ANATOMY LECTURE SOLE OF FOOT 10.11.2008

Dermatomes of the foot

MUSCLES OF POSTERIOR COMPARTMENT OF LEG Tibialis posterior Flexor digitorum longus Flexor hallucis longus

Artery & Nerve Posterior tibial artery Tibial nerve

BONES OF FOOT TARSAL : Metatarsal phalanx Calcaneus Talus Navicular Cuniform (laeral,intermediate and medial) Metatarsal phalanx

Skin and fascia Skin: thick & hairless firmly attached to the underlying deep fascia. Deep fascia: Plantar aponeorosis: apex Δ central thickened deep fascia attached to the medial & lateral tubercles of calcaneum, base distally. function: protection of deeper structures & maintain the arches of the foot.

Muscles of the sole: There are four layers of muscles: first layer: abductor hallucis, flexor digitorum brevis, abductor digiti minimi 2nd layer: quadratus plantae lumbricalis, flexor digitorum longus tendon, flexor hallucis longus tendon. 3rd layer: flexor hallucis brevis adductor hallucis, flexor digiti minimi brevis 4th layer interossei, peroneus longus tendon tibialis posterior tendon.

Muscles of the Sole of the Foot (First Layer) flexor hallucis brevis ORIGIN cuboid, lateral cuneiform bones; tibialis posterior insertion INSERTION medial & lateral sides of base of proximal phalanx of big toe NERVE medial plantar nerve ACTION flexes metatarsophalangeal joint of big toe; supports medial longitudinal arch adductor hallucis (oblique head) bases of 2nd, 3rd & 4th metatarsal bones lateral side base of proximal phalanx big toe deep branch of lateral plantar flexes big toe, supports transverse arch adductor hallucis (transverse head) plantar ligaments lateral side of base of proximal phalanx big toe deep branch of lateral plantar nerve flexes big toe; supports transverse arch flexor digiti minimi brevis base of 5th metatarsal bone lateral side of base of proximal phalanx of big toe superior branch of lateral plantar nerve flexes little toe

muscles of Sole of Foot (Second Layer) flexor accessorius (quadratus plantae) ORIGIN medial and lateral sides of calcaneum INSERTIONtendons flexor digitorum longus NERVE lateral plantar nerve ACTION aids long flexor tendon to flex lateral four toes flexor digitorum longus tendon shaft of tibia base of distal phalanx of lateral four toes tibial nerve flexes distal phalanges of lateral four toes; plantar flexes foot; supports longitudinal arch lumbricals tendons of flexor digitorum longus dorsal extensor expansion of lateral four toes 1st lumbrical from medial plantar; remainder lumbricals from deep branch of lateral plantar nerve extends toes at interphalangeal joints flexor hallucis longus shaft of fibula base of distal phalanx of big toe flexes distal phalanx of big toe; plantar flexes foot; supports medial longitudinal arch

Muscles of Sole of Foot (Third Layer) flexor hallucis brevis ORIGIN cuboid, lateral cuneiform bones; tibialis posterior insertion INSERTION medial & lateral sides of base of proximal phalanx of big toe NERVE medial plantar nerve ACTION flexes metatarsophalangeal joint of big toe; supports medial longitudinal arch adductor hallucis (oblique head) bases of 2nd, 3rd & 4th metatarsal bones lateral side base of proximal phalanx big toe deep branch of lateral plantar flexes big toe, supports transverse arch adductor hallucis (transverse head) plantar ligaments lateral side of base of proximal phalanx big toe deep branch of lateral plantar nerve flexes big toe; supports transverse arch flexor digiti minimi brevis base of 5th metatarsal bone lateral side of base of proximal phalanx of big toe superior branch of lateral plantar nerve flexes little toe

Muscles of Sole of Foot (Fourth Layer) dorsal interossei (4) ORIGIN adjacent sides of metatarsal bones INSERTION bases of phalanges and dorsal expansion of corresponding toes NERVElateral plantar nerve ACTION abduct toes with 2nd toe as the reference; flex metatarsophalangeal joints; extend interphalangeal joint plantar interossei (3) 3rd, 4th, and 5th metatarsal bones bases of phalanges & dorsal expansion of corresponding toes lateral plantar nerve adduct toes with 2nd toe as reference; flex metatarsophalangeal joints; extend interphalangeal joints tendon of peroneus longus see above tendon of tibialis posterior

Arteries of the Sole of the Foot The arteries of the sole of the foot: are derived from the posterior tibial artery. It splits into the medial and lateral plantar arteries. The medial plantar artery passes along the medial part of the sole of the foot and terminates by branching into digital branches. The lateral plantar artery becomes the plantar arterial arch which anastomoses by way of a perforating artery with the dorsal pedis artery. The arch gives rise to several metatarsal branches which split into digital branches.

NERVES

Nerves of the Sole of the Foot The medial and lateral plantar nerves supply muscles and skin of the sole of the foot. The medial plantar nerve gives rise to digital branches which then give rise to common digital branches and finally, the terminal branches. This nerve supplies the skin of the medial three and one half digits. The lateral plantar nerve gives rise to motor branches, a deep branch and finally branches to the skin of the lateral one and one-half digits.

Arches of the Foot All of the bones of the foot are held together by ligaments but there are three that are strongly implicated in maintaining the arches of the foot: long plantar ligament calcaneocuboid ligament calcaneonavicular ligament

The longitudinal arch of the foot is higher on the medial side The longitudinal arch of the foot is higher on the medial side. It is made up of the 1st three digits and their metatarsals, the cuneiforms, the navicular bone and the talus. The lateral longitudinal arch is made up of digits 4 and 5 and their metatarsals, the cuboid and the calcaneum. It is much shallower than the medial arch. The transverse arch of the foot is primarily formed by the 5 metatarsal bones.

THANK YOU THANKYOU Thank you for attention Anatomy Dr. Kumar Associate Professor Dr. Mashair Instructor THANKYOU