Transcript 24-sole2008-05

The sole of the foot
Skin
It is thick & hairless. It is firmly attached to
the underlying deep fascia by fibrous
bands.
It shows a few creases at the sites of skin
movement .
Sweat glands are present in large numbers
The sensory nerve supply of it is derived
from the 1- medial calcaneal branch of the
tibial nerve ( it innervates the medial side of
the heel ) .
2- Branches from the medial planter nerve
( from tibial nerve ) they innervate the
medial two third of the sole .
3- Branches from the lateral planter nerve
( from tibial nerve )they innervate lateral
third of the sole.
4- Branches from saphenous nerve ( from
femoral ) they supply medial border till ball
of big toe.
5- Branches from the sural nerve ( from
posterior tibial ) they supply lateral border &
lateral side of the little toe .
Deep fascia
The plantar aponeurosis is triangular and
occupies the central area of the sole .
It is formed as a thickening of the deep
fascia .
Its apex is attached to the medial &lateral
tubercles of the calcaneum.
Its base is divided into 5 slips at the bases of
the toes .Each slip divides into 2 bands , one
passing superficially to the skin and the
other passing deeply to the root of the toe.
Then each deep band divides into 2 bands
which diverge around the flexor tendons and
fuse with the fibrous flexor sheath & the
deep transverse ligament .
The function of the plantar aponeurosis
The deep fascia which covers the abductor
of the big & little toes is thinner & weak .
1- give firm attachment to the overlying skin At the junction of the medial & lateral
2- protect vessels, nerves, tendons
borders of plantar aponeurosis with the
& synovial sheaths .
3-thinner deep fascia fibrous septa pass
assist in maintaining the arches of the foot superiorly to form fascial spaces of the sole.
First layer of the plantar
muscles of the right foot
1- Abductor hallucis
medial plantar nerve
2- Flexor digitorum brevis
medial planter nerve
3- Abductor digiti minimi
lateral planter nerve
Second layer of the plantar
muscles of the right foot
1- Quadratus plantae
lateral planter nerve
2- Lumbricals
first …….medial planter nerve
the remainder 3 …lateral planter n
3- Flexor digitorum longus tendon
tibial nerve
4- Flexor hallucis longus tendon
tibial nerve
Third layer of the plantar
muscles of the right foot
1- flexor hallucis brevis
medial plantar nerve
2- Adductor hallucis
deep branch of the lateral plantar n
3- flexor digiti minimi brevis
lateral plantar nerve
Fourth layer of the plantar
muscles of the right foot
1- Dorsal interossei
lateral plantar nerve
2- Plantar interossei
lateral plantar nerve
3- Peroneus longus tendon
superficial peroneal nerve
4- Tibialis posterior tendon
tibial nerve
Tendons of the second layers
1- flexor hallucis longus : Its tendon enters the sole by passing behind the medial malleolus
beneath the flexor retinaculum . It runs forward below the sustentaculum tali and crosses deep to
the flexor digitorum longus tendon. It then enters the fibrous sheath of the big toe to insert into the
base of the distal phalanx.
2- flexor digitorum longus : Its tendon enters the sole by passing behind the medial malleolus
beneath the flexor retinaculum. It passes forward along the medial surface of the sustentaculum tali
then crosses the tendon of FHL. It receives on its lateral border the insertion of the quadratus
plantae muscle. It divides into 4 tendons giving origin to lumbrical muscles . They enter the fibrous
sheath of the lateral 4 toes. Each tendon perforates the corresponding tendon of FDB& inserted
into the base of the distal phalanx .
Fibrous flexor sheaths (deep fascia )
The inferior surface of each toe, from the head of the metatarsal to base of the distal
phalanx , is provided with strong fibrous sheath, which is attached to the sides of the
phalanges.
Its distal end is closed & attached to the base of the distal phalanx. It with the inferior
surface of the phalanges & the interphalangeal joints form a blind tunnel in which lie the
flexor tendons of the toe. It is thick over the phalanges but thin and lax over the joints.
The proximal ends of the fibrous sheaths of the toes receive the deeper parts of the 5
slips of the plantar aponeurosis.
Synovial flexor sheaths
1- The tendon of the flexor hallucis longus is surrounded by a synovial sheath , which
extends upward behind the medial malleolus & above the flexor retinaculum. Distally it
extends to the base of the 1st metatarsal . As it enters the fibrous sheath it acquires a
digital synovial sheath .
2- The flexor digitorum longus synovial sheath extends upward behind the medial
malleolus & for a short distance above the flexor retinaculum. Distally it extends to
the navicular.As the 4 tendons enter the fibrous flexor sheath,it acquires a digital
synovial sheath .
3- The tibialis posterior synovial sheath passes beneath the flexor retinaculum to the
tuberosity of the navicular bone .
4- The tendon of the peroneus longus is surrounded by a synovial sheath . It
passes beneath the peroneal retinacula . As the tendon winds around the
lateral margin of the cuboid . It is thickened & contains a sesamoid
cartilage. A second synovial sheath surrounds the tendon as it crosses the
sole.
Arteries of the sole
1- Medial plantar artery
It is the smaller branch of the terminal branches of the posterior tibial artery.
It arises beneath the flexor retinaculum and passes forward deep to the abductor
hallucis muscle . It ends by supplying the medial side of the big toe .
During its course it gives off numerous muscular , cutaneous and articular branches.
Veins of the sole
unite behind the medial malleolus to form the posterior
.
Medial & lateral plantar veins
tibial venae comitantes
2- Lateral plantar artery
It is the larger branch of the terminal branches of the posterior tibial artery .
It arises beneath the flexor retinaculum and passes forward deep to the abductor
hallucis & the flexor digitorum brevis .
On reaching the base of the 5th metatarsal, it is under the cover of abductor digiti
minimi . It curves medially to form the plantar arch and at the proximal end of the 1st
intermetatarsal space joins the dorsalis pedis artery . During its course , it gives off
numerous muscular, cutaneous and articular branches .
The plantar arch gives off plantar digital arteries to the toes .
Nerves of the sole
1- Medial plantar nerve
It is a terminal branch of the tibial nerve . It arises beneath the flexor retinaculum .
It runs forward deep to the abductor hallucis with the medial plantar nerve. It comes
to lie in the interval between the abductor hallucis and the flexor digitorum brevis.
Branches :
1- muscular to abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and the
1st lumbrical muscle .
2cutaneous : plantar digital nerves which run to the sides of the medial 3 and half
toes. They extend onto the dorsum and supply the nail beds & tips of the toes.
Lateral plantar nerve
It is a terminal branch of the tibial nerve . It arises beneath the flexor retinaculum .
It runs forward deep to the abductor hallucis & the flexor digitorum brevis with the lateral
plantar artery. On reaching the base of the 5th metatarsal , it divides into superficial &
deep branches .
Branches :
1- From the main trunk : cutaneous branches to the skin of the lateral part of the sole
and muscular to quadratus plantae ( 2nd ) & abductor digiti
minimi.
2- From the superficial terminal branch :
To the flexor digiti minimi & the interosseous muscles of the 4th intermetatarsal space.
Plantar digital branches pass to the sides of the lateral one and half toes .
They extend onto the dorsum and supply the nail beds & tips of the toes.
3- From the deep terminal branch :
It curves medially with the lateral plantar artery (plantar arch ). It supplies the adductor
hallucis ; the 2nd , 3rd and 4th lumbricals ; all the interossei except those of the 4th
intermetatarsal space .