a groove it
Longus thirds of the lateral obliquely and is shares with the tendon of peroneous brevis; groove is
 attached by two plantarflex the foot;
surface of the fibula,
slips, one to the they are the
the deep surface of the
lateral side of the plantarflexors when
deep fascia, the anterior
1st metatarsal base the tibial nerve is
and posterior crural converted into a canal by the superior fibular (peroneal)
and one to the Nerve (L5, S1)
intermuscular septa, and paralysed. retinaculum, so that the tendon of fibularis longus and
plantar
occasionally by a few brevis (which lies in front of the longus tendon) are
posterolateral In addition,
fibres from the lateral contained in a common synovial sheath (from above the
aspect of the peronoeus longus is
condyle of the tibia lateral malleolus to the peroneal trochlea, where the
medial cuneiform
a factor in sheath divides to accompany the respective insertions)
maintaining the
lateral longitudinal Tendon of Longus runs obliquely forwards on the lateral
and transverse side of the calcaneus, below the peroneal trochlea and
of the Anterior the tendon of fibularis brevis, and deep to the Inferior
arches of the foot
Tibial Artery; the Fibular Retinaculum to enter the sole of the foot lying
due to the oblique
Arises from the distal superior is against the posterior ridge (here the tendon possesses a
direction of its
two-thirds of the commonly the sesamoid fibrocartilage which often ossifies - os peroneum).
tendon across the
fibula; in the middle larger It crosses the lateral side of the cuboid and then runs under
sole which would
third of the bone its the cuboid in a groove that is converted into a canal by the
enable it to support
origin lies anterior that lesser, variable, long plantar ligament
Tendon of brevis each arch
of peroneus longus and contribution from
passes above the Between Peroneous Longus’ attachments to the head and
the two muscles, and the fibular artery in
peroneal trochlea to shaft of the fibula there is a gap through which the
their tendons maintain Superficial Peroneal the distal part of the
Fibularis be inserted into the Fibularis brevis may common fibular nerve passes
this relationship. (Superficial Fibular) leg
(Peroneous) tubercle on the limit inversion of the Nerve (L5, S1)
Brevis Also arises from the lateral surface of Tendon of fibularis brevis then runs forwards on the
foot and so relieve
anterior and posterior the base of the 5th lateral side of the calcaneus above the fibular trochlea
strain on the ligaments
crural intermuscular metatarsal bone and the tendon of fibularis longus
that are tightened by
septa this movement (lateral Tendon of Peroneous longus changes direction below
part of interosseous the lateral malleolus and on the cuboid bone
talocalcaneal, lateral
talocalcaneal and Longus is the more superficial of the two muscles of lateral
calcaneofibular compartment
ligaments)

Posterior (Flexor) Compartment

 (Produces Plantar flexion
Superficial Flexor Group
Gastrocnemius and soleus, collectively known as the triceps surae, constitute a powerful muscular mass whose main function is plantar flexion of the foot, although soleus in particular has an important
postural role. large size is a defining human characteristic, and is related to the upright stance and bipedal locomotion of the human. Gastrocnemius and plantaris act both on the knee and ankle joints;
soleus on the latter alone

Arises by two heads, Forms the belly of the calf & two
connected to the heads of gastrocnemius form
As the muscle
condyles of the femur by the lower boundaries of the
strong, flat tendons.descends, the muscle POPLITEAL FOSSA
fibres begin to insert Each head of
Medial, larger, head - into a broad dense gastrocnemius is Lateral head is partially
attached to a aponeurosis that supplied by medial overlaid by the tendon of
depression at the There is a bursa between each
develops on its and lateral sural biceps femoris, the medial
upper and posterior Triceps surae head and the capsule of the knee
anterior surface; up arteries head by
part of the medial (Gastrocnemius & joint. The medial bursa
to this point the correspondingly semimembranosus;
femoral condyle Soleus), constitute a communicates with the joint
muscular masses of (branches of muscle is superficial to
behind the adductor powerful muscular cavity and the lateral bursa may
the two heads popliteal artery the rest of its length
tubercle, and to a mass whose main do so. The medial bursa may also
remain separate. The usually at level of
slightly raised area on function is plantar communicate with the
aponeurosis tibiofemoral joint
the popliteal surface of flexion of the foot semimembranosus bursa.
gradually narrows line) Superficial surface of the
Gastrocnemius the femur just above the and receives the Tibial Nerve (S1, S2)
muscle is separated by
medial condyle. tendon of soleus on the deep fascia from the
its deep surface to Also a flexor of the Gastrocnemius is tested by
Lateral head - attached Blood supply to the short saphenous vein and
form the calcaneal Knee plantar flexion of the foot against
to a recognizable area on calcaneal tendon is the fibular
tendon (Achilles resistance, in the supine position
the lateral surface of Provides force for poor: the predominant communicating and sural
tendon / Tendo and with the knee extended
the lateral femoral propulsion in walking, artery is a recurrent nerves. The common
Calcaneus) branch of the fibular nerve crosses
condyle and to the running and leaping.
lower part of the Inserts on the posterior tibial behind the lateral head of
corresponding middle third of the artery which mainly the muscle, partly under
supracondylar line. posterior calcaneal supplies peritendinous cover of biceps femoris
surface tissues
Both heads also arise
from subjacent areas of
the capsule of the knee
joint.
 Its slender tendon Can be harvested for use as a
runs distally and tendon graft but is absent
medially, deep to the unilaterally or bilaterally in
medial head of about 10–20% of subjects
gastrocnemius and Lower limb equivalent
continues along the of palmaris longus Superficially - lateral
Arises from the lower medial border of sural and popliteal
part of the lateral the calcaneal Muscle is almost arteries
vestigial in man and is Tibial Nerve (S1, S2) –
supracondylar line of the tendon with which (often from lateral Deeply - lateral
femur & oblique it fuses normally inserted well
Plantaris short of the plantar branch / ramus which superior genicular
popliteal ligament of the supplies lateral head artery
knee aponeurosis, usually
into the calcaneus. It is of gastrocnemius)
Inserts on the Distal tendon shares
therefore presumed to blood supply with
middle third of the
act with calcaneal tendon
posterior calcaneal
gastrocnemius.
surface just medial
to the calcaneal
tendon

Aponeurotic Origin Broad flat muscle situated immediately deep (anterior) to

arising from the Eventually unites gastrocnemius
posterior surface of the with the Superior B.S. - arises
head and proximal Powerful plantar
gastrocnemius from the popliteal
quarter of the shaft of flexor of the ankle Tibial Nerve (S1, S2) –
aponeurosis to form artery at about the
the fibula; the soleal Its deep surface is related to flexor digitorum longus, flexor
the Achilles tendon, Soleus, acting from two branches, one in level of the soleal
line and the middle hallucis longus, tibialis posterior and the posterior tibial
inserting on the popliteal fossa and arch,
Soleus third of the medial below, is said to be vessels and tibial nerve, from all of which it is separated by
border of the tibia; and middle 1/3 of the more concerned with one on its deep
from a fibrous band posterior calcaneal surface in the calf Inferior B.S. - from the the deep transverse fascia of the leg.
steadying the leg on proximal part of the
between the tibia and surface the foot in standing fibular artery or
fibula (the soleal arch
that arches over the sometimes from the
popliteal vessels and posterior tibial
tibial nerve) artery

Deep Flexor Group

Lies deep (anterior to) the deep transverse fascia, and consists of popliteus, which acts on the knee joint, and flexor digitorum longus, flexor hallucis longus and tibialis posterior, which all produce plantar
flexion at the ankle in addition to their specific actions on joints of the foot and digits .
Insertion is within
the capsule of the
Arises from the medial
two-thirds of the knee joint by a
triangular area above strong tendon, 2.5
the soleal line on the cm long, which is
posterior surface of the attached to a
Popliteus
tibia, and into the depression at the
tendinous expansion anterior end of the
covering its surface popliteal groove on
the lateral aspect of
the lateral femoral
condyle
Popliteus is attached to Forms the floor of the lower
the medial aspect of the part of the popliteal fossa
fibular head by the
popliteofibular
Medially Rotates the
ligament, that passes
tibia on the femur or, Tendon lies within the capsule of
Branch of Tibial Nerve laterally & inferiorly from
when the tibia is the knee joint, entering it
(L4-5, S1) the popliteus tendon in a
fixed, Laterally beneath the arcuate popliteal
sheet of tissue
rotates the femur on **this nerve also Medial and lateral ligament (see p. 138), to which
inferior genicular
the tibia innervates the superior  Ligament is the superficial fibres of the muscle
tibiofibular joint and arteries are attached
single most
‘Unlocks' the joint at
the crural interosseous important
the beginning of
membrane. stabilizer of the
flexion of the fully
posterolateral
extended knee
region of knee
 Resists external
rotation of the
tibia on the femur

Flexor Arises from the
Digitorum posterior surface of the
Longus tibia medial to tibialis
posterior from just
distal the soleal line to
within 7 or 8 cm of the
distal end of the bone
Tendons passes Weak Plantar Flexors Tibial Nerve (L5, S1- Posterior tibial Muscle ends in a tendon that extends along almost the whole
forward as four S2) artery (transversely of its posterior surface. The tendon gradually crosses tibialis
separate tendons, When the foot is off the running branches) posterior on its superficial aspect and passes behind the
one each for the ground, both muscles medial malleolus where it shares a groove with tibialis
second to fifth toes, flex the phalanges of posterior, from which it is separated by a fibrous septum, i.e.
deep to the tendons the toes, acting each tendon occupies its own compartment lined by a
of flexor digitorum primarily on the synovial sheath.
brevis. After giving distal phalanges
off the lumbricals, it Tendon of flexor digitorum longus then curves obliquely
When the foot is on the forwards and laterally, in contact with the medial side of the
passes through the ground and under load,
fibrous sheaths of sustentaculum tali, passes deep to the flexor retinaculum,
they act synergistically and enters the sole of the foot on the medial side of the
the lateral four toeswith the small muscles tendon of flexor hallucis longus
Attached to the of the foot and,
plantar surfaces of especially in the case of
the bases distal flexor digitorum
phalanges of lateral longus, with the
four toes; each lumbricals and
 passes between the
slips of the
corresponding
tendon of flexor
digitorum brevis at
the base of the
proximal phalanx

In the sole of the interossei to maintain Its fibres pass obliquely Bulkiest and most powerful of
foot, the tendon of the pads of the toes down to a tendon that the three deep muscles of the
flexor hallucis longus in firm contact with occupies nearly the whole calf
passes forward in the the ground, enlarging length of the posterior
second layer like a the weight-bearing aspect of the muscle. This Tested by flexion of the hallux
Arises from the distal against resistance
bowstring beneath area and helping to tendon grooves the
two-thirds of the
stabilize the heads of
posterior surface of the the arched medial posterior surface of the
border; crosses the the metatarsal bones, lower end of the tibia,
fibula (except for the
tendon of flexor which form the then, successively, the
lowest 2.5 cm of this
digitorum longus fulcrum on which the posterior surface of the
surface); the adjacent
from medial to body is propelled tallus and the inferior
interosseous
lateral, curving forwards. Tibial nerve, (L5, S1- Numerous branches surface of the
Flexor Hallucis membrane and the
Longus obliquely superior to 2 - mainly S1) of the Fibular Artery sustentaculum tali of the
posterior crural Very active during
intermuscular septum; it calcaneus. Fibrous bands
toe-off and tip-toe (Flexor Retinaculum)
and from the fascia Continues on the movements
covering tibialis convert the grooves on
plantar aspect of the talus and the
posterior, which it the hallux, and runs
overlaps to a calcaneus into a canal
in an osseo- lined by a synovial sheath
considerable extent aponeurotic tunnel
to be attached to
the plantar aspect
of the base of the
distal phalanx

Tibialis Its proximal attachment More superficial and Principal invertor of Tibial nerve, (L4-5) Muscular branches Tendon passes deep to At its origin it lies between flexor
Posterior consists of two tapered larger division of forefoot; also adducts of sural, peroneal that of flexor digitorum hallucis longus and flexor
processes, separated by tendon, which is a forefoot, plantar and posterior tibial longus, with which it digitorum longus, and is
an angular interval that direct continuation flexes ankle, and arteries shares a groove behind overlapped by both, but
is traversed by the of the tendon, is helps to supinate the the medial malleolus, especially by the former
Tendon is supplied by
 attached to the each enclosed in a Most deeply placed muscle of the
tuberosity of the separate synovial sheath calf
navicular, from
which fibres Passes deep to the flexor
anterior tibial vessels. retinaculum and
continue to the
Medial process - arises superficial to the deltoid
inferior surface of
from the posterior ligament to enter the foot.
the medial
surface of the In the foot it is at first
cuneiform foot
interosseous inferior to the plantar
membrane, except at deeper lateral calcaneonavicular
its most distal part, division gives rise ligament (SPRING
and from a lateral area to the tendon of Initiates elevation of LIGAMENT), where it
arteries of the medial
on the posterior origin of the medial the heel contains a sesamoid
malleolar network
surface of the tibia limb of flexor fibrocartilage
Contributes to and by the medial
between the soleal line hallucis brevis, and
maintaining the medial plantar artery. Tendon divides into 2
above and the junction then continues
of the middle and longitudinal arch of the
between this muscle
lower thirds of the foot.
and the navicular
shaft below. and medial
cuneiform to end on
Lateral part - arises
the intermediate
from a medial strip of
cuneiform and the
the posterior fibular
bases of the second,
surface in its upper
third and fourth
two-thirds.
metatarsals; the slip
to the fourth
metatarsal is the
strongest

Muscle Origin Insertion Action Innervation Vascular Supply Relations Notes / Function
Ankle & Foot
Tibiofibular joints
The superior tibiofibular joint is a synovial joint between the lateral tibial condyle and the fibular head. The articulating surfaces are almost flat. The capsule is reinforced by anterior and posterior
ligaments. The joint cavity may occasionally communicate posteriorly with the bursa deep to the popliteus tendon and thence with the knee joint.

The interosseous membrane consists of strong fibres that slope steeply from the tibia down to the fibula, and are continuous distally with the interosseous tibiofibular ligament.

The inferior tibiofibular joint is a fibrous joint (syndesmosis) between the convex medial surface of the distal end of the fibula and the concave fibular notch of the distal tibia. The bones are held together
by anterior and posterior tibiofibular ligaments and are strongly bound by the interosseous tibiofibular ligament, whose fibres occupy the triangular area on each bone at the lower end of the interosseous
border

Only slight movements occur at the tibiofibular joints, the fibula rotating laterally a little during dorsiflexion at the ankle.

Superior extensor retinaculum binds down the tendons of tibialis anterior, extensor hallucis longus, extensor digitorum longus and fibularis tertius immediately proximal to the anterior aspect of the
talocrural joint. The anterior tibial vessels and deep fibular nerve pass deep to the retinaculum and the superficial fibular nerve passes superficially. The retinaculum is attached laterally to the distal end of
the anterior border of the fibula and medially to the anterior border of the tibia.

Inferior extensor retinaculum is a Y-shaped band lying anterior to the talocrural joint. The stem of the Y is at the lateral end, where it is attached to the upper surface of the calcaneus, in front of the
sulcus calcanei. The band passes medially, forming a strong loop around the tendons of fibularis tertius and extensor digitorum longus. At the medial end of the loop, two diverging limbs extend medially to
complete the ‘Y' shape of the retinaculum. The proximal of the two limbs consists of two layers. The deep layer passes deep to the tendons of extensor hallucis longus and tibialis anterior, but superficial to
the anterior tibial vessels and deep fibular nerve, to reach the medial malleolus. The superficial layer crosses superficial to the tendon of extensor hallucis longus and then adheres firmly to the deep one.
The distal limb extends downwards and medially and blends with the plantar aponeurosis. It is superficial to the tendons of extensor hallucis longus and tibialis anterior, the dorsalis pedis artery and the
terminal branches of the deep fibular nerve.

Flexor Retinaculum - attached anteriorly to the tip of the medial malleolus, distal to which it is continuous with the deep fascia on the dorsum of the foot. From its malleolar attachment it extends
posteroinferiorly to the medial process of the calcaneus and the plantar aponeurosis

Superior Peroneal Retinaculum, a band of deep fascia that extends from the back of the malleolus to the lateral surface of the calcaneus;

At the peroneal trochlea, Inferior Peroneal Retinaculum, a band of fascia attached to the peroneal trochlea and to the calcaneus above and below the peroneal tendons

Fascial compartments of the foot

There are four main compartments of the plantar aspect of the foot (Jones 1949). The medial compartment contains abductor hallucis and flexor hallucis brevis, and is bounded inferiorly and medially by
the medial part of the plantar aponeurosis and its medial extension, laterally by an intermuscular septum, and dorsally by the first metatarsal. The central compartment contains flexor digitorum brevis,
the lumbricals, flexor accessorius and adductor hallucis, and is bounded by the plantar aponeurosis inferiorly, the osseofascial tarsometatarsal structures dorsally and intermuscular septa medially and
laterally. The lateral compartment contains abductor digiti minimi and flexor digiti minimi brevis, and its boundaries are the fifth metatarsal dorsally, the plantar aponeurosis inferiorly and laterally, and
an intermuscular septum medially. The interosseous compartment contains the seven interossei and its boundaries are the interosseous fascia and the metatarsals. The dorsal aspect of the foot
effectively contains a single compartment which is occupied by the extensor tendons and extensor digitorum brevis, and which is roofed by the deep dorsal fascia.

MEDIAL LONGITUDINAL ARCH

The medial margin of the foot arches up between the heel proximally and the medial three metatarsophalangeal joints to form a visible arch. It is made up of the calcaneus, talar head, navicular, the
three cuneiforms and the medial three metatarsals. The bones themselves contribute little to the stability of the arch, whereas the ligaments contribute significantly. The most important ligamentous
structure is the plantar aponeurosis, which acts as a tie beam between the anterior and posterior supporting pillars (i.e. posterior part of the inferior calcaneal surface and the three metatarsal
heads, respectively). Dorsiflexion, especially of the hallux, draws the two pillars together, thus heightening the arch: the so-called ‘windlass' mechanism. Next in importance is the spring ligament,
which supports the head of the talus. If this ligament fails, the navicular and calcaneus separate, allowing the talar head, which is the highest point of the arch, to descend. The talocalcaneal ligaments and the
anterior fibres of the deltoid ligament, from the tibia to the navicular, also contribute to the stability of the arch.

LATERAL LONGITUDINAL ARCH

The lateral longitudinal arch is much less pronounced arch than the medial one. The bones making up the lateral longitudinal arch are the calcaneus, the cuboid and the fourth and fifth
metatarsals: they contribute little to the arch in terms of stability. The pillars are the calcaneus posteriorly, and the lateral two metatarsal heads, anteriorly. Ligaments play a more important role in
stabilizing the arch, especially the lateral part of the plantar aponeurosis and the long and short plantar ligaments. However, the most important contribution to the maintenance of the lateral
arch is made by the tendon of fibularis longus. The lateral two tendons of flexor digitorum longus (and flexor accessorius), the muscles of the first layer (lateral half of flexor digitorum brevis and abductor
digiti minimi) and fibularis brevis and peroneus tertius also contribute to the maintenance of the lateral longitudinal arch.

TRANSVERSE ARCH
The bones involved in the transverse arch are the bases of the five metatarsals, the cuboid and the cuneiforms. The intermediate and lateral cuneiforms are wedge-shaped and thus adapted to
maintenance of the transverse arch. The stability of the arch is mainly provided by the ligaments, which bind the cuneiforms and the metatarsal bases, and also by the tendon of fibularis longus,
which tends to approximate the medial and lateral borders of the foot. A shallow arch is maintained at the metatarsal heads by the deep transverse ligaments, transverse fibres that bind together
the digital slips of the plantar aponeurosis, and, to a lesser extent, by the transverse head of adductor hallucis.

Pes planus denotes an excessively flat foot. There is no precise degree of flatness that defines pes planus, but it may be either physiological or pathological. In physiological pes planus, the feet are flexible
and rarely problematic. In marked contrast, pathological pes planus is often associated with stiffness and pain.

Pes cavus denotes an excessively high-arched foot. The majority of cases arise as a result of a neurological disorder (e.g. Charcot–Marie–Tooth disease, diastematomyelia, poliomyelitis). According to the
anatomical location of the deformity, pes cavus may be classified into hindfoot, midfoot or forefoot cavus. When pes cavus involves all three parts of the foot it is called ‘global' cavus.

Ligaments of Foot
Long plantar Ligament - extends from the plantar surface of the calcaneus (anterior to the processes of its tuberosity) and from its anterior tubercle, to the ridge and tuberosity on the plantar surface of
the cuboid. Deep fibres are attached to the cuboid and more superficial fibres continue to the bases of the second to fourth, and sometimes fifth, metatarsals. This ligament, together with the groove on the
plantar surface of the cuboid, makes a tunnel for the tendon of fibularis longus. It is a most powerful factor limiting depression of the lateral longitudinal arch.

Short Plantar Ligament (Plantar Calcaneocuboid Ligament) - deeper than the long plantar ligament, from which it is separated by areolar tissue. It is a short, wide band of great strength, stretching from
the anterior calcaneal tubercle and the depression anterior to it, to the adjoining part of the plantar surface of the cuboid; it also sustains the lateral longitudinal arch.

Deltoid Ligament (Medial Ligament of Foot)

 Composed of posterior & anterior tibiotalar ligament, tibiocalcaneal ligament and tibionavicular ligmanets
 Strong, triangular band, attached to the apex and the anterior and posterior borders of the medial malleolus
 Of its superficial fibres, the anterior (tibionavicular) pass forwards to the navicular tuberosity, behind which they blend with the medial margin of the plantar calcaneonavicular ligament; inter-
mediate (tibiocalcaneal) fibres descend almost vertically to the entire length of the sustentaculum tali; posterior fibres (posterior tibiotalar) pass posterolaterally to the medial side of the talus
and its medial tubercle
 Deep fibres (anterior tibiotalar) pass from the tip of the medial malleolus to the non-articular part of the medial talar surface.
  Ligament is crossed by the tendons of tibialis posterior and flexor digitorum longus. It is rarely injured alone, and when torn, is commonly associated with a fracture of the distal fibula

Spring Ligament (Plantar Calcaneonavicular Ligament) - broad, thick band connecting the anterior margin of the sustentaculum tali to the plantar surface of the navicular; sustains the medial
longitudinal arch of the foot; composed of collagen (not elastic fibres)

EXTRINSIC MUSCLES
Anterior group - Tibialis anterior, extensor hallucis longus, extensor digitorum longus and fibularis tertius

Lateral group - Fibularis longus and fibularis brevis

Posterior group

Superficial group – Gastrocnemius, Soleus, and Plantaris

Deep group - Flexor hallucis longus, flexor digitorum longus and tibialis posterior, which all act on the ankle joint and joints of the foot

INTRINSIC MUSCLES
Plantar muscles of the foot: First layer
(All three extend from the calcaneal tuberosity to the toes, and all assist in maintaining the concavity of the foot)
Muscle fibres end in a
Abductor hallucis arises tendon, which,
Medial malleolar
principally from the together with the
network, medial
flexor retinaculum, but medial tendon of flexor calcaneal branches of
also from the medial hallucis brevis, is the lateral plantar
process of the attached to the artery, medial plantar
calcaneal tuberosity, medial side of the Medial plantar artery (directly and via
Abductor Abducts the Hallux
Hallucis the plantar base of the proximal nerve, (S1, S2) superficial and deep
aponeurosis, and the phalanx of the hallux. branches), the 1st
intermuscular septum Some fibres are plantar metatarsal
artery and perforators
between this muscle attached more
from the plantar
and flexor digitorum proximally to the
arterial arch
brevis medial sesamoid bone
of this toe

Flexor Arises by a narrow Divides into four Flexes the lesser toes Medial plantar Lateral and medial Lies immediately deep to At the bases of the proximal
Digitorum tendon from the tendons, which pass to at the proximal nerve, (S1, S2) plantar arteries, the the central part of the phalanges, each tendon divides
Brevis medial process of the the lateral four toes; interphalangeal joint, plantar metatarsal plantar aponeurosis. Its around the corresponding
calcaneal tuberosity, the tendons enter with equal effect in any arteries and the deep surface is separated tendon of flexor digitorum
from the central part of digital fibrous flexor position of the ankle plantar digital from the lateral plantar longus; the two slips then
 reunite and partially
decussate, forming a tunnel
sheaths on plantar through which the tendon of
aspect to be inserted flexor digitorum longus passes
the plantar
on the middle to the distal phalanx
aponeurosis, and from
phalanx accompanied arteries to the lateral vessels and nerves by a
the intermuscular septa joint The way in which the tendons
by the tendons of four toes thin layer of fascia.
between it and adjacent of flexor digitorum brevis divide
flexor digitorum
muscles and attach to the phalanges is
longus, which lie deep
to them identical to that of the tendons
of flexor digitorum superficialis
in the hand

Arises from both Medial and lateral

processes of the plantar arteries, the
calcaneal tuberosity, plantar digital artery
Attached, with flexor Despite its name,
from the plantar to the lateral side of
digiti minimi brevis, abductor digiti minimi
surface of the bone minimus, branches
to the lateral side of is more a flexor than Lateral plantar **more a flexor than an
Abductor Digiti between them, from the from the plantar arch,
Minimi the base of the an abductor of the nerve, (S1-3) abductor
plantar aponeurosis and the fourth plantar
proximal phalanx of metatarsophalangeal
from the intermuscular metatarsal artery and
the fifth toe joint of the little toe
septum between the end twigs of the
muscle and flexor arcuate and lateral
digitorum brevis tarsal arteries

Plantar muscles of the foot: Second layer

Flexor Tendon Terminations of the tendons of the long and short flexor muscles are contained in osseo-aponeurotic canals similar to those that occur in the fingers. These canals are bounded above by
Sheaths the phalanges, and below by fibrous bands, the digital fibrous sheaths, which arch across the tendons and attach on either side to the margins of the phalanges. Along the proximal and
intermediate phalanges, the fibrous bands are strong, and the fibres are transverse (anular part); opposite the joints they are much thinner and the fibres decussate (cruciform part).
Each osseo-aponeurotic canal has a synovial lining, which is reflected around its tendon; within this sheath, vincula tendinum are arranged as they are in the fingers.

Tendon of flexor hallucis longus - passes forward like a bowstring beneath the medial longitudinal arch of the foot. It is crossed inferiorly by the tendon of flexor digitorum longus, to
the medial two of whose divisions it gives off a strong slip. It next lies in a groove between the two sesamoids beneath the head of the first metatarsal bone, and finally is inserted into the
base of the distal phalanx of the big toe. It is invested by a synovial sheath throughout its whole course in the foot.

Tendons of flexor digitorum longus - enters the sole on the medial side of the tendon of flexor hallucis longus. At its point of division into its four tendons of insertion it crosses
superficial to the tendon of flexor hallucis longus, which gives a strong slip to the tendons for the second and third toes. It also receives the insertion of flexor accessorius. The four
tendons pass forwards in the sole deep to those of flexor digitorum brevis and after giving off the lumbricals they enter the fibrous sheaths of the lateral four toes. Each tendon
 perforates the tendon of flexor digitorum brevis and passes on to be inserted into the base of the distal phalanx.

Medial head - larger and

more fleshy; it’s attached In action of running,
Arises by two heads, with the
to the medial concave Flexor Digitorum is
long plantar ligament situated
surface of the The muscle belly unable to flex digits
deeply in the interval between
calcaneus, below the inserts into the when ankle is flexed
the two heads.
groove for the tendon tendon of flexor (plantarflexion).
Accessorius Stem of the medial Medial plantar nerve
Flexor of flexor hallucis digitorum longus at Muscle sometimes absent
subsequently takes plantar artery (to the passes medial to and the
Digitorum longus. the point where it is Lateral plantar altogether
Accessorius over and permits medial head), the lateral plantar nerve
bound by a fibrous nerve, (S1-3)
(Quadratus Lateral head - flat and flexion lateral plantar artery passes superficial to By pulling on the tendons of
slip to the tendon of
Plantae) tendinous; it’s attached and the plantar arch flexor accessorius. flexor digitorum longus, flexor
flexor hallucis longus
to the calcaneus distal and where it divides Straightens the oblique digitorum accessorius
to the lateral process of into its four tendons pull of tendons of flexor provides a means of flexing the
the tuberosity, and to digitorum longus lateral four toes in any position
the long plantar of the ankle joint
ligament

lateral plantar artery

and plantar arch, and
Four small muscles (numbered
Arise from tendons of by four plantar
from the medial side of the
flexor digitorum longus Lumbricals help to metatarsal arteries
1st lumbrical foot) which are accessory to
as far back as their Muscles end in maintain extension of (four distal
(unicipital) - Medial perforating arteries the tendons of flexor digitorum
angles of separation, tendons that pass the interphalangeal longus
Plantar Nerve (S2-3) joined by three
each springing from the distally on the medial joints, while the
sides of two adjacent sides of the four lesser flexor digitorum proximal perforating In injuries of the tibial nerve,
Lumbrical 2nd, 3rd & 4th arteries).
tendons, except for the toes and are attached longus tendons are and in conditions such as the
Muscles lumbrical (bicipital)
first lumbrical to the dorsal digital flexing the toes, so hereditary motor–sensory
- Deep branch of the Tendons are supplied neuropathies (e.g. Charcot–
(unicipital), which arises expansions on their that in walking and
only from the medial proximal phalanges running the toes do
lateral plantar nerve by twigs from the marie–tooth disease),
(S2 S3) dorsal digital arteries
border of the first not buckle under. lumbrical dysfunction
(and their parent
tendon contributes to clawing of the
dorsal metatarsal
toes
arteries) to the lateral
four toes.
Plantar muscles of the foot: Third layer
Bifurcate tendon of
origin;

Lateral limb arises from

the medial part of the
A sesamoid bone usually
plantar surface of the
occurs in each tendon near its
cuboid, posterior to the
Belly of the muscle attachment. Clinical problems
groove for the tendon of
divides into medial with flexor hallucis brevis are
fibularis longus, and
and lateral parts, the Branches of the usually related to the
from the adjacent part
twin tendons of medial plantar artery, associated sesamoid bones.
of the lateral
which are attached, Flexes the proximal Medial plantar the first plantar However, excision of both
Flexor Hallucis cuneiform.
Brevis by way of sesamoid phalanx of the hallux nerve, (S1, S2) metatarsal artery, the sesamoids leads to disruption
Medial limb has a deep bones, to the sides of lateral plantar artery of both tendons and a
attachment directly the base of the and the plantar arch subsequent extension
continuous with the proximal phalanx of deformity at the first
lateral division of the the hallux metatarsophalangeal joint:
tendon of tibialis such surgery is therefore not
posterior, and a more recommended
superficial attachment to
the middle band of the
medial intermuscular
septum.

Adductor Oblique Head: springs Medial part of oblique Partly flexes the Deep branch of the Branches of the
Hallucis from the bases of the head blends with the proximal phalanx of lateral plantar medial plantar artery,
second, third and lateral part of flexor the hallux, but also nerve, (S2-3) the lateral plantar
fourth metatarsal hallucis brevis and is stabilizes the artery, the plantar
bones, and from the attached to the metatarsal heads arch and the first to
fibrous sheath of the lateral sesamoid fourth plantar
tendon of peroneus bone of the hallux. Draws the big toe metatarsal arteries
longus The lateral part of towards the axis of
oblique head joins the the metatarsus and
Transverse Head: transverse head and is assists in
narrow, flat fasciculus, also attached to the maintaining the
arises from the plantar lateral sesamoid transverse arch.
metatarsophalangeal bone and directly to
ligaments of the third,
 fourth and fifth toes,
and from the deep
the base of the first
transverse metatarsal
phalanx of the hallux
ligaments between
them

Distal tendon that End twigs of the

Arises from the medial
inserts into the lateral arcuate and lateral
part of the plantar
side of the base of the tarsal arteries, and
surface of the base of Flexes the Superficial branch
proximal phalanx of the lateral plantar
Flexor Digiti the fifth metatarsal metatarsophalangeal of the lateral plantar
Minimi Brevis the minimus; this artery and its digital
bone, and from the joint of the little toe nerve (S2, S3)
tendon usually blends (plantar) branch to
sheath of Peroneous
laterally with that of the lateral side of
longus
abductor digiti minimi minimus

Plantar muscles of the foot: Fourth layer

 Consists of the plantar and dorsal interossei and the tendons of tibialis posterior and peroneous longus
 When describing adduction and abduction of the toes, the axis of reference is a longitudinal axis corresponding to the shaft of the 2nd metatarsal (unlike the hand where reference is made to the
long axis of the third metacarpal)
Their tendons are Abduct the toes Deep branch of the Arcuate artery, lateral Between the heads of
attached to the bases relative to the lateral plantar nerve and medial tarsal each of the three lateral
of the proximal longitudinal axis of the (S2 and S3), arteries, the first to muscles, there is an
phalanges and to the second metatarsal. fourth plantar arteries angular space through
Four bipennate muscles,
dorsal digital They also flex the Exception 4 th
and the first to fourth which a perforating artery
each arising by two
expansions. The first metatarsophalangeal interosseous space - dorsal metatarsal passes to the dorsum of
Dorsal heads from the sides of
Interossei inserts into the medial joints and extend the superficial branch of arteries (receiving the foot. Between the
the adjacent metatarsal
side of the second toe; interphalangeal joints the lateral plantar proximal and distal heads of the first muscle,
bones
the other three pass to of the lesser toes. The perforating arteries), the corresponding space
nerve (S2-3)
the lateral sides of the hallux and little toe and by the dorsal transmits the terminal
second, third and have their own digital arteries of the part of the dorsalis pedis
fourth toes. abductors lateral four toes artery to the sole

Plantar Arise from the bases and Insert into the medial Adduct the third, Lateral plantar artery, Plantar interossei lie Three plantar interossei. They
Interossei medial sides of the third, sides of the bases of fourth and fifth toes, the plantar arch, the plantar to the dorsal lie below, rather than between,
fourth and fifth the proximal flex the second to fourth interossei and deep to the the metatarsal bones, and each
metatarsal bones phalanges of the metatarsophalangeal plantar metatarsal muscles of the third layer is connected to one metatarsal
numerically joints and extend the arteries and the bone only
corresponding toes, interphalangeal dorsal digital arteries
 and into their dorsal of the lateral three
joints.
digital expansions toes.

Extensor muscles of the foot (Dorsum)

Muscle slants distally and
Medial part of the medially across the dorsum
muscle is usually a of the foot, and ends in four
Anterior perforating
more or less distinct tendons.
branch of the fibular
Thin muscle which arises slip, ending in a tendon
artery, the anterior
from the distal part of that crosses the
lateral malleolar Extensor hallucis brevis,
the superolateral dorsalis pedis artery Assists in extending
artery, lateral tarsal courses dorsomedially Muscle is subject to much
surface of the superficially to insert the phalanges of the
arteries, dorsalis and passes superficial to variation, e.g. Accessory slips
calcaneus in front of into the dorsal aspect middle three toes via
Extensor pedis arteries, arcuate the dorsalis pedis artery from the talus and navicular,
the shallow lateral of the base of the the tendons of
Digitorum Lateral terminal artery, the first, and the deep fibular an extra tendon to the fifth
groove for fibularis proximal phalanx of extensor digitorum
Brevis branch of the deep second and third nerve. The remaining digit, an absence of one or
brevis, from the the hallux; this slip is longus; in the hallux,
fibular nerve, L5, S1 dorsal metatarsal three tendons pass more tendons. It may be
(& Extensor interosseous sometimes termed it assists in extension
arteries, proximal and obliquely deep to the connected to the adjacent
Hallucis Brevis) talocalcaneal ligament, EXTENSOR HALLUCIS of the
distal perforating corresponding tendons of dorsal interosseous muscles.
and from the deep BREVIS. The other metatarsophalangeal
arteries, and the extensor digitorum
surface of the stem of three tendons attach joint.
dorsal digital arteries longus Extensor Hallucis
the inferior extensor to the lateral sides of
to the medial four Brevis - Most Medial
retinaculum the tendons of
toes (including the tendon of Extensor
extensor digitorum
hallux) Digitorum Brevis formed by
longus for the second,
third and fourth toes. distinct slip from medial
part of muscle