1. Sole Of The Foot Dr. Rakesh Kumar Verma Assistant Professor
Department of Anatomy
KGMU UP Lucknow

2. SKIN
Thick Nerve Supply

3. Skin
Skin Thick and hairless.Firmly bound down to the underlying deep fascia by numerous fibrous bands. Shows a few flexure creases at the sites of skin movement. Sweat glands are present in large numbers. The sensory nerve supply to the skin of the sole of the foot

4. SUPERFICIAL FASCIA
Cutaneous Nerves
Cutaneus Arteries

5. CUTANEOUS NERVES Medial calcaneal branch of the tibial nerve
Medial plantar nerve
Lateral plantar nerve
Sural & saphenous nerve

6. DEEP FASCIA Planter Aponeurosis Deep transverse metatarsal Ligament
Fibrous flexor sheath
Septae

7. Plantar aponeurosis Definition: Attachment:
Thickened band of deep fascia in the sole of the foot.
Attachment:
Posteriorly: Medial tubercle of calcaneus.
Anteriorly: Divides into 5 slips which pass to the 5 toes.
On each side: Attached to the metatarsal bones by medial and lateral intermuscular septa.

8. Plantar aponeurosis Functions:
Protects the underlying nerves and vessels.
Maintains the longitudinal arches of the foot.

10. MUSCLES FOUR LAYERS
FIRST(SUPERFICIAL)
SECOND
THIRD
FOURTH

11. 1st Layer Three Muscles: Abductor hallucis Flexor digitorum brevis
Abductor digiti minimi

12. 1st Layer

14. SECOND LAYER 1.QUADRATUS PLANTAE/FLEXOR DIGITORUM ACCESSORIOUS
2.LUMBRICALS
3.TENDON OF FLEXOR DIGITORUM LONGUS
4.TENDON OF FLEXOR HALLUCIS LONGUS

15. 2nd Layer Two Tendons: Flexor halusis longus Flexor digitorum longus
Two Muscles:
Quadratus Plantae (Flexor digitorum accessorius)
4 Lumbricals muscles

18. 1st & 2nd Layers

19. 3rd Layer Three Muscles: Flexor hallucis brevis. Adductor hallucis
Flexor digiti minimi brevis

21. FOURTH LAYER 1.DORSAL INTEROSSEI (4) 2.PLANTER INTEROSSEI(3)
3.TENDON OF PERONEUS LONGUS
4.TENDON OF TIBIALIS POSTERIOR

22. 4th Layer Two Tendons: Tibialis posterior Peroneus Longus Two Muscles:
3 Planter Interossei
4 Dorsal Interossei

24. 3rd & 4th Layers

25. NERVES
MEDIAL PLANTER
LATERAL PLANTER

26. Medial Plantar Nerve
It is larger of the two terminal branch of the posterior tibial nerve.
Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle.
Terminate at the bases of the metatarsal bones by dividing into 3 planter digital nerves.

27. Medial Plantar Nerve Branches:
Muscular (to four muscles) to: Abductor hallucis.
Flexor digitorum brevis.
Flexor hallucis brevis
First lumbrical muscle
Cutaneous: Planter cutaneous branches:
To the skin of the medial 2/3 of the sole of the foot.
Planter digital nerves
Articular branches: To intertarsal and tarso-metatarsal joints.

28. Lateral Plantar Nerve
It is smaller of the two terminal branches of the posterior tibial nerve. Enters the foot midway between the medial malleolus and the medial tubercle of the calcaneus under cover the flexor retinaculum. Passes forwards and laterally deep to abductor hallusis. Terminate at the base of the 5th metatarsal bone, by dividing into a superficial and a deep branches.

29. Lateral Plantar Nerve Branches: Muscular : Cutaneous:
Flexor digitoum accessorius muscle
Abductor digiti minimi
Flexor digiti minimi brevis
Adductor halucis muscle.
Interossei
2nd, 3rd & 4th lumbricals.
Cutaneous:
Skin of the lat. 1/3 of the sole
Skin on the lat.side of the planter surface of the little toe and the adjoining sides of the 4th & 5th toes.
The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.

31. NERVES OF SOLE Tibial nerve Lat. Plantar Nerve Med. Plantar Nerve
To Flex. Dig. Accessorius
To Abd. Digiti Minimi
Br. to Abd. Hallucis
Br. to Flex. Dig. Brevis
Deep Branch
Superficial Branch
Br. to Flex. Hal. Brevis
1st Lumbrical
To Flex. Dig. Min. Brevis & Muscles of
4th interos. space
2nd Lumbrical

33. Medial Plantar Artery
One of the two terminal branches of the posterior tibial artery. Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle. Passes b/w the abd.hallucis and flexor digitorum brevis.

34. Medial Plantar Artery Muscular
Termination: By anastmosing with the 1st planter metatarsal artery.
Branches:
Muscular
Digital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.

35. Lateral Plantar Artery
One of the two terminal branches of the posterior tibial artery.
At first between the 1st and 2nd layers, then curves medially between the 3rd and 4th layers of the sole.
Turns medially with the deep branch of the lateral planter nerve with slight forward convexity to from the plantar arch between the 3rd & 4th layers of muscles.

36. Lateral Plantar Artery
Branches:
Muscular
Anastomotic branches: b/w arcuate & lateral tarsal arteries of the dorsalis pedis artery.
Posterior perforating arteries:
3 branches which anastomose with the dorsal metatarsal arteries.
Planter digital artery: to the lateral side of the little toe.
Three planter metatarsal arteries

37. Transverse section through sole of right foot
3 Prox. Perforating A
Dorsalis Pedis A.
4th layer
Metatarsal - 1
Metatarsal - 5
3nd layer
2nd layer
Deep Br. Of
Lat. Plantar art.
1st layer
Trunk of Lateral
Plantar art.

39. APPLIED ANATOMY ARCHES OF FOOT PAIN MTEATARSALGIA PLANTAR FASCITIS
INFECTION
INJURY
DIABETIC FOOT
CALCANEAL SPUR

47. QUESTION-1 Which dermatome is mainly stimulated in plantar reflex:
A) L 4
B) L 5 C) S 1
D) S 2

48. QUESTION-2
All of the following belong to 3rd layer of muscles in sole except:
A) Flexor hallucis brevis
B) Abductor hallucis
C) Adductor hallucis
D) Flexor digiti minimi brevis

49. QUESTION-3
During walking though the flexor digitorum longus contracting strongly, the toes do not buckle because of action of all the following muscles except:
A) flexor digitorum accessorious
B) Extensor digitorum longus
C) Lumbricles
D) Interossei

50. QUESTION-4
Plantar arch mainly formed by medial plantar artery – True/ false

51. QUESTION-5
In tarsal tunnel syndrome the sensory supply to which area of the sole is Mainly affected:
A) Heel
B) Medial margin of sole
C) Middle part of sole
D) Lateral part of sole