The Foot. Dr. Wegdan Moh.Mustafa Medicine Faculty Assistant Professor Mob:

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2 The Foot Dr. Wegdan Moh.Mustafa Medicine Faculty Assistant Professor Mob:

3 The skeleton of the foot

4 Cutaneous innervations

5 Sole of foot

6 layers of muscles

7 First layer -Abductor hallucis -Flexor digitorum brevis -Abductor digiti minimi

8 Muscle Nerve Origin Insertion Supply Nerve Action Abductor hallucis Medial tubercle of tuberosity of calcaneus base of proximal phalanx of 1st digit Abducts and flexes big toe digit Flexor Medial tubercle of digitorum brevis tuberosity of calcaneus; plantar aponeurosis Abductor digiti minimi Medial and lateral tubercles of tuberosity of calcaneus; plantar aponeurosis middle phalanges of lateral four digits base of proximal phalanx of 5th digit Lateral plantar nerve Medial plantar nerve Flexes lateral four digits Abducts and flexes little toe

9 Second layer -Tendon of flexor hallucis longus -Tendon of flexor digitorum longus -Lumbrical muscles -Quadratus plantae

10 Muscle Nerve Origin Insertion Supply Nerve Action Quadratus plantae Lumbricals Medial surface and lateral margin of calcaneus Tendons of flexor digitorum longus tendon of flexor digitorum longus Dorsal extensor expansion over lateral four digits Lateral plantar nerve Medial one: medial plantar nerve Lateral three: lateral plantar nerve Assists flexor digitorum longus in flexing lateral four toes Flex proximal phalanges, extend middle and distal phalanges of lateral four toes

11 Third layer -Flexor hallucis brevis -Adductor hallucis -Flexor digiti minimi

12 Muscle Nerve Origin Insertion Supply Nerve Action Flexor hallucis brevis Adductor hallucis Flexor digit minimi brevis cuboid and lateral cuneiforms Oblique head: bases of metatarsals 2to4 Transverse head: plantar ligaments Base of 5th metatarsal base of proximal phalanx of 1st digit base of proximal phalanx of 1st digit Base of proximal phalanx of 5th digit Medial plantar nerve Lateral plantar nerve Flexes proximal phalanx of 1st digit adduct 1st digit Flexes proximal phalanx of 5th digit, thereby assisting with its flexion

13 Fourth layer -Tendon of peroneus longus -Tendon of tibialis posterior -Dorsal & plantar interosseous muscles

14 Muscle Nerve Origin Insertion Supply Nerve Action Plantar interossei (three muscles) Dorsal interossei (four muscles) Inferior surfaces of 3 rd to 5th metatarsal bones Adjacent sides of metatarsal bones bases of phalanges of 3 rd to 5th digits 1st: medial side of proximal phalanx of 2nd digit; 2 nd to 4 th : lateral sides of 2 nd to 4 th digits Lateral plantar nerve Adduct digits and flex metatarsophalang eal joints Abduct digits and flex metatarsophalang eal joints

15 Nerves Medial & lateral plantar

16 Medial Plantar Nerve Is a terminal branch of the tibial nerve Branches: Muscular branches: to the abductor hallucis, the flexor digitorum brevis, the flexor hallucis brevis, and the first lumbrical muscle. Cutaneous branches: skin on medial two-thirds of the sole and medial three and one-half toes. The nerves extend onto the dorsum and supply the nail beds and the tips of the toes

17 Lateral Plantar Nerve Is a terminal branch of the tibial nerve On reaching the base of the fifth metatarsal bone, it divides into superficial and deep branches Branches: Motor: supply all intrinsic muscles in the sole, except for the muscles supplied by the medial plantar nerve. Cutaneous: innervates the skin on the lateral onethirds of the sole and the adjacent plantar surfaces of the lateral one and one-half digits.

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19 Muscle on dorsum of the foot

20 Muscle Origin Insertion Nerve supply Action Extensor digitorum brevis Superolateral surface of the calcaneus Base of proximal phalanx of great toe and lateral sides of the tendons of extensor digitorum longus of toes II to IV Deep fibular nerve Extends toes

21 Deep peroneal nerve Origin: one of the terminal branches of the common peroneal nerve Branches Muscular branche: to muscle on the dorsum of foot Cutaneous branch: supplies the skin between the great and second toes

22 Retinacula of the Ankle The retinacula are thickenings of the deep fascia that keep the long tendons around the ankle joint in position

23 Any Question 23