Feet by dr. armaan singh

Anatomy of Feet

By- Dr. Armaan Singh

FootFoot

Tarsal bonesCalcaneusTalusNavicularCuboidCuneiformsFive metatarsalsPhalanges

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Tarsal Canal and Tarsal SinusTarsal Canal and Tarsal Sinus

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Inversion and EversionInversion and Eversion

Inversion is raising the medial border of the foot

Sole of the foot looks medially

Close packEversion is raising the

lateral border of the foot Sole of the foot looks

laterallyLeast pack

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Initiated at the transverse tarsal joint

CalcaneocuboidAnterior portion of

the talocalcaneonavicular

Last, 1963

Inversion and Eversion

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Main movement takes place at the clinical sub-talar joint i.e.• Talocalcaneal • Inferior portion of the

talocalcaneonavicularThe pivot is the

ligament of the neck of the talus

Inversion and Eversion

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AxisAxis

Upwards forwards and medially

Middle of most convex posterior facet on superior surface of calcaneus

Middle of most convex of the anterior head of talus

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Talocalcaneal Anatomical Talocalcaneal Anatomical SubTalar JointSubTalar Joint

Synovial plane jointConcave inferior aspect

of body of talusConvex posterior facet

on superior surface of the calcaneus

Articular surface is covered with hyaline cartilage

Part of the clinical subtalar joint

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Capsule attached just beyond the articular margins

Synovial membrane lines capsule and non articular structures

Interosseous ligament

Talocalcaneal Anatomical SubTalar Joint

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Subtalar InterosseosusSubtalar Interosseosus

Capsule of both talocalcaneal

Posterior portion of the talocalcaneonavicular joint

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Talocalcaneonavicular JointTalocalcaneonavicular Joint

Synovial ball and socket joint

Ball is anterior and inferior aspect of the head of the talus

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SocketTwo anterior facets

on the superior surface of the calcaneus

Posterior aspect of the navicular

Spring ligament Medial limb of

birfurcate i.e. lateral calcaneonavicular (LCN)

Talocalcaneonavicular Joint

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Capsule attached just beyond the articular margin

Interosseous ligament post

Medial are theSpring ligament and

superficial portion deltoid ligament

Lateral are the lateral calcaneo navicular ligament of bifurcate

Ligament neck of talus

Talocalcaneonavicular Joint

Plantar Calcaneonavicular LigamentPlantar Calcaneonavicular Ligament

Plantar calcaneonavicular or spring ligament is attached to

Sustentaculum taliTuberosity of navicularCovered by articular

cartilage

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Ligaments of Sub-Talar JointLigaments of Sub-Talar Joint

Inferior extensor retinaculum

Ligament of the neck of talus

Interosseous ligamentBifurcate ligament

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Ligament of Neck of TalusLigament of Neck of Talus

Sinus tarsi toLateral aspect of neck

of talusPivot of inversion and

eversionLast,1963

*

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Inferior Extensor RetinaculumInferior Extensor Retinaculum

Medial root inside the tarsal sinus

Intermediate to talus with the interosseous ligament, inside sinus

Lateral root to calcaneus outside sinus

Klein & Spreitzer, 1993

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Tarsal Canal and Tarsal SinusTarsal Canal and Tarsal Sinus

FatNerve endingsBranches of posterior

tibial and peroneal arteries

Capsules and ligaments of talocalcaneal and talocalcaneonavicular joints

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Ligament AttachmentsLigament Attachments

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Bifurcate LigamentBifurcate Ligament

Lateral calcaneonavicular ligament (CNL) is medial limb

Medial calcaneocuboid ligament (CCL) is lateral limb

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Two individual ligaments

Separate attachmentsDifferent fiber

orientationDifferent histologySmith, 2001

Bifurcate Ligament

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Lateral Calcaneonavicular LigamentLateral Calcaneonavicular Ligament

Folded and twisted appearance

Prominent medial and lateral edges/folds

Three groups of fibres• Medial• Lateral (deep)• Intra-articular

Smith 2001

N

A

C

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Intra-capsular CC jointSmaller than CNL, always

presentHourglass shaped fibres,

twisted mediallySmith 2001

Medial Calcaneo Cuboid Ligament

Talocalcaneonavicular JointTalocalcaneonavicular Joint

Synovial membrane lines the capsule and non-articular structures nerve supply

Tibial nerveDeep and superficial

peroneal nerves

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InvertorsIn dorsi-flexionTibialis anteriorIn plantar-flexionTibialis posterior

Talocalcaneonavicular Joint

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EvertorsIn dorsi-flexionPeroneus tertius In plantar-flexionPeroneus longusPeroneus brevis

Talocalcaneonavicular Joint

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Calcaneo Cuboid JointCalcaneo Cuboid Joint

Plane synovialLigamentsCapsularLigament of neck of

talusLong and short

plantar ligamentBifurcate ligament

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The long plantar ligamentShort plantar ligamentSupport the calcaneo cuboid

portion of the transverse tarsal joint

Calcaneo Cuboid Joint

Long Plantar LigamentLong Plantar Ligament

Long plantar is attached toMedial, lateral and anterior

tubercles of calcaneusEither side of the groove on

the cuboidBase of middle three Metatarsals

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Short Plantar LigamentShort Plantar Ligament

Short plantar Broader and wider and

deep to long plantarAnterior to anterior tubercle

of calcaneusPosterior to posterior ridge

on cuboid

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Inferior SurfaceInferior Surface

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Cutaneous Supply of SoleCutaneous Supply of Sole

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Sole of FootSole of Foot

SkinPlantar aponeurosisAttached toMedial and lateral tubercles of

calcaneusFive slips Divide into twoFuse deep transverse ligament of

sole Abduction and adduction from a line

drawn through the middle of second toe

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First Layer of SoleFirst Layer of Sole

Abductor hallucisMedial plantar nerveFlexor digitorum brevisMedial plantar nerveAbductor digiti minimiLateral plantar nerve

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Long flexor tendonsTibial nerveFlexor hallucis longusTibial nerveFlexor digitorum longusTibial nerveFour lumbricalsUnipennate medial plantar nerveBipennate lateral plantar nerveFlexor accessoriusLateral plantar nerve

Second Layer of Sole

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Flexor hallucis brevisMedial plantar nerveAdductor hallucisFlexor digiti minimi Lateral plantar nerveVessels run between

1st and 2nd layer3rd and 4th layers

Third Layer of Sole

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Tendons Tibialis posteriorTibial nervePeroneus longusSuperficial peroneal nerveDorsal interosseiLateral plantar nerve

Fourth Layer of Sole

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Seasmoid BonesSeasmoid BonesLarger medial inAbductor hallucis and

medial half of flexor hallucis brevis

Smaller lateral inAdductor hallucis and Lateral half of flexor

hallucis brevis

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FootFoot

If sesamoid bones are bipartite

It is always bilateralIf fracture singleTake off point of

walking is hallux Flexor hallucis

longusTibial nerve

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Joints of FootJoints of FootMid-tarsal compound synovialMetatarso-phalangeal jointSynovial condylar jointDeep transverse ligament of

soleInterphangeal jointsSynovial hinge

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Second MetatarsalSecond MetatarsalSecond metatarsal is

the most fixedThinnest Longest Stress fractures

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Longitudinal ArchesLongitudinal Arches

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ArchesArches

LongitudinalMedialLateralTransverse TarsalMetatarsal heads

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Posterior pillarCalcaneusKeystoneTalusNavicular, medial,

intermediate and lateral cuneiforms

Anterior pillarsHeads of medial three

metatarsals

Medial Longitudinal Arches

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Tie beamPlantar aponeurosis

Medial Longitudinal Arches

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Spring ligamentDeltoid ligamentTibialis anteriorDeep peroneal nerveTibialis posteriorFlexor hallucis longusTibial nerve

Medial Longitudinal Arches

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Tibialis anteriorTibialis posteriorFlexor hallucis longusFlexor medial longus

(medial 3)Short flexor muscles

Medial Longitudinal Arches

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Supports of Arches

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Posterior pillarCalcaneusAnterior pillarsHeads of lateral two

metatarsalsKeystoneCuboid

Lateral Longitudinal Arches

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Tie beamPlantar aponeurosis

Lateral Longitudinal Arches

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Peroneus longusPeroneus brevisShort flexor muscles on lateral

aspectLong and short plantar ligaments

Supports of Lateral Arches

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Supports of Lateral Arches

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Transverse Arch

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Medial pillarHead of first

metatarsal Lateral pillarDeep transverse

ligament of soleTransverse head of

adductor hallucis

Transverse Arch

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Depressed archHead of the third

metatarsal compresses the lateral branch of medial digital nerve

Morton’s metatarsalgia Pain increased by tight

shoes, relieved by taking shoes off

Transverse Arch

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Morton’s MetatarsalgiaMorton’s Metatarsalgia

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Second MetatarsalSecond Metatarsal

Second metatarsal is the most fixed

Thinnest Longest Stress fracturesCan effect any other

bone

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Foot ProblemsFoot Problems

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Nerve Supply of the FootNerve Supply of the FootMedial calcaneal nerveMedial plantar nerveThree and half toesLateral plantar nervesOne and half toes

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Nerve Supply of Dorsum Nerve Supply of Dorsum Superficial peroneal

nerveDeep peroneal nerve, first

cleftSaphenous nerve, medial

border to base of big toeSural nerve, lateral

border

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Nerve SupplyNerve Supply

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Feet Feet

Pronated or flat footIncrease knee and back

painMedial tibial syndromeCuboid syndromePes cavus rigid footAchilles tendonosis

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Pronated FootPronated Foot

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Foot PrintsFoot Prints

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Pes CavusPes Cavus

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Foot ProblemsFoot Problems

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Foot ProblemsFoot Problems

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Foot ProblemsFoot Problems

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Foot ProblemsFoot Problems

Server’s

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Netter

Heel Pain

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Heel Pain

Netter

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