Appendicular Skeleton – Lower Limb

Though the bones in the upper and lower limbs differ in their functions, they share the same
basic structural pattern. Like the upper limb, the lower limb includes three segments; the
thigh comprising of the femur, the leg which includes the tibia and fibula, and the foot
which includes the tarsals, metatarsals, and phalanges. The pelvic girdle, however, differs
from the shoulder girdle as it includes one big irregular shaped bone (the hip bone) in
contrast to the two bones of the shoulder girdle.

The two hip bones articulate with each other anteriorly at the pubic symphysis and with the
sacrum posteriorly to form the bony pelvis.

The hip bone is also called the pelvic bone or coxal bone. The hip bone is large and
irregularly shaped. It is formed by a fusion of three bones: the ilium, the ischium, and the
pubis. During childhood, these three bones are separate, united by a cartilage around the
acetabulum, a bony depression for the articulation with the head of the femur. In adults the
ilium, ischium and pubis are fused but their names are retained.

The ilium forms the superior region of the hip bone. It consists of a bony body and ala
(wing). The latter extends anteriorly as the anterior superior iliac spine and posteriorly as
the posterior superior iliac spine. Below each of the superior spines, there are the
corresponding inferior iliac spines: the anterior inferior and posterior inferior iliac spines.
The lateral surface is called the gluteal surface as it serves for the origin of the gluteal
muscles. The medial surface is called iliac fossa where the iliacus muscle takes its origin.
The surface for the articulation with the sacrum is divided into two areas: the auricular (ear-
like) surface that participates in the synovial joint – anteriorly; and posteriorly – the iliac
tuberosity that participates in formation of the fibrous joint.

The ischium forms the postero-inferior region of the hip bone. It is shaped as an arch with a
superior body and a thinner inferior ramus that is continuous with the inferior ramus of the
pubis. The triangular ischial spine lies posterior to the acetabulum. The greater sciatic notch
is located above the ischial spine and the lesser sciatic notch is located below the ischial
spine.

The pubis forms the anterior region of the hip bone. It has a body in front that continues
with the two rami: the superior ramus and the inferior ramus of the pubis. The pubic
tubercle is a small round prominence at the upper aspect of the body of the pubis. It is a
palpable structure. This is a point of attachment for the inguinal ligament. A large hole, the
obturator foramen, occurs between the pubic and the ischium. The name ‘obturator’ means
‘closed gap’ and this foramen is enclosed by a fibrous membrane, the obturator membrane.
The femur is a single bone of the thigh. The head is found on the proximal end of the femur.
The head of the femur is carried on the neck that is positioned at an angle to the femoral
shaft. The neck is the weakest part of the femur and is frequently fractured in a broken hip.
At the posterior aspect of the proximal femoral shaft there are two large rough tubercles
called the greater and lesser trochanters. The posterior aspect of the shaft features a
double line called ‘linea aspera’ for muscle attachments. At the distal end of the femur the
two femoral condyles are located: the medial and the lateral femoral condyles. These
participate in the articulation with the proximal tibia at the knee joint. Separating the two
condyles, is the intercondylar fossa. Anteriorly, the distal femur contains the patellar
surface for the articulation with the patella bone at the knee joint. The lateral and medial
epicondyles are located above each corresponding condyle – they serve for muscle
attachments.

The tibia is the medial and weight-bearing bone of the leg. It features two large condyles
(the medial and the lateral) at its proximal end. These carry flat articular surfaces (tibial
plateau) for the articulation with the corresponding femoral condyles. Anteriorly, the
proximal tibia has the tibial tuberosity for the attachment of the patellar ligament. The
posterior aspect of the tibia has a prominent soleal line, an origin site for the soleus muscle.
The shaft of the tibia has a sharp anterior border that is palpable together with the medial
surface of the tibia as they are located subcutaneously. Distally, the end of the tibia is flat.
This is the surface for the articulation with the talus at the ankle joint. The medial end of the
distal tibia bears the medial malleolus, which forms the medial bulge palpable at the ankle.
Both the upper and lower extremities of the tibia feature the surfaces for the articulation
with the fibula. The fibula is the lateral bone of the leg. It does not participate at the knee
joint. Proximally, the fibula has the head that articulates with the lateral tibial condyle.
Distally, the fibula ends up with the lateral malleolus that can be palpated as the lateral
bulge at the ankle. Both the distal tibia and the distal fibula articulates with the talus which
forms the ankle joint.

The skeleton of the foot can be divided into three regions: tarsals, metatarsals, and
phalanges. The foot has two important functions: it bears the body weight and it acts as a
lever to propel the body forward during walking or running. The tarsus forms the posterior
aspect of the foot and comprises 7 bones. The two main weight-bearing bones are the talus
and the calcaneus. The talus articulates with the tibia and fibula at the ankle joint. While the
calcaneus forms the heel of the foot. The tarsals articulate with the metatarsals anteriorly.
These five small long bones articulate with the proximal phalanges of the digits. The digits
are numbered 1 to 5 starting with the great toe (hallux). Each digit comprises of three
phalanges (proximal, middle and distal) except for the hallux that has only two phalanges –
the proximal and the distal.

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To support body weight, the foot is structured in such a way that it is arched upward. There
are two longitudinal and one transverse arches. These arches are supported by the
interlocking bones, by strong ligaments and by muscle tendons. As a result, arches give way
when weight is applied to the foot, then spring back when the weight is removed.

We have now examined the bones forming the appendicular skeleton. These include the
free upper and lower limbs and their girdles. The upper limb main function is to position the
hand in the best way to support manipulation, thus mobility is the prime aim. The main
function of the lower limb is not only locomotion (mobility) but also weight-bearing.

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