Foot. Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology
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1 Foot Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology
2 Dorsum of the Foot Sole of the Foot
3 Plantar aponeurosis It is a triangular thickening of deep fascia in the sole of the foot Attachments: Apex: is attached to calcaneus Base: divides into five slips that pass into the toes. Function: protects the deeper structures and supports the longitudinal arches of the foot Plantar view
4 Plantar aponeurosis
5 Muscles of the Sole of the Foot The muscles of the sole are conveniently described in four layers from the inferior layer superiorly Unlike the small muscles of the hand, the sole muscles have few delicate functions and are chiefly concerned with supporting the arches of the foot. Although their names would suggest control of individual toes, this function is rarely used in most people First layer: 1-Abductor hallucis 2-Flexor digitorum brevis 3-Abductor digiti minimi Plantar view
6 Second layer: 1-Quadratus plantae 2-Lumbricals 3-Flexor digitorum longus tendon 4-Flexor hallucis longus tendon Plantar view
7 Third layer: 1-Flexor hallucis brevis 2-Adductor hallucis 3-Flexor digiti minimi brevis Plantar view
8 Fourth layer: 1-Interossei 2- Fibularis longus tendon 3-Tibialis posterior tendon Plantar view
9 Posterior tibial artery Arteries of the Sole of the Foot Lateral Plantar Artery Medial Plantar Artery Is the smaller of the terminal branches of the posterior tibial artery Ends by supplying the medial side of the big toe Medial Plantar Artery Lateral Plantar Artery Is the larger of the terminal branches of the posterior tibial artery Forms the plantar arch At the proximal end of the first intermetatarsal space joins the dorsalis pedis artery Plantar view
10 Anterior tibial artery Arteries of the Dorsum of the Foot Dorsalis Pedis Artery (the Dorsal Artery of the Foot) Starts as a continuation of anterior tibial artery Enters the sole of the foot (between the two heads of the first dorsal interosseous muscle) and joins the lateral plantar artery Dorsal view
11 Surface anatomy
12 Tibial nerve Nerves of the Sole of the Foot Lateral Plantar Nerve Medial Plantar Nerve Is a terminal branch of the tibial nerve Supplies the medial 2/3 of sole and medial three and a half toes Medial Plantar Nerve Lateral Plantar Nerve Is a terminal branch of the tibial nerve Supplies lateral 1/3 of sole and lateral one and a half toes The nerves extend onto the dorsum and supply the nail beds and the tips of the toes These nerves supply most intrinsic muscles of the foot Plantar view
13 Nerves of the Dorsum of the Foot Deep fibular nerve Superficial fibular nerve?????? Dorsal view
14 The Arches of the Foot A segmented structure can hold up weight only if it is built in the form of an arch The foot has three such arches: 1. Medial Longitudinal Arch 2. Lateral Longitudinal Arch 3.Transverse Arch Function of arches of the foot Protect the soft tissues of the sole Distribution of the body weight
15 Lateral view Note The bones of the foot do not lie in a horizontal plane. They form longitudinal and transverse arches relative to the ground, which absorb and distribute downward forces from the body during standing and moving on different planes Normally, the ball of the foot carries about 40% of the weight and the heel carries about 60%.
16 Body weight Arches of the Foot The bones of the foot are arranged in two arches that are held in position by ligaments and tendons 50% on the right side 50% on the left side The heel The ball of the foot Usually, the arches are fully developed by age 12 or 13.
17 In the newborn and young child, the foot appears to be flat because of the presence of a large amount of subcutaneous fat on the sole of the foot Arches do not develop until about 2-3 years of age, meaning flat feet during infancy is normal
18 When a person wears high-heeled shoes, the distribution of weight changes so that the ball of the foot may carry up to 80% and the heel 20%. As a result, the fat pads at the ball of the foot are damaged, joint pain develops, and structural changes in bones may occur.
19 Plantar surface showing the surface of contact with the ground when standing
20 Calcaneus Talus Navicular Cuneiforms Cuboid 5 th 1 st 2 nd 3 rd 4 th Plantar view
21 Medial Longitudinal Arch It is formed by the calcaneus, talus, navicular, three cuneiforms and first three metatarsal bones Lateral Longitudinal Arch It is formed by the calcaneus, cuboid and 4th and 5th metatarsal bones Note: The lateral arch is the flatter and lies on the ground in the standing position Plantar view
22 Transverse Arch It is formed by the metatarsal bases, the cuboid and the three cuneiform bones
23 Ligaments that support the arches include: Plantar calcaneonavicular (spring ligament) Ahort plantar ligament (Plantar calcaneocuboid) Long plantar ligament Plantar aponeurosis Muscles that provide dynamic support for the arches during walking include: Tibialis anterior Tibialis posterior Fibularis longus
24 Calcaneus Cuboid Long plantar ligament runs from calcaneus and cuboid to the bases of the lateral metatarsal bones Plantar view
25 Calcaneus Short plantar ligament (Plantar calcaneocuboid ) Long plantar ligament Cuboid Plantar view
26 Sustentaculum tali Calcaneus Talus Medial view Medial cuniform Navicular Calcaneus
27 Medial view Plantar calcaneonavicular (spring ligament)
28
29 Flat foot (pes planus) Is a condition in which the medial longitudinal arch is depressed or collapsed. As a result, 1-The foot is everted 2-The head of the talus is no longer supported by calcaneus 3-The body weight forces the talus downward and medially Pes: foot
30 Pes cavus (claw foot) Is a condition in which the medial longitudinal arch is excessively high Most cases are caused by muscle imbalance, as in poliomyelitis
31 Plantar fasciitis It happens to person who is standing or walking for long time It causes pain and tenderness of the sole of the foot Repeated attacks of this condition induce ossification in the posterior attachment of the aponeurosis
32 Tarsal tunnel syndrome Due to compression of tibial nerve as it travels through the tarsal tunnel. Manifestation : Motor Sensory
33 Tarsal tunnel syndrome: distribution of sensory loss
34 Tarsal tunnel syndrome due to ganglion
35 Tibial nerve in tarsal tunnel
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