Transcript Slide 1

Sole Of The Foot
Dr. Rakesh Kumar Verma
Assistant Professor
Department of Anatomy
KGMU UP Lucknow
SKIN
Thick
Nerve Supply
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
SUPERFICIAL FASCIA
Cutaneous Nerves
Cutaneus Arteries
CUTANEOUS NERVES
Medial calcaneal
branch of the tibial
nerve
Medial
plantar
nerve
Lateral
plantar
nerve
Sural & saphenous
nerve
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
MUSCLES FOUR LAYERS
FIRST(SUPERFICIAL)
SECOND
THIRD
FOURTH
1st Layer
• Three Muscles:
1)Abductor hallucis
2)Flexor digitorum
brevis
3)Abductor
digiti
minimi
1st Layer
SECOND LAYER
• 1.QUADRATUS
PLANTAE/FLEXOR
DIGITORUM
ACCESSORIOUS
• 2.LUMBRICALS
• 3.TENDON OF FLEXOR
DIGITORUM LONGUS
• 4.TENDON OF FLEXOR
HALLUCIS LONGUS
2nd Layer
• Two Tendons:
1) Flexor halusis longus
2) Flexor
digitorum
longus
• Two Muscles:
1) Quadratus Plantae
(Flexor
digitorum
accessorius)
2) 4 Lumbricals muscles
1st & 2nd Layers
rd
3
Layer
• Three Muscles:
1)Flexor hallucis
brevis.
2)Adductor
hallucis
3)Flexor
digiti
minimi brevis
FOURTH LAYER
• 1.DORSAL
INTEROSSEI (4)
2.PLANTER
INTEROSSEI(3)
• 3.TENDON OF
PERONEUS LONGUS
• 4.TENDON OF
TIBIALIS POSTERIOR
th
4
• Two Tendons:
1)Tibialis posterior
2)Peroneus Longus
• Two Muscles:
1)3
Planter
Interossei
2)4 Dorsal Interossei
Layer
3rd & 4th Layers
NERVES
MEDIAL PLANTER
LATERAL PLANTER
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.
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
branches:
cutaneous
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.
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.
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.
Tibial nerve
Lat. Plantar Nerve
Med. Plantar Nerve
Br. to Abd. Hallucis
NERVES OF SOLE
To Flex. Dig. Accessorius
To Abd. Digiti Minimi
Br. to Flex. Dig. Brevis
Deep Branch
Superficial Branch
Br. to Flex. Hal. Brevis
1st Lumbrical
2nd Lumbrical
To Flex. Dig. Min. Brevis
& Muscles of
4th interos. space
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.
Medial Plantar Artery
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.
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.
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
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.
APPLIED ANATOMY
• ARCHES OF FOOT
• PAIN
• MTEATARSALGIA
• PLANTAR FASCITIS
• INFECTION
• INJURY
• DIABETIC FOOT
• CALCANEAL SPUR
QUESTION-1
• Which dermatome is mainly 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 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
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