Lower extremities arteries and nervesYou might take actions like standing, walking, or jumping for granted but they would be impossible without the extraordinary ability of your legs to perform intricate and coordinated movements. However, such complex actions require an equally complex anatomy and neurovasculature supply.
As you know, the lower extremity is divided into four main regions:
In this page, we’re going to study the most important arteries, veins and nerves passing through and supplying each of these regions, as well as their respective branches.
It is the largest artery that brings oxygenated blood to the entire lower extremity.
Branches include: superficial epigastric artery, superficial circumflex iliac artery, superficial external pudendal artery, deep external pudendal artery, deep femoral artery, descending genicular artery
Hip and thigh: femoral, gluteal (superior, inferior), obturator, deep femoral, descending genicular arteries
Knee and leg: popliteal, superior genicular (medial, lateral), inferior genicular (medial, lateral), tibial (anterior, posterior), anterior malleolar (medial, lateral), fibular/peroneal arteries
Ankle and foot: malleolar (anterior, posterior) arteries, dorsalis pedis artery/dorsal artery of the foot, plantar arteries (medial, lateral), tarsal arteries (medial, lateral), arcuate artery, dorsal metatarsal arteries, deep plantar arch, plantar metatarsal arteries
Superficial venous system: superficial dorsal network, plantar venous networks, marginal veins, metatarsal veins -> small/short saphenous vein -> popliteal vein and great/long saphenous vein -> femoral vein
Deep venous system: digital veins, metatarsal veins -> deep plantar and dorsal venous arches -> tibial (anterior, posterior) and fibular veins -> popliteal vein -> femoral vein
The nerves of the lower limb stem from the lumbosacral plexus.
Hip and thigh: femoral, saphenous, femoral cutaneous (lateral, posterior), sciatic, obturator, gluteal (superior, inferior), cluneal (superior, medial, inferior) nerves
Knee and leg: genicular (superior, middle, inferior), common fibular/peroneal, superficial fibular/peroneal, deep fibular/peroneal, tibial nerves
Ankle and foot: dorsal digital nerves, proper plantar digital nerves, lateral dorsal cutaneous nerve, plantar (medial, lateral) nerves
- Femoral Artery
The largest and most significant artery that brings oxygenated blood to the entire lower extremity is the femoral artery. It gives off several branches throughout the thigh which supply the skin of the inguinal and the external genital areas, as well as some muscles of the thigh. These branches include the: superficial epigastric artery, superficial circumflex iliac artery, superficial external pudendal artery, deep external pudendal artery, deep femoral artery, and descending genicular artery.
Take a look at the following resources and tackle the quiz to master the femoral artery, its course, and branches, the main source of all subsequent lower extremity arteries and the femoral triangle.
Hip and thigh
In addition to the femoral artery, there are several other important ones traveling through the hip and thigh: gluteal (superior and inferior), obturator, deep femoral, and descending genicular arteries.
The two gluteal arteries stem from the internal iliac arteries and supply blood to the piriformis, quadratus femoris, and gluteal muscles. In addition, they also supply the skin over the upper thigh and gluteal regions. The obturator artery also originates from the internal iliac artery and supplies the adductor muscles of the thigh. As you’ve seen previously, the deep femoral and descending genicular arteries originate directly from the femoral artery. They supply several muscles of the thigh and gluteal regions, as well as the knee joint, respectively.
Knee and leg
Continuing further down the lower extremity, we reach the arteries of the knee and leg: popliteal, superior genicular (medial and lateral), inferior genicular (medial and lateral), tibial (anterior and posterior), anterior malleolar (medial and lateral), and fibular/peroneal arteries.
The popliteal artery is a direct continuation of the femoral artery carrying blood further down the lower limb. In the knee, it gives off the superior and inferior genicular arteries which wrap around this region and supply it with blood. Read about the arterial anastomoses of the lower extremity here.
The popliteal artery then splits into the anterior and posterior tibial arteries that travel all the way towards the foot. The anterior tibial artery is the main blood supply for the anterior compartment of the leg.
The posterior tibial artery supplies oxygenated blood to structures of the leg, such as the tibia , medial malleolus, and calcaneus with its surrounding muscles. In addition, it supplies a large number of leg muscles via its important branch, the fibular artery.
As you can see, there are quite a lot of arteries that supply the lower limb. In order to avoid any confusion, take a look at the following two resources which provide you with a quick overview.
Ankle and foot
When it comes to the arteries of the foot, there are several important candidates: dorsalis pedis artery/dorsal artery of the foot, plantar arteries (medial and lateral), tarsal arteries (medial and lateral), arcuate artery, dorsal metatarsal arteries, deep plantar arch, and plantar metatarsal arteries.
Within the foot, the anterior and posterior tibial arteries continue as the dorsalis pedis artery and the plantar arteries, respectively. The plantar arteries supply the skin and muscles of the lateral and medial sides of the foot.
The tarsal, arcuate, and dorsal metatarsal arteries all stem from the dorsalis pedis artery. They supply the metatarsals, extensor digitorum brevis muscle, and the structures of the medial side of the foot. The dorsal metatarsal arteries also supply the toes via their branches called the dorsal digital arteries.
The deep plantar arch supplies the structures of the sole, or underside of the foot, as well as the toes via branches named plantar metatarsal arteries.
The arteries of the foot can be challenging to grasp, just like the major arteries, nerves and veins of the body.
The venous drainage of the lower limb can be divided into superficial and deep systems. As you know, venous drainage happens in the opposite direction compared to the arterial blood supply.
Starting from the foot, the superficial system begins with the superficial dorsal and plantar venous networks, together with the marginal and metatarsal veins. These veins drain from one into another, ultimately ending up in one of the two saphenous veins: small saphenous or great saphenous vein.
The small/short saphenous vein ascends along the posterior leg, ultimately draining into the popliteal vein located within the popliteal fossa. The great/long saphenous vein travels along the medial leg, but continues along the thigh as well, opening into the femoral vein. The great saphenous vein also receives blood from the small saphenous along its course.
As the name implies, the deep venous system is located deeper within the lower limb than the superficial one. In the foot, it starts with the digital and metatarsal veins that drain into the corresponding deep plantar and dorsal venous arches. These drain into larger veins that closely follow the course of the similarly named arteries. From here, the veins of the leg and thigh mirror the arteries.
Hip and thigh
So far we have covered all the major arteries and veins and the structures they supply/drain. Now it’s time to look at the nerves of the lower limb, which stem from the lumbosacral plexus. The significant ones of the hip and thigh are the following: femoral, saphenous, femoral cutaneous (lateral and posterior), sciatic, obturator, gluteal (superior and inferior), and cluneal (superior, medial, and inferior) nerves.
The femoral and sciatic nerves are the most important ones because they are the main sources of all subsequent lower extremity nerves. The femoral nerve originates from the lumbar plexus (L2-L4) and supplies various muscles of the anterior hip and thigh, such as the iliacus, sartorius, and the four quadriceps femoris muscles.The saphenous nerve is the largest branch of the femoral nerve. It innervates the skin of the front and medial sides of the leg. The femoral cutaneous nerves supply the skin of the posterior and lateral surfaces of the thigh, the posterior surface of the leg, as well as the skin of the perineum.
The sciatic nerve is the longest single and continuous nerve in the entire body. It originates from the sacral plexus (L4-S3) and travels all the way down the posterior aspect of the lower limb., The sciatic nerve innervates the entire skin of the leg, the posterior thigh muscles, and the muscles of the leg and foot.
The obturator nerve innervates the adductor muscles as well as the skin on the medial aspect of the thigh. As the name suggests, the gluteal nerves innervate the three glutei muscles (maximus, medius and minimus). The cluneal nerves arise from the L1-S3 spinal nerves, as does the posterior femoral cutaneous nerve. They are responsible for innervating the skin of the gluteal region.
Knee and leg
Following the lower limb down to the knee, we come across another set of nerves. This joint is directly innervated by superior genicular (medial and lateral), middle genicular, and inferior genicular (medial and lateral) nerves.
Travelling past the knee and into the leg, we meet another set of important nerves particular to this region: common fibular/peroneal nerve, superficial fibular/peroneal, deep fibular/peroneal, and tibial nerves.The common fibular nerve is actually a branch of the sciatic nerve. It innervates the knee via three articular branches and the skin of the posterolateral surface of the leg via its lateral sural cutaneous branch. The nerve then splits into its superficial and deep branches which innervate the lateral and anterior compartments of the leg, respectively. The superficial branch also supplies the skin over the dorsum of the foot.
The tibial nerve is the second branch of the sciatic nerve and innervates the posterior compartment muscles of the leg: gastrocnemius, popliteus, soleus, plantaris, tibialis posterior, flexor digitorum longus, and flexor hallucis longus.
Click on the following study unit to learn more about the nerves of the leg and knee.
Ankle and foot
The ankle region is innervated by articular branches of the tibial and deep fibular nerves.
Regarding the nerves of the foot, we have the following: dorsal digital nerves, proper plantar digital nerves, lateral dorsal cutaneous nerve, and plantar (medial and lateral) nerves.The dorsal digital nerves and the proper plantar digital nerves provide innervation to the toes, while the lateral dorsal cutaneous nerve supplies only the skin over the lateral side of the little toe. The plantar nerves are branches of the tibial nerve and they innervate the skin of the lateral two toes and sole of the foot, together with the intrinsic muscles of the foot.
As you can see, there are quite a lot of nerves supplying the lower limb. In order to avoid any confusion, take a look at the following resources which provide you with a quick overview.
We have designed a quiz specially for the neurovasculature of the lower extremity. Take this custom quiz now and learn more about the arteries, veins and nerves of the lower limb!