The Foot

•Bones•Joint•Muscles•Artery & Nerves

Superficial veins

Great saphenous vein

Small saphenous vein

Arteries

Ant. Tibial

Dorsalis pedis artery

Ant. Tibial

Post. Tibial

• Medial plantar• Crosses over the two

tendons long flexor

• Lateral plantar• Deep to flexor digitorum brevis

Nerves

Fibular n.

Medial plantar n.

• Flexor digitorum brevis• Flexor hallucis brevis• Abductor hallucis

Common plantar digital n.

Lateral plantar n.– Flexor accessories – Abductor digiti minimi– Interosseous muscles (deep brunch)– Adductor hallucis (deep brunch)– Flexor digiti minimi brevis (sup. brunch)

Surface anatomy of lower limb

14

Ankle and footmedial and lateral malleolus

Tarsal tunnel

Tendons

Dorsalis pedis a.

Plantar arch

20

Normal Knee – Anterior, Extended

21

Surface Anatomy - Anterior, Extended

Patella

Hollow

Indented

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Normal Knee – Anterior, Flexed

23

Surface Anatomy - Anterior, Flexed

Head OfFibula

Patella

TibialTuberosity

24

Palpation – Anterior*Patella:

Lateral and Medial Patellar Facets

Superior AndInferior Patellar Facets

Patellar Tendon**

Lateral Fat PadMedial Fat Pat

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Surface Anatomy - Medial

Medial FemoralCondyle

Patella

JointLine

MedialTibial Condyle

TibialTuberosity

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Palpation - Medial

Medial Collateral Ligament (MCL)*

Pes anserine bursa**

Medial joint line

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Surface Anatomy – Lateral

Patella

Head OfFibula

TibialTuberosity

Quadriceps

Common fibular nerve

Injury to the common peroneal nerve

• The common fibular nerve may be severed during fracture of the fibula neck.

• Results in paralysis of all muscles in the anterior and lateral compartments of the leg.

• The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop.

• Foot-drop: the foot drops and the toes drag of the floor when walking.

Popliteal fossa

PNS Throughout Life

• Dermatome – an area of skin

• Innervated by cutaneous branches of a single spinal nerve• Embryonic muscles migrate to new locations

• Some skin dermatomes become displaced

• Muscles and skin always retain their original nerve supply

Posterior

Map of Dermatomes

Anterior

Innervation of the Skin: Dermatomes

• Upper limb – skin is supplied by nerves of the brachial plexus

• Lower limb:Lumbar nerves – anterior surfaceSacral nerves – posterior surface

Elsie (L.3 ) is trying to rescue her clumsy man Slim (SI) from a septic tank (SciaTIC nerve), using a rope and a balloon. He has some GLUe (nerves to GLUteus muscles) on his leg. She is pregnant· is FEMale (FEMoral nerve) and has an OBstetric

condition (OBturator nerve).

lumbar disc herniation

lumbar disc herniation

Disc Level Root Comp. Weakness Reflex

Involvement Sensory Loss Pain Distribution

L3-L4 L4 quadriceps, tibialis anterior knee jerk medial knee and shin anterior thigh

L4-L5 L5 extension of big toe no significant big toe back of thigh, lateral calf

L5-S1 S1 gastrocnemius (ankle plantar flexion)

Achilles lateral foot and heel back of thigh and calf

Lower limb dermatomes

• L1 Dermatome:over trochanter and groin

• L2 Dermatome:front of thigh to knee

• L3 Dermatome:upper buttock, anterior thigh and knee, medial lower leg

• L4 Dermatome:lateral Buttock, lateral thigh, medial leg, dorsum of foot, big toe

• L5 Dermatome:Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of

foot, medial half of sole, first, second, and third toes• S1 Dermatome:

Buttock, thigh, and posterior leg• S2 Dermatome:

Buttock, thigh, and posterior leg• S3 Dermatome:

Groin, medial thigh to knee• S4 Dermatome:

Perineum, genitals, lower sacrum