Sole Of The Foot Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow.
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Transcript of Sole Of The Foot Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow.
Sole Of The Foot
Dr. Rakesh Kumar Verma
Assistant ProfessorDepartment of AnatomyKGMU UP Lucknow
SKIN
ThickNerve Supply
SkinSkin Thick and
hairless.Firmly bound down to the underlying deep fascia by numerous fibrous bands.
Shows a few flexure creases at the sites of skin movement.
Sweat glands are present in large numbers.
The sensory nerve supply to the skin of the sole of the foot
SUPERFICIAL FASCIA
Cutaneous Nerves
Cutaneus Arteries
CUTANEOUS NERVES
Medial calcaneal branch of the tibial nerve
Medial plantar nerve
Lateral plantar nerve
Sural & saphenous nerve
DEEP FASCIA
Planter AponeurosisDeep transverse metatarsal
LigamentFibrous flexor sheathSeptae
Plantar aponeurosis • Definition:
Thickened band of deep fascia in the sole of the foot.
• Attachment: Posteriorly: Medial
tubercle of calcaneus.Anteriorly: Divides
into 5 slips which pass to the 5 toes.
On each side: Attached to the metatarsal bones by medial and lateral intermuscular septa.
Plantar aponeurosis
• Functions: Protects the
underlying nerves and vessels.
Maintains the longitudinal arches of the foot.
MUSCLES FOUR LAYERS
FIRST(SUPERFICIAL)
SECOND
THIRD
FOURTH
1st Layer
• Three Muscles: 1)Abductor hallucis2)Flexor digitorum
brevis3)Abductor digiti
minimi
1st Layer
SECOND LAYER
• 1.QUADRATUS PLANTAE/FLEXOR DIGITORUM ACCESSORIOUS
• 2.LUMBRICALS• 3.TENDON OF FLEXOR
DIGITORUM LONGUS• 4.TENDON OF FLEXOR
HALLUCIS LONGUS
2nd Layer• Two Tendons:
1) Flexor halusis longus2) Flexor digitorum
longus• Two Muscles:
1) Quadratus Plantae (Flexor
digitorum accessorius)
2) 4 Lumbricals muscles
1st & 2nd Layers
3rd Layer• Three
Muscles: 1)Flexor hallucis
brevis.2)Adductor
hallucis3)Flexor digiti
minimi brevis
FOURTH LAYER
• 1.DORSAL INTEROSSEI (4) 2.PLANTER INTEROSSEI(3)
• 3.TENDON OF PERONEUS LONGUS
• 4.TENDON OF TIBIALIS POSTERIOR
4th Layer• Two Tendons:
1)Tibialis posterior2)Peroneus Longus
• Two Muscles: 1)3 Planter
Interossei2)4 Dorsal Interossei
3rd & 4th Layers
NERVESMEDIAL PLANTER
LATERAL PLANTER
Medial Plantar NerveIt is larger of the two terminal
branch of the posterior tibial nerve.
Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle.
Terminate at the bases of the metatarsal bones by dividing into 3 planter digital nerves.
Medial Plantar Nerve• Branches: Muscular (to four muscles)
to: Abductor hallucis.1) Flexor digitorum brevis.2) Flexor hallucis brevis 3) First lumbrical muscle Cutaneous:
Planter cutaneous branches:
1) To the skin of the medial 2/3 of the sole of the foot.
2) Planter digital nerves Articular branches: To
intertarsal and tarso-metatarsal joints.
Lateral Plantar NerveIt is smaller of the two terminal
branches of the posterior tibial nerve.
Enters the foot midway between the medial malleolus and the medial tubercle of the calcaneus under cover the flexor retinaculum. Passes forwards and laterally deep to abductor hallusis.
Terminate at the base of the 5th metatarsal bone, by dividing into a superficial and a deep branches.
Lateral Plantar NerveBranches: Muscular :
1) Flexor digitoum accessorius muscle
2) Abductor digiti minimi3) Flexor digiti minimi brevis4) Adductor halucis muscle.5) Interossei6) 2nd, 3rd & 4th lumbricals.
Cutaneous: 1) Skin of the lat. 1/3 of the sole2) Skin on the lat.side of the planter
surface of the little toe and the adjoining sides of the 4th & 5th toes.
3) The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.
Tibial nerve
Med. Plantar Nerve
Deep Branch Superficial Branch
NERVES OF SOLE
To Flex. Dig. Accessorius
To Abd. Digiti Minimi
To Flex. Dig. Min. Brevis & Muscles of4th interos. space
Lat. Plantar Nerve
Br. to Abd. Hallucis
Br. to Flex. Dig. Brevis
Br. to Flex. Hal. Brevis
1st Lumbrical
2nd Lumbrical
Medial Plantar ArteryOne of the two terminal
branches of the posterior tibial artery.
Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle. Passes b/w the abd.hallucis and flexor digitorum brevis.
Medial Plantar ArteryTermination: By
anastmosing with the 1st planter metatarsal artery.
Branches:
Muscular
Digital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.
Lateral Plantar Artery• One of the two terminal
branches of the posterior tibial artery.
• At first between the 1st and 2nd layers, then curves medially between the 3rd and 4th layers of the sole.
• Turns medially with the deep branch of the lateral planter nerve with slight forward convexity to from the plantar arch between the 3rd & 4th layers of muscles.
Lateral Plantar Artery• Branches: Muscular Anastomotic branches: b/w arcuate &
lateral tarsal arteries of the dorsalis pedis artery.
Posterior perforating arteries: 3 branches which anastomose with the dorsal
metatarsal arteries.
Planter digital artery: to the lateral side of the little toe.
Three planter metatarsal arteries
Transverse section through sole of right foot
Dorsalis Pedis A.
2nd layer
1st layer
3nd layer
Trunk of LateralPlantar art.
Deep Br. Of Lat. Plantar art.
4th layer
Metatarsal - 1Metatarsal - 5
3 Prox. Perforating A
APPLIED ANATOMY• ARCHES OF FOOT• PAIN• MTEATARSALGIA• PLANTAR FASCITIS• INFECTION• INJURY• DIABETIC FOOT• CALCANEAL SPUR
QUESTION-1• Which dermatome is mainly stimulated in
plantar reflex:• A) L 4• B) L 5
C) S 1• D) S 2
QUESTION-2• All of the following belong to 3rd layer of
muscles in sole except:• A) Flexor hallucis brevis• B) Abductor hallucis • C) Adductor hallucis • D) Flexor digiti minimi brevis
QUESTION-3
• During walking though the flexor digitorum longus contracting strongly, the toes do not buckle because of action of all the following muscles except:
• A) flexor digitorum accessorious • B) Extensor digitorum longus• C) Lumbricles• D) Interossei
QUESTION-4
• Plantar arch mainly formed by medial plantar artery – True/ false
QUESTION-5
• In tarsal tunnel syndrome the sensory supply to which area of the sole is Mainly affected:
• A) Heel• B) Medial margin of sole• C) Middle part of sole• D) Lateral part of sole