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Neurovasculature of the lower limbs

Last updated: September 6, 2021

Summarytoggle arrow icon

The arteries of the lower limb arise from the external iliac artery, a branch of the common iliac branch of the abdominal aorta. Behind the inguinal ligament, the external iliac artery continues as the femoral artery, which is the main artery of the thigh. The femoral artery continues as the popliteal artery, which divides into the anterior tibial, posterior tibial, and fibular arteries, which supply the leg and foot. The venous system of the lower limbs consists of a superficial and a deep venous system. The long saphenous vein and the short saphenous vein comprise the superficial venous system, which drains into the deep venous system via perforator veins. The deep veins accompany the arteries of the lower limbs and drain into the external iliac veins, which drain into the inferior vena cava. The lower limbs are innervated by the nerves of the lumbosacral plexus, which is composed of the lumbar plexus (T12–L4) and the sacral plexus (L4–S4). The major motor nerves of the thigh are the femoral nerve, the obturator nerve, and the sciatic nerve. The tibial nerve and the common peroneal nerve are the major motor nerves of the leg. The lower limb receives cutaneous innervation from pure sensory nerves (e.g., saphenous nerve, sural nerve) as well as from mixed sensorimotor nerves (e.g., femoral nerve, tibial nerve, deep peroneal nerve).

Overview [1]

The lower limb is supplied by the femoral artery, which receives blood from the abdominal aorta via the external iliac artery.

Overview of arteries
Artery Origin Course Branches and supply Anatomical relations
Femoral artery
Profunda femoris artery (deep femoral artery; deep artery of the thigh)
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Fibular artery (peroneal artery)
Dorsalis pedis artery


NAVEL: Nerve, Artery, Vein, Empty space (femoral canal), and Lymphatics (order of the contents of the femoral triangle, from lateral to medial)

The sites where the peripheral pulses are best palpated:
Femoral artery: midinguinal point
Popliteal artery: within the popliteal fossa
Posterior tibial artery: between the Achilles tendon and the posterior border of the medial malleolus
Dorsalis pedis artery: against the navicular bone, just lateral to the extensor hallucis longus tendon

Overview [1]

Veins of the lower limbs

Major veins of the lower limbs

Overview of veins of the lower limbs
Veins Superficial veins Deep veins
Great saphenous vein (long saphenous vein) Short saphenous vein (small saphenous vein) Popliteal vein Femoral vein External iliac vein
Origin
Course
Termination
Main tributaries
Drains
  • The anteromedial aspect of the sole, leg, and thigh
  • The lower leg
  • The lower leg

Important relations

Veins of the leg

Veins of the foot

Overview

  • The lower limb is innervated by branches of the lumbosacral plexus.
  • Lumbosacral plexus: a network of nerves composed of two distinct plexuses
  • Lumbosacral trunk
    • Formed by the fusion of lumbar nerves L4 and L5
    • Contributes to the sacral plexus

Lumbar plexus

Nerves of the lumbar plexus

Nerve

Nerve root Important characteristics Course Motor innervation Sensory innervation
Iliohypogastric nerve
  • T12–L1
  • Mixed sensorimotor nerve
Ilioinguinal nerve
  • T12–L1
  • Mixed sensorimotor nerve
Genitofemoral nerve
  • L1–L2
  • Sensorimotor nerve
  • Genital branch: labia majora (in women) or scrotum (in men)
  • Femoral branch: anteromedial thigh

Lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve) [3]

  • L2–L3
  • Pure sensory nerve
  • None
  • Skin over the anterolateral aspect of thigh (up to the knee)
Femoral nerve
Saphenous nerve
  • L2–L4
  • None
  • Skin over the medial aspect of the knee, leg, and foot
Obturator nerve
  • Sensorimotor nerve

Incidentally, I Got Laid On Friday: Iliohypogastric, Ilioinguinal, Genitofemoral, Lateral femoral cutaneous, Obturator, Femoral (nerves of the lumbar plexus)

Sacral plexus

Sacral plexus branches
Nerve Nerve roots Important characteristics Course Motor innervation Sensory innervation
Superior gluteal nerve
  • L4–S1
  • Motor nerve
  • None
Inferior gluteal nerve
  • L5–S2
  • Motor nerve
  • None

Posterior cutaneous nerve of thigh

(posterior femoral cutaneous nerve)

  • Sensory nerve
  • None
Sciatic nerve
  • Sensorimotor nerve
  • Thickest nerve of the body
  • Courses through the infrapiriform foramen
  • Courses towards the popliteal fossa, covered by the ischiocrural muscles (giving off muscular branches along its course)
  • Divides into the tibial nerve and common fibular nerves that supply the leg and foot
Pudendal nerve
  • Mixed sensorimotor nerve

Nerve to piriformis

  • S1–S2
  • Motor nerve
  • Does not exit the pelvis
  • Terminates by piercing the piriformis and supplying it
  • None
Nerve to obturator internus
  • L5–S2
  • Motor nerve
  • None
Nerve to quadratus femoris
  • L4–S1
  • Motor nerve
  • None

SIPPS: Superior gluteal nerve, Inferior gluteal nerve, Posterior cutaneous nerve of thigh, Pudendal nerve, Sciatic nerve (nerves of the sacral plexus)

Branches of the sciatic nerve

Sciatic nerve branches
Nerve Nerve roots Important characteristics Motor innervation Sensory innervation
Tibial nerve
Common peroneal nerve
(common fibular nerve)
  • Sensorimotor nerve
Sural nerve
  • Sensory nerve
  • Formed by the union of sural (cutaneous) branches from the tibial and common peroneal nerves
  • Accompanied by the short saphenous vein
  • None
  • Skin over the posterolateral aspect of the distal 1/3rd of the leg and the lateral border of the foot

TIPPED: tibial nerve injury versus peroneal nerve injury
TIP: Tibial nerve Inverts and Plantarflexes the foot; injury leads to an inability to walk on the TIPtoes
PED: Peroneal nerve Everts and Dorsiflexes the foot; injury leads to foot drop

  1. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences ; 2016
  2. Benglis DM, Vanni S, Levi AD. An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. Journal of Neurosurgery: Spine. 2009; 10 (2): p.139-144. doi: 10.3171/2008.10.spi08479 . | Open in Read by QxMD
  3. Lateral Femoral Cutaneous Nerve. https://radiopaedia.org/articles/lateral-femoral-cutaneous-nerve. Updated: January 1, 2018. Accessed: November 18, 2018.
  4. Posterior Femoral Cutaneous Nerve. https://radiopaedia.org/articles/posterior-femoral-cutaneous-nerve. Updated: January 1, 2018. Accessed: November 18, 2018.
  5. Anterior Tibial Artery. https://radiopaedia.org/articles/anterior-tibial-artery. Updated: January 1, 2018. Accessed: November 25, 2018.
  6. Posterior Tibial Artery. https://radiopaedia.org/articles/posterior-tibial-artery. Updated: January 1, 2018. Accessed: November 25, 2018.
  7. Arterial Supply to the Foot. https://radiopaedia.org/articles/arterial-supply-to-the-foot. Updated: January 1, 2018. Accessed: November 25, 2018.