ANATOMY LECTURE

SOLE OF FOOT10.11.2008

Dermatomes of the footDermatomes of the foot

MUSCLES OF POSTERIOR MUSCLES OF POSTERIOR COMPARTMENT OF LEGCOMPARTMENT OF LEG

Tibialis posteriorTibialis posterior

Flexor digitorum Flexor digitorum longuslongus

Flexor hallucis longusFlexor hallucis longus

Artery & NerveArtery & Nerve

Posterior tibial arteryPosterior tibial artery

Tibial nerve Tibial nerve

BONES OF FOOTBONES OF FOOT

TARSAL :TARSAL :CalcaneusCalcaneus

TalusTalus

NavicularNavicular

CuniformCuniform

(laeral,intermediate(laeral,intermediate

and medialand medial))

MetatarsalMetatarsal

phalanxphalanx

Skin and fasciaSkin and fascia

Skin:Skin: thick & hairless thick & hairless firmly attachedfirmly attached

to the underlying deep fasciato the underlying deep fascia.. Deep fascia:Deep fascia:

Plantar aponeorosisPlantar aponeorosis: : apex apex ΔΔ central thickened deep fascia central thickened deep fasciaattached to the medial & lateral tubercles of attached to the medial & lateral tubercles of calcaneum, base distally.calcaneum, base distally.function: protection of deeper structures & function: protection of deeper structures & maintain the arches of the footmaintain the arches of the foot..

Muscles of the sole:Muscles of the sole:

There are four layers of musclesThere are four layers of muscles::first layer:first layer: abductor hallucis,abductor hallucis, flexor digitorum brevis,flexor digitorum brevis, abductor digiti minimiabductor digiti minimi2nd layer:2nd layer: quadratus plantaequadratus plantaelumbricalis, flexor digitorum longus tendon, lumbricalis, flexor digitorum longus tendon, flexor hallucis longus tendon.flexor hallucis longus tendon.3rd layer3rd layer:: flexor hallucis brevisflexor hallucis brevis adductor hallucis, flexor digiti minimi brevisadductor hallucis, flexor digiti minimi brevis 4th layer4th layerinterossei, peroneus longus tendoninterossei, peroneus longus tendontibialis posterior tendontibialis posterior tendon..

Muscles of the Sole of the Foot (First Layer)Muscles of the Sole of the Foot (First Layer)

MUSCLEMUSCLEflexor flexor hallucis hallucis brevisbrevis

ORIGINORIGINcuboid, lateral cuboid, lateral cuneiform bones; cuneiform bones; tibialis posterior tibialis posterior insertioninsertion

INSERTIONINSERTIONmedial & lateral sides medial & lateral sides of base of proximal of base of proximal phalanx of big toephalanx of big toe

NERVENERVEmedial plantar medial plantar nervenerve

ACTIONACTIONflexes metatarsophalangeal flexes metatarsophalangeal joint of big toe; supports joint of big toe; supports medial longitudinal archmedial longitudinal arch

adductor adductor hallucis hallucis (oblique (oblique head)head)

bases of 2nd, 3rd & bases of 2nd, 3rd & 4th metatarsal bones4th metatarsal bones

lateral side base of lateral side base of proximal phalanx big proximal phalanx big toetoe

deep branch deep branch of lateral of lateral plantarplantar

flexes big toe, supports flexes big toe, supports transverse archtransverse arch

adductor adductor hallucis hallucis (transve(transverse rse head)head)

plantar ligamentsplantar ligamentslateral side of base of lateral side of base of proximal phalanx big proximal phalanx big toetoe

deep branch deep branch of lateral of lateral plantar nerveplantar nerve

flexes big toe; supports flexes big toe; supports transverse archtransverse arch

flexor flexor digiti digiti minimi minimi brevisbrevis

base of 5th base of 5th metatarsal bonemetatarsal bone

lateral side of base of lateral side of base of proximal phalanx of big proximal phalanx of big toetoe

superior superior branch of branch of lateral plantar lateral plantar nervenerve

flexes little toeflexes little toe

muscles of Sole of Foot (Second Layer)muscles of Sole of Foot (Second Layer)

MUSCLEMUSCLEflexor flexor accessoriuaccessorius s (quadratus (quadratus plantae)plantae)

ORIGINORIGINmedial medial and and lateral lateral sides of sides of calcaneucalcaneumm

INSERTIONINSERTIONttendons endons flexor flexor digitorum digitorum longuslongus

NERVENERVElateral plantar nervelateral plantar nerve

ACTIONACTIONaids long flexor tendon aids long flexor tendon to flex lateral four toesto flex lateral four toes

flexor flexor digitorum digitorum longus longus tendontendon

shaft of shaft of tibiatibia

base of base of distal distal phalanx of phalanx of lateral four lateral four toestoes

tibial nervetibial nerve

flexes distal phalanges flexes distal phalanges of lateral four toes; of lateral four toes; plantar flexes foot; plantar flexes foot; supports longitudinal supports longitudinal archarch

lumbricalslumbricals

tendons tendons of flexor of flexor digitorum digitorum longuslongus

dorsal dorsal extensor extensor expansion expansion of lateral of lateral four toesfour toes

1st lumbrical from medial 1st lumbrical from medial plantar; remainder plantar; remainder lumbricals from deep lumbricals from deep branch of lateral plantar branch of lateral plantar nervenerve

extends toes at extends toes at interphalangeal jointsinterphalangeal joints

flexor flexor hallucis hallucis longuslongus

shaft of shaft of fibulafibula

base of base of distal distal phalanx of phalanx of big toebig toe

tibial nervetibial nerve

flexes distal phalanx of flexes distal phalanx of big toe; plantar flexes big toe; plantar flexes foot; supports medial foot; supports medial longitudinal archlongitudinal arch

Muscles of Sole of Foot (Third Muscles of Sole of Foot (Third Layer) Layer)

MUSCLEMUSCLEflexor flexor hallucis hallucis brevisbrevis

ORIGINORIGINcuboid, lateral cuboid, lateral cuneiform bones; cuneiform bones; tibialis posterior tibialis posterior insertioninsertion

INSERTIONINSERTIONmedial & lateral medial & lateral sides of base of sides of base of proximal phalanx proximal phalanx of big toeof big toe

NERVENERVEmedial medial plantar plantar nervenerve

ACTIONACTIONflexes flexes metatarsophalangeal metatarsophalangeal joint of big toe; supports joint of big toe; supports medial longitudinal archmedial longitudinal arch

adductor adductor hallucis hallucis (oblique (oblique head)head)

bases of 2nd, 3rd bases of 2nd, 3rd & 4th metatarsal & 4th metatarsal bonesbones

lateral side base lateral side base of proximal of proximal phalanx big toephalanx big toe

deep deep branch of branch of lateral lateral plantarplantar

flexes big toe, supports flexes big toe, supports transverse archtransverse arch

adductor adductor hallucis hallucis (transvers(transverse head)e head)

plantar ligamentsplantar ligamentslateral side of lateral side of base of proximal base of proximal phalanx big toephalanx big toe

deep deep branch of branch of lateral lateral plantar plantar nervenerve

flexes big toe; supports flexes big toe; supports transverse archtransverse arch

flexor flexor digiti digiti minimi minimi brevisbrevis

base of 5th base of 5th metatarsal bonemetatarsal bone

lateral side of lateral side of base of proximal base of proximal phalanx of big toephalanx of big toe

superior superior branch of branch of lateral lateral plantar plantar nervenerve

flexes little toeflexes little toe

Muscles of Sole of Foot (Fourth Muscles of Sole of Foot (Fourth Layer)Layer)

MUSCLEMUSCLEdorsal dorsal interossei interossei (4)(4)

ORIGINORIGINadjacent adjacent sides of sides of metatarsal metatarsal bonesbones

INSERTIONINSERTIONbases of phalanges and bases of phalanges and dorsal expansion of dorsal expansion of corresponding toescorresponding toes

NERVENERVElateral lateral plantar plantar nervenerve

ACTIONACTIONabduct toes with 2nd toe as the reference; abduct toes with 2nd toe as the reference; flex metatarsophalangeal joints; extend flex metatarsophalangeal joints; extend interphalangeal jointinterphalangeal joint

plantar plantar interossei interossei (3)(3)

3rd, 4th, and 3rd, 4th, and 5th 5th metatarsal metatarsal bonesbones

bases of phalanges & bases of phalanges & dorsal expansion of dorsal expansion of corresponding toescorresponding toes

lateral lateral plantar plantar nervenerve

adduct toes with 2nd toe as reference; adduct toes with 2nd toe as reference; flex metatarsophalangeal joints; extend flex metatarsophalangeal joints; extend interphalangeal jointsinterphalangeal joints

tendon of tendon of peroneus peroneus longuslongus

see abovesee above see abovesee above see see aboveabove see abovesee above

tendon of tendon of tibialis tibialis posteriorposterior

see abovesee above see abovesee above see see aboveabove see abovesee above

Arteries of the Sole of the FootArteries of the Sole of the Foot The arteries of the sole of the foot:The arteries of the sole of the foot:

are derived from the are derived from the posterior tibial arteryposterior tibial artery..

It splits into the medial and lateral plantar arteries. It splits into the medial and lateral plantar arteries.

The The medial plantar arterymedial plantar artery

passes along the medial part of the solepasses along the medial part of the sole of the foot and terminates byof the foot and terminates by branching into digital branches. branching into digital branches.

The The lateral plantar arterylateral plantar artery becomes the becomes the plantar arterial archplantar arterial arch which anastomoses by way ofwhich anastomoses by way of a perforating artery with thea perforating artery with the dorsal pedis arterydorsal pedis artery. . The arch gives rise to several metatarsalThe arch gives rise to several metatarsal branches which split into branches which split into digital branchesdigital branches. .

NERVESNERVES

Nerves of the Sole of the FootNerves of the Sole of the Foot

The The medial and lateral plantar nervesmedial and lateral plantar nerves supply supply muscles and skin of the sole of the foot.muscles and skin of the sole of the foot.

The The medial plantar nervemedial plantar nerve gives rise to digital gives rise to digital branches which then give rise to common digital branches which then give rise to common digital branches and finally, the terminal branches. This branches and finally, the terminal branches. This nerve supplies the skin of the medial three and nerve supplies the skin of the medial three and one half digits.one half digits.

The The lateral plantar nervelateral plantar nerve gives rise to motor gives rise to motor branches, a deep branch and finally branches to branches, a deep branch and finally branches to the skin of the lateral one and one-half digits. the skin of the lateral one and one-half digits.

Arches of the FootArches of the Foot

All of the bones of the foot are All of the bones of the foot are held together by ligaments but held together by ligaments but there are three that are strongly there are three that are strongly implicated in maintaining the implicated in maintaining the

arches of the footarches of the foot:: 1.1. long plantar ligament long plantar ligament

2.2. calcaneocuboid ligament calcaneocuboid ligament

3.3. calcaneonavicular ligament calcaneonavicular ligament

The The longitudinallongitudinal arch arch of the foot is of the foot is higher on the higher on the medialmedial side. It is side. It is made up of the 1st three digits and made up of the 1st three digits and their metatarsals, the cuneiforms, their metatarsals, the cuneiforms, the navicular bone and the talus.the navicular bone and the talus.

The The lateral longitudinallateral longitudinal arch is arch is made up of digits 4 and 5 and their made up of digits 4 and 5 and their metatarsals, the cuboid and the metatarsals, the cuboid and the calcaneum. It is much shallower calcaneum. It is much shallower than the medial arch.than the medial arch.

The The transversetransverse arch arch of the foot is of the foot is primarily formed by the 5 metatarsal primarily formed by the 5 metatarsal bones. bones.

THANK YOUTHANK YOU

Thank you for attentionThank you for attention

AnatomyAnatomy Dr. KumarDr. Kumar Associate Professor Associate Professor Dr. MashairDr. Mashair InstructorInstructor