(the planter aspect of the foot)

SkinSkin• Thick & hairless, lacks pigmentation• Possesses abundant sweat glands• Firmly bound down to the underlying

deep fascia by numerous fibrous bands

• Shows few flexor creases at the sites of skin movement.

• The subcutaneous tissue contains a lot of fat, especially in the heel

• Extremely sensitive to touch due to a high concentration of nerve endings. This makes the sole sensitive to surfaces that are walked on

Cutaneous Nerve Supply Cutaneous Nerve Supply • Medial side of the heel:

• Medial calcaneal branch of the tibial nerve

• Medial 2/3 of the sole:• Branches from the medial

plantar nerve• Lateral 1/3 of the sole:

• Branches from the lateral plantar nerve

• Along the Medial border:• Saphenous nerve

• Along the Lateral border:• Sural nerve

Deep FasciaDeep Fascia• Lies beneath the

subcutaneous tissue and

surrounds the intrinsic foot muscles

• Much thicker in the central part and thinner where it covers the intrinsic muscles of big toe and little toe

• The central thicker part forms triangular planter aponeurosis

Planter AponeurosisPlanter Aponeurosis• A triangular thickening of the deep fascia

that protects the underlying nerves, blood vessels, and muscles.

• Apex is attached to the medial and lateral tubercles of the calcaneum.

• Base divides into five slips that pass into the toe

• Each slip further divides into the:• Superficial band to the skin• Deep band passing to the root of the

toes, where it divides into two, diverging along the flexor tendons and fusing with the fibrous sheath and the deep transverse ligaments

• The medial and lateral borders of the thick aponeurosis are continuous with the thinner deep fascia covering the abductors of the big and little toes.

From each of these borders, fibrous septa pass superiorly into the sole and take part in the formation of the fascial spaces of the sole.

• FunctionsFunctions To give a firm

attachment to the overlying skin

To protect the underlying vessels, nerves and tendons and their synovial sheaths

To assist in maintaining the arches of the foot.

Muscles of the SoleMuscles of the Sole• The sole contains both Extrisic & Intrinsic muscles• These muscles:

Help to flex, extend, abduct, and adduct the toes Enable the toes to lift and curl. Support the arches of the foot Are supplied by branches of tibial nerve Are supplied by branches of posterior tibial artery Are arranged in four layersfour layers.

• From superficial to From superficial to deepdeep

• The muscles of the first layer are: Abductor hallucis Flexor digitorum

brevis Abductor digiti minimi

• The muscles of the second layer are:

• Accessory flexor (quadratus plantae)

• Lumbricals • Tendons of the

flexor digitorum longus from which the lumbricals arise

• The muscles of the third layer are:

• Flexor hallucis brevis

• Adductor hallucis oblique head transverse head

• Flexor digiti minimi brevis

• The muscles of the fourth layer are:

• Dorsal interossei• Plantar interossei• Tendon of the

peroneus longus• Tendon of the tibialis

posterior

Long Tendons of the Sole of the Foot• Flexor Digitorum Longus TendonFlexor Digitorum Longus Tendon• Enters the sole by passing:

behind the medial malleolus beneath the flexor retinaculum.

• Passes forward across the medial surface of the sustentaculum tali

• Then crosses the tendon of flexor hallucis longus, from which it receives a strong slip.

• It is here that it receives on its lateral border the insertion of the quadratus plantae muscle.

• The tendon now divides into its four tendons of insertion, which pass forward, giving origin to the lumbrical muscles.

• The tendons then enter the fibrous sheaths of the lateral four toes

Each tendon perforates the corresponding tendon of flexor digitorum brevis and passes on to be inserted into the base of the distal phalanx (compare with the insertion of the flexor digitorum profundus in the hand)

• Flexor Hallucis Longus TendonFlexor Hallucis Longus 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, to which it gives a strong slip.

• It then enters the fibrous sheath of the big toe and is inserted into the base of the distal phalanx.

Fibrous Flexor SheathsFibrous Flexor Sheaths• The inferior surface of

each toe (from the head of the metatarsal bone to the base of the distal phalanx), is provided with a strong fibrous sheath, which is attached to the sides of the phalanges.

Their distal ends are closed and are attached to the base of the distal phalanges

Their proximal ends receive the deeper parts of the slips of plantar aponeurosis

• The fibrous sheath, together with the inferior surfaces of the phalanges and the interphalangeal joints, forms a blind tunnel for the flexor tendons of the toes

Phalanx

Fibrous sheath

Synovial sheath

Flexor tendon

Synovial Flexor SheathsSynovial Flexor Sheaths• The tendons of the flexor muscles are surrounded

by synovial sheaths

The synovial sheaths of flexor digitorum longus extend:• Above the flexor retinaculum• Extend distally as far as the navicular bone

The synovial sheath of the flexor hallucis longus extends:

• Upwards behind the medial malleolus above the flexor retinaculum• Ends distally at the base of the first metatarsal bone.

• Peroneus Longus TendonPeroneus Longus Tendon• Enters the foot from behind the

lateral malleolus• Runs obliquely across the sole

to be inserted into the base of the first metatarsal bone and the adjacent part of the medial cuneiform.

• The tendon grooves the inferior surface of the cuboid where it is held in position by the long plantar ligament and is surrounded by a synovial sheath

• Tibialis Posterior TendonTibialis Posterior Tendon• Enters the foot from:

behind the medial malleolus. beneath the flexor retinaculum

• Runs downward and forward above the sustentaculum tali to be

• Inserted mainly into the tuberosity of the navicular.

• Small tendinous slips pass to the cuboid and the cuneiforms and to the bases of the second, third, and fourth metatarsals.

• The tendon is surrounded by a synovial sheath.

Arteries of the Sole of the FootArteries of the Sole of the Foot• Posterior tibial artery

enters the foot: Medially under the

medial malleolus Deeper to flexor

retinaculum• Divides to give the

medial and lateral plantar arteries which supply the sole

• Medial Plantar ArteryMedial Plantar Artery• The smaller of the terminal

branches of the posterior tibial artery.

• Arises beneath the flexor retinaculum and passes forward deep to the abductor hallucis

• Ends by supplying the medial side of the big toe

Gives numerous muscular, cutaneous & articular branches

• Lateral Plantar ArteryLateral Plantar Artery• The larger of the terminal

branches of the posterior tibial artery, arises beneath the flexor retinaculum

• Passes forward deep to the abductor hallucis and the flexor digitorum brevis

• On reaching the base of the fifth metatarsal bone, the artery curves medially to form the plantar arch

• At the proximal end of the first intermetatarsal space joins the dorsalis pedis artery

Gives numerous muscular, cutaneous & articular branches and plantar digital arteries to the toes.

Planter ArchPlanter Arch• Formed by lateral plantar

artery • Anastomoses with the dorsal

pedis artery by way of a perforating artery which pierces through the proximal end of the first intermetatarsal space

• The arch gives rise to several metatarsal branches which split into digital branches.

Veins of the Sole of the FootVeins of the Sole of the Foot

• Medial and lateral plantar veins accompany the corresponding arteries, and they unite behind the medial malleolus to form the posterior tibial venae comitantes.

Nerves of the Sole of the FootNerves of the Sole of the Foot• Tibial nerveTibial nerve

enters the foot medially: Under the medial

malleolus Deeper to flexor

retinaculum• Divides to give the

medial and lateral plantar nerves which supply the sole

• Medial Plantar Medial Plantar NerveNerve

• Runs forward deep to the abductor hallucis, with the medial plantar artery

• Comes to lie in the interval between the abductor hallucis and the flexor digitorum brevis muscles

• BranchesBranches• Muscular branches to the:

Abductor hallucis Flexor digitorum brevis Flexor hallucis brevis First lumbrical muscle

• Cutaneous branches: Plantar digital nerves run to

the sides of the medial 3½ toes

The nerves extend onto the dorsum and supply the nail beds and the tips of the toes.

• Lateral Plantar Nerve• Runs forward deep to the

abductor hallucis and the flexor digitorum brevis, in company with the lateral plantar artery

• On reaching the base of the fifth metatarsal bone, it divides into: Superficial Deep branches

• Branches

• From the main trunk Muscular branches to

the: Quadratus plantae Abductor digiti minimi

Cutaneous branches to the: skin of the lateral part of

the sole

• From the superficial terminal branch Muscular branches to the:

Flexor digiti minimi Interosseous muscles of

the fourth intermetatarsal space

Cutaneous branches Plantar digital branches

to the sides of the lateral 1½ toes.

Extend onto the dorsum and supply the nail beds and tips of the toes.

• From the deep terminal branch Muscular branches to

the:• Adductor hallucis• Second, third, and

fourth lumbricals• All the interossei,

except those in the fourth intermetatarsal space

• Long plantar Long plantar ligament stretches from the calaneum to the cuboid & to the bases of the 2nd, 3rd & 4th metatarsal bones

• Short planter Short planter (plantar calcaneocuboid) ligament, connects the calcaneum to the cuboid, lies on the deep aspect of the long plantar ligament

Ligaments of the sole of footLigaments of the sole of foot

CA

NCU

CA

N

• Plantar calcaneonavicular Plantar calcaneonavicular ligamentligament extends from the calcaneus to the navicular bone and prevents the head of the talus from pushing down between the calcaneus and the navicular bones.

This ligament is also know as the spring ligament since it is believed to give a spring-like action to the foot when walking.

CA

N

CA

N TT

• Soles are the site of the planter (Babinski’s) reflex

A. When the sole of the foot is stroked firmly on the outer side from the heel to the front in persons over the age of 2 years

B. Normal response is planterflexion (flexion) of the toes. (Negative Babinski's response)

C.Abnormal response is dorsiflexion of the big toe and often a fanning of the other toes (Positive Babinski's response)

D.Under 2 years of age, extension of the toes is the normal response Under 2 years: toes

are extended

D

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