Transcript Sole Of The Foot - King George's Medical University

SOLE OF THE FOOT
Dr. Jyoti Chopra
Professor
Department of Anatomy
KGMU UP Lucknow
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.
CUTANEOUS NERVES
 Medial calcaneal branch
of the tibial nerve,
which innervates the
medial side of the heel;
 Medial plantar nerve,
which innervate the
medial two thirds of the
sole;
 Lateral plantar nerve,
which innervate the
lateral third of the sole.
DEEP FASCIA
Planter aponeurosis
Deep transverse metatarsal ligament
Fibrous flexor sheath
Septae
PLANTAR APONEUROSIS
• Definition:
 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.
PLANTAR APONEUROSIS
• Functions:
Protects
underlying
and vessels.
Maintains
longitudinal
of the foot.
the
nerves
the
arches
1ST LAYER
• Three Muscles:
1)Abductor hallucis
2)Flexor digitorum
brevis
3)Abductor
digiti
minimi
1ST LAYER
Dr M Eladl
2ND LAYER
• Two Tendons:
1) Flexor halusis longus
2) Flexor
digitorum
longus
• Two Muscles:
1) Quadratus Plantae
(Flexor
digitorum
accessorius)
2) 4 Lumbricals muscles
Dr M Eladl
1ST & 2ND LAYERS
Dr M Eladl
3RD LAYER
• Three Muscles:
1)Flexor hallucis
brevis.
2)Adductor
hallucis
3)Flexor
digiti
minimi brevis
Dr M Eladl
4TH LAYER
• Two Tendons:
1)Tibialis posterior
2)Peroneus Longus
• Two Muscles:
1)3
Planter
Interossei
2)4 Dorsal Interossei
Dr M Eladl
3RD & 4TH LAYERS
Dr M Eladl
MEDIAL PLANTAR NERVE
Origin: The larger of the two terminal
branches of the posterior tibial nerve.
Course: Enter the foot midway between
medial malleolus and medial tubercle of
calcaneus
under cover the flexor retinaculum
Passes deep to the abductor hallucis
Pass between the abductor hallucis and
flexor digitorum brevis
Medial planter vessels along its medial
side
Termination: At the bases of the
metatarsal bones by dividing into 3
planter digital nerves.
Dr M Eladl
MEDIAL PLANTAR NERVE
• Branches:
 Muscular (to four muscles)
to: Abductor hallucis.
1) Flexor digitorum brevis.
2) Flexor hallucis brevis
3) First lumbrical muscle
 Cutaneous:
Planter cutaneous branches:
1) To the skin of the medial 2/3
of the sole of the foot.
2) Planter digital nerves
 Articular
branches:
To
intertarsal
and
tarsometatarsal joints.
Dr M Eladl
LATERAL PLANTAR NERVE
Origin: The smaller of the two
terminal branches of the posterior
tibial nerve.
Course: Passes between medial
malleolus and medial tubercle of
the calcaneus under flexor
retinaculum
Passes deep to abductor hallusis
Passes between flexor digitorum
brevis & flexor digitoum accessorius
Lateral planter vessels run along its
lateral side.
Termination: At the base of the
5th metatarsal bone, by dividing
into a superficial and a deep
branches.
Dr M Eladl
LATERAL PLANTAR NERVE
Branches: Muscular :
1) Flexor
digitoum
accessorius
muscle
2) Abductor digiti minimi
3) Flexor digiti minimi brevis
4) Adductor halucis muscle.
5) Interossei
6) 2nd, 3rd & 4th lumbricals.
 Cutaneous:
1) Skin of the lat. 1/3 of the sole
2) Skin on the lat.side of the planter
surface of the little toe and the
adjoining sides of the 4th & 5th
toes.
3) The planter digital branches, also,
supply the skin on the dorsum of
the terminal phalanges of the
lateral one and half toes.
Dr M Eladl
MEDIAL PLANTAR ARTERY
Origin: Terminal branch of
posterior tibial artery
Course:
Enter the foot midway between
medial malleolus and medial
tubercle of calcaneus, under
flexor retinaculum
Passes deep to abductor hallucis
Runs b/w abd.hallucis and flexor
digitorum brevis
Accompanied by two venae
comitantes
Med.planter nerve runs along its
lat. side
Dr M Eladl
MEDIAL PLANTAR ARTERY
Branches
Cutaneous
Muscular
Digital:
3 superficial digital
branches these branches
end by anastmosing with the
first, second and third
planter metatarsal arteries.
Dr M Eladl
LATERAL PLANTAR ARTERY
• Origin: One of the two
terminal branches of the
posterior tibial artery
• Course:
At first between the 1st and
2nd layers
Curves medially between
the 3rd and 4th layer
Lateral planter nerve lies
along its medial side
Dr M Eladl
Termination:
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 and joins
medially with dorsalis pedis
artery (Plantar Arch).
LATERAL PLANTAR ARTERY
•



Branches:
Muscular
Cutaneous
Anastomotic branches:
 Anastomosis with branches of arcuate &
lateral tarsal arteries of the dorsalis pedis
artery.
 Planter digital artery: to the lateral
side of the little toe
 Four planter metatarsal arteries
 Proximal & distal perforating arteries:
 3 PP & 4 DP ascend through the proximal
and distal ends of interosseous spaces to
anastomose with the dorsal metatarsal
arteries.
Dr M Eladl
QUESTION-1
• Which dermatome is stimulated in plantar
reflex:
A) L 4
B) L 5
C) S 1
D) S 2
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
QUESTION-3
• During walking though the flexor digitorum
longus contracts 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
QUESTION-4
• Plantar arch mainly formed by medial plantar
artery – True/ false
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