The University Of Jordan Faculty Of Medicine FOOT. Dr.Ahmed Salman Assistant Prof. of Anatomy. The University Of Jordan

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1 The University Of Jordan Faculty Of Medicine FOOT Dr.Ahmed Salman Assistant Prof. of Anatomy. The University Of Jordan

2 Tarsal Tunnel Syndrome Due to compression of Tibial nerve as it travels through the tarsal tunnel. Tarsal tunnel is found flexor retinculum Manifestation : Motor Sensory

3 FOOT

5 Sole of the Foot Plantar aponeurosis It is a triangular thickening of the deep fascia of sole. Attachment : apex: is attached to the medial and lateral tubercles of the calcaneum base : it divides into five slips that pass into the toes. Function : protects the underlying nerves, blood vessels, and muscles

6 Plantar Fasciitis It happen 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

layers from the inferior layer superiorly.

7 Muscles of the Sole of the Foot Dr Amjad Shatarat The muscles of the sole are conveniently described in four layers from the inferior layer superiorly. First layer: 1- Abductor hallucis 2- Flexor digitorum brevis 3-Abductor digiti minimi

8 Second layer: 1-Quadratus plantae 2-Lumbricals 3-Flexor digitorum longus tendon 4- Flexor hallucis longus tendon Dr Amjad Shatarat

9 Third layer: 1-Flexor hallucis brevis 2-Adductor hallucis 3- Flexor digiti minimi brevis Dr Amjad Shatarat

Unlike the small muscles of the hand, the

and are chiefly concerned with supporting

Although their names would suggest control

10 Fourth layer: 1- Interossei 2- peroneus longus tendon 3- Tibialis posterior tendon. 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

Dr Amjad Shatarat Arteries of the Sole of the Foot Medial Plantar Artery

posterior tibial artery It ends by supplying the medial side of the big toe

terminal branches of the posterior tibial artery forms the plantar arch at

11 Dr Amjad Shatarat Arteries of the Sole of the Foot Medial Plantar Artery The medial plantar artery is the smaller of the terminal branches of the posterior tibial artery It ends by supplying the medial side of the big toe Lateral Plantar Artery The 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

dorsal interosseous muscle, the dorsalis pedis artery

12 Dorsalis Pedis Artery (the Dorsal Artery of the Foot) On entering the sole between the two heads of the first dorsal interosseous muscle, the dorsalis pedis artery immediately joins the lateral plantar artery Dr Amjad Shatarat

Nerves of the Sole of the Foot Medial Plantar Nerve The medial plantar

digital nerves run to the sides of the medial three and a half toes.

the toes Remember it is similar to the median nerve Lateral Plantar Nerve

13 Nerves of the Sole of the Foot Medial Plantar Nerve The medial plantar nerve is a terminal branch of the tibial nerve Cutaneous branches: Plantar digital nerves run to the sides of the medial three and a half toes. The nerves extend onto the dorsum and supply the nail beds and the tips of the toes Remember it is similar to the median nerve Lateral Plantar Nerve The lateral plantar nerve is a terminal branch of the tibial nerve Dr Amjad Shatarat

14 Bones of the Foot

15 Important Joints of the Foot Subtalar Articulation : is the posterior joint between the talus and the calcaneum Ligaments :1-Medial and lateral (talocalcaneal) ligaments strengthen the capsule. 2-The interosseous (talocalcaneal) ligament is strong and is the main bond of union between the two bones. It is attached above to the sulcus tali and below to the sulcus calcanei. Mid tarsal joints Include : Talocalcaneonavicular Calcaneocuboid Type : Plane Synovial Movements : Inversion and eversion Inversion is much more free than eversion why? (L. malleolus is lower than the M. malleolus).

16 Important ligament of the Foot Plantar calcaneonavicular ligament (spring ligament). Short plantar ligament : lies deep to the above ligament, extends from calcaneus to cuboid bone. Long plantar ligament : from calcaneus and cuboid to the bases of the middle 3 metatarsal bones.

Arches of the Foot The bones of the foot are arranged in two arches that are held in position by ligaments and tendons body weight 100% The arches provide an ideal distribution of body weight over

19 Arches of the Foot The bones of the foot are arranged in two arches that are held in position by ligaments and tendons body weight 100% The arches provide an ideal distribution of body weight over the soft and hard tissues of the foot Normally, the ball of the foot carries about 40% of the weight and the heel carries about 60%. 50% On the right side 50% On the left side Usually, the arches are fully developed by age 12 or % 30% The ball of the foot The heel Dr Amjad Shatarat

The foot has three such arches: In the young child, the foot appears to

20 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: In the 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. Dr Amjad Shatarat

21 Arches of the foot The foot has 3 Arches 1. Medial Longitudinal Arch 2. lateral Longitudinal Arch 3. Transverse Arch Function of arches of the foot (1)Protect the soft tissues of the sole (2)Distribution of the body weight

22 Arches of the foot Medial Longitudinal Arch Calcaneum, talus Navicular The 3 cuneiform bones. The medial 3 metatarsals Lateral Longitudinal Arch Calcaneum, cuboid Lateral 2 metatarsals. Transverse arch Bases of the 5 metatarsals. The 3 cuneiform and cuboid.

Mechanisms of Arch Support Examination of the

engineering methods used for its support The

Dr Amjad Shatarat The inferior edges of the

by binding their lower edges together with metal

connecting the ends effectively prevents

of the arch A suspension bridge: multiple

23 Mechanisms of Arch Support Examination of the design of any stone bridge reveals the following engineering methods used for its support The shape of the stones: the stones are wedge shaped Dr Amjad Shatarat The inferior edges of the stones are tied together: This is accomplished by binding their lower edges together with metal staples The use of the tie beams: a tie beam connecting the ends effectively prevents separation of the pillars and consequent sagging of the arch A suspension bridge: multiple supports suspending the arch from a cable above the level of the bridge

24 Factors maintains Arches of the foot Medial Longitudinal Arch Lateral Longitudinal Arch Transverse arch (1)Bony Factor -Sustentaculum tali -The rounded head of the talus is the keystone (2)Ligamentous factors Medial part of the plantar aponeurosis. Plantar calcaneo-navicular ligament (spring ligament) (3)Muscular factors : Flexor halluces longus, bervis abductor halluces Medial 1/2 of flexor digitorum longus, bervis Tibialis posterior. Tibialis anterior suspends the arch from above (1)Bony Factor The cuboid is the keystone (2)ligamentous factors Lateral part of plantar aponeurosis. Long plantar ligament. Short plantar ligament. (3)Muscular factors : Abductor digiti minimi Lateral 1/2 of flexor digitorum longus,bervis Peroneus longus Peroneus brevis (1)Bony Factor The marked wedge shaping of the cuneiform bases of the metatarsal bones (2) Ligamentous factors : Transverse metatarsal ligaments. Strong plantar ligaments (3) Muscular factors : Peroneus longus Peroneus brevis

Flat foot Is a condition in which the medial longitudinal arch

As a result, 1-The forefoot is displaced laterally everted.

forces it downward and medially between the calcaneum and the

The causes of flat foot are both congenital and acquired When a

weight changes so that the ball of the foot may carry up to 80%

27 Flat foot Is a condition in which the medial longitudinal arch is depressed or collapsed. As a result, 1-The forefoot is displaced laterally everted. 2-The head of the talus is no longer supported 3-The body weight forces it downward and medially between the calcaneum and the navicular bone. The causes of flat foot are both congenital and acquired When a person wears high-heeled shoes, however, 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. Dr Amjad Shatarat

28 Pes cavus (clawfoot) : Is a condition in which the medial longitudinal arch is excessively high. Most cases are caused by muscle imbalance, as in poliomyelitis

29 1 2 3

The plantar aponeurosis

Anatomy of the foot The plantar aponeurosis Is a triangular thickening of the deep fascia Its apex is attached to the medial and lateral tubercles of the calcaneum. The base of the aponeurosis divides