Transcript Clinical Anatomy of the Foot2014+++

Clinical Anatomy of The Foot
By Dr.Sanaa Alshaarawy
OBJECTIVES OF Clinical Anatomy Of FOOT
After the end of this lecture you should able to :
•Know the Function of foot arches.
•Describe the Medial, Lateral longitudinal and
Transverse arches.
•Know Maintenance of the longitudinal arches.
•Describe Applied anatomy regarding the arches.
•Describe Clinical Anatomy regarding deep
fascia,muscles,joints,nerves and vessels.
• Describe the Tarsal Tunnel Syndrome.
Arches of the Foot
•The foot arches are formed by the bones,
ligaments, and tendons of the foot.
Function :
They act as a weight bearing.
They act as a locomotive part of the
body in walking & running.
They provide space in the sole of foot to
contain and protect the muscles, nerves
and blood vessels of the sole.
 They provide support and flexibility to
the foot.
Medial Longitudinal Arch
•The "medial longitudinal arch"
is the most prominent foot
arch.
• It runs from front to back along
the inner edge of the foot.
•This arch absorbs the majority
of the shock of impact while
walking, jumping or running.
Medial Longitudinal Arch
•This arch is very tall and is extremely flexible due to its large number
of component bones.
•Its apex (the trochlear surface of the talus) and its two extremities
which are the medial tubercle of the calcaneum and the heads of
1st -3rd metatarsals..
• It is formed of calcaneum, talus, navicular, 3 cuneiform bones, and
first medial 3 metatarsal bones.
Lateral Longitudinal Arch
It runs along the outer edge of the foot.
It is most visible in people with very high arches.
It is difficult to define its apex because although body weight
is transmitted into it via the talus, the talus is not part of the arch.
The extremities are the lateral tubercle of the calcaneum and
the heads of 4th -5th metatarsals.
This arch is flat and contains relatively few bones.
It is formed of calcaneum, cuboid and lateral 4th & 5th
metatarsal bones.
Transverse Arch
• It runs across the midfoot.
• Lies at the level of tarso-metatarsal
joints.
• It provides support and flexibility to the
foot.
• This arch is maintained by the same
muscles and ligaments as the longitudinal
arches.
•Formed of bases of all metatarsal bones,
cuboid and 3 cuneiform bones.
Factors Maintaining Foot Arches
These arches are maintained by :
•The shape of the foot bones which allows them to interlock.
•The activity of muscles.
• A wide variety of ligaments (plus the tendons of muscles acting
as ligaments) play an important role in supporting the arches..
Maintenance of the longitudinal arches
•The longitudinal arches are supported and
stabilised by :
•The shape of the bones which allows them to
interlock
•The muscles whose tendons run into the apex of the
arches and tend to increase their height (e.g. tibialis
anterior)
•The muscles whose tendons run into the sole of the
foot where they have a longitudinal course. They prevent
the extremities separating (e.g. peroneus longus and
small intrinsic muscles which also run longitudinally).
•A variety of longitudinally arranged ligaments which
prevent the extremities separating, for example the
long and short plantar ligaments and by the plantar
calcaneonavicular ("spring") ligament.
ligaments
Maintenance of the longitudinal arches

The plantar aponeurosis arises posteriorly
from calcaneus and distally divides into five bands that
become continuous with the fibrous digital sheaths that
enclose the flexor tendons of the toes.
• It has slips to the toes, Extending (raising) the toes and
heightening the longitudinal arches.
Applied Anatomy of Foot
BIRTH DEFECTS (Clubfoot).
High Arches.
Flat Foot.
BIRTH DEFECTS :
Clubfoot is a common congenital deformity involving one foot or both.
The affected foot appears to have been rotated internally at the ankle.
In babies with clubfoot the ligaments and tendons of muscles are
shorter than usual causing their feet to be twisted.
In many cases, the defect can be corrected using casts on the childs's
feet and legs but some cases may require surgery.
Without treatment, people with club feet often appear to walk on their
ankles or on the sides of their feet. However with treatment, the majority
of patients recover completely during early childhood and are able to
walk.
Pes Cavus
(High Foot Arch)
• Cavus foot is a condition in which the foot has a very high
arch.
• It is the opposite of flat foot.
• It is much less common than flat foot.
• There is a fixed plantar flexion deformity of the foot.
Pes Cavus (High Foot Arch)
Causes :
 It may be hereditary or acquired, They are
more associated with an orthopedic,
neurological or neuromuscular conditions.
Neuromuscular diseases that cause changes in
muscle tone (shortening of muscles or tendons
of leg or sole), in most cases due to
poliomyelitis.
It usually need foot support. A high arch may
cause significant disability.
Symptoms :
•Shortened length of foot.
•Difficulty fitting shoes.
•Hammertoes (bent toes) or claw toes.
•Foot pain associated with walking, standing,
and running.
Pes planus (Flat Foot)
The medial longitudinal arch is
depressed, so the foot is displaced laterally
and everted.
Causes of flat foot :
• Congenital.
• Stretched or torn tendons.
• Damage or inflammation of the tibialis posterior
tendon, which connects from your lower leg, along
your ankle, to the middle of the arch
• Broken or dislocated bones.
• Some health conditions, such as rheumatoid
arthritis.
• Nerve problems.
• So weak muscles & ligaments are stretched and
pain is produced after walking for a short distance.
Other factors that can increase your risk include:
Obesity
Diabetes
Pregnancy
Long standing or Long walking.
Anatomical Importance of the
Deep Fascia Of Foot
• The deep fascia is thin on the
dorsum of the foot.
•The plantar fascia, the deep fascia
of the sole, is thicker in the central part
(plantar aponeurosis) and weaker
medial and lateral parts.
• The plantar fascia holds parts of
the foot together, helps protect the sole
from injury, and helps support the
longitudinal arches of the foot.
The Anatomical Importance of the Muscles of the Foot
• Of the 20 individual muscles of the foot,
14 are located on the plantar aspect, 2 are
on the dorsal aspect, and 4 are
intermediate in position.
• On the dorsum of the foot, there are two
closely connected muscles: the extensor
digitorum brevis (EDB) and extensor
hallucis brevis (EHB). These muscles
form a fleshy mass on the lateral part of
the dorsum of the foot, they aid the
extensor digitorum and extensor hallucis
longus to extend digits.
The Anatomical Importance of the Muscles of the Foot
Most of the muscles are
lying in the sole.
The plantar muscles
(muscles of the sole) are
located in four layers.
They don’t work as
complicated as the small
muscles in the hands; they
mostly work together to
support the arches of the
foot.
The Anatomical Importance of the Muscles of the Foot
•Rather than producing actual movement, they are most active in fixing
the foot or to maintain balance.
• Plantar interossei ADduct and arise from a single metatarsal as
unipennate muscles.
• Dorsal interossei ABduct and arise from two metatarsals as
bipennate muscles.
Joints of the Foot
Subtalar (talocalcaneal) Joint :
Articulation :
• Inferior surface of
body of talus.
• Upper surface of
calcaneum.
• It is a talocalcaneal part
of talocalcaneonavicular
joint.
Movements :
• Inversion.
• Eversion.
Nerves and Arteries Of Foot
•The tibial nerve and posterior
tibial artery divide posterior to
the medial malleolus into the
medial and lateral plantar nerves
and arteries.
•These nerves & arteries supply
the intrinsic muscles of the sole
of foot.
Clinical Anatomy of the Dorsal venous arch of Foot
Is a superficial vein that connects the small
saphenous vein and the great saphenous vein.
It drains deoxygenated blood from the foot.
It lies superior to the metatarsal bones.
Clinical significance :
Varicose veins: The great saphenous vein, like
other superficial veins, can become varicose; swollen,
twisted and lengthened.
• Elevating the legs provides temporary symptomatic
relief.
• Advice about regular exercise.
• Wearing of compression stockings.
Venous Thrombosis : if the blood clot is located
near the sapheno-femoral junction , a clot fragment
can migrate to the deep venous system and to the
pulmonary circulation. Also it can be associated
with, or progress to a deep vein thrombosis which
must be treated immediately.
Dorsalis Pedis Artery
It supplies the dorsum of the
foot.
 It arises at the anterior
aspect of ankle joint as a
continuation of the anterior
tibial artery.
It terminates at the first
intermetatarsal space, where it
divides into two branches, the
first dorsal metatarsal artery
and the deep plantar artery.
Clinical Anatomy of the dorsalis pedis artery
The dorsalis pedis artery pulse
can be palpated lateral to the
extensor hallucis longus tendon on
the dorsum of the foot.
It is often examined, by
physicians, in cases of peripheral
vascular disease.
Recently, MR angiography has
been reported as an accurate
technique for analyzing the foot
arteries in diabetic patients referred
for surgical revascularization.
What is the tarsal tunnel?
It is a space in the foot
located between bones and
the flexor retinaculum .
What are the symptoms of
tarsal tunnel syndrome?
When the tibial nerve is compressed in
the tarsal tunnel, patients commonly
complain of numbness over the bottom
of the foot, as well as complaints of
burning pain, and tingling over the base
of the foot and heel.
What is the cause of tarsal
tunnel syndrome?
Unknown in most cases, but can be the
result of fractures, benign tumors,
muscle injury, or foot deformities.
THANK YOU