Dorsum of foot and medial side of leg

Anatomy of dorsum of foot and medial side of the leg in easy going style

1. MEDIAL SIDE OF THE LEG & DORSUM OF FOOT Dr Diwakar Dhurandhar 7803848382

2. BONES OF THE FOOT

3. THE CUTANEOUS INNERVATION T he deep peroneal s u p p lies the web of nerve sk i n between the contiguous sides of the first and second toes The superficial peroneal nerve supplies the remainder of dorsum of foot. Medial side by the saphenous nerve, which extends distally to the head of the first metatarsal. Lateral side by the sural nerve

4. Dorsum of the foot Cutaneous Innervation

5. Dorsal Venous Arch The dorsal venous arch lies in the subcutaneous tissue over the heads of the metatarsal bones and drains on the medial side into the great saphenous vein and on the lateral side into the small saphenous vein . The great saphenous vein leaves the dorsum of the foot by ascending into the leg in front of the medial malleolus. The small saphenous vein ascends into the leg behind the lateral malleolus .

6. DE E P FASCIA OF THE DO R SUM OF THE F O OT The deep fascia is th in , where it is continuous with the inferior extensor retinaculum MUSCLE OF THE DORSUM OF THE FOOT Extensor Digitorum Brevis Origin: upper surface of the calcaneum and from the inferior extensor retinaculum Insertion: by four tendons into the proximal phalanx of big toe and long extensor tendons to second, third, and fourth toes Nerve Supply: Deep peroneal nerve . Action: Extension of the medial 4 toes .

7. MUSCLE OF THE DORSUM OF THE FOOT

8. THE INSERTION OF LONG EXTENSOR TENDONS The tendon of extensor digitorum longus passes deep to the superior and inferior extensor retinacula. The tendon divides into four, which pass to the lateral four toes. Opposite the metatarsophalangeal joints of the second, third, and fourth toes, each tendon is joined on its lateral side by a tendon of extensor digitorum brevis. The Extensor Expansion On the dorsal surface of each toe, the extensor tendon joins the fascial expansion called extensor expansion Near the proximal interphalangeal joint, the extensor expansion splits into three parts: a central part, which is inserted into the base of the middle phalanx, and two lateral parts, which converge to be inserted into the base of the distal phalanx . The dorsal expansion, receives the tendons of insertion of the interosseous and lumbrical muscles

9. Extensor Expansion

10. SYNOVIAL SHEATH OF THE EXTENSOR TENDON

11. DORSALIS PEDIS ARTERY Origin: It is the direct continuation of the anterior tibial artery. Course: It begins midway between the 2 malleoli (at the ankle joint) superficial in position and is crossed by the inferior extensor retinaculum and the first tendon of extensor digitorum brevis. Relations: On its lateral side lie the terminal part of the deep peroneal nerve and the extensor digitorum longus tendons. On the medial side lies the tendon of extensor hallucis longus. Its pulsations can easily be felt. Termination by passing downward into the sole between the two heads of the first dorsal interosseous muscle, where it joins the lateral plantar artery and completes the plantar arch

12. deep plantar artery dorsalis pedis artery anterior tibial artery

13. Branches 1. The medial and lateral tarsal arteries 2. The first dorsal metatarsal artery which supplies both sides of the big toe 3. The arcuate artery , which gives off the second, third, and fourth dorsal metatarsal arteries, which run to the clefts of the toes, where each of them divides into two dorsal digital arteries. 4. The deep plantar artery passes deeply to enter the sole of the foot, where it joins the lateral plantar artery to form the deep plantar arch .

14. Deep Peroneal Nerve (The anterior tibial nerve ) The deep peroneal nerve enters the dorsum of the foot by passing deep to the extensor retinacula on the lateral side of the dorsalis pedis artery. It divides into medial, and lateral branches. The medial branch supplies the skin of the adjacent sides of the big and second toes. The lateral branch supplies the extensor digitorum brevis muscle. Both terminal branches give articular branches to the joints of the foot.

15. Extensor Retinacula B and shaped thickenings of deep fascia prevent bowstringing underlying tendons

16. Sup. Extensor Retinacula Band like Attachments – laterally to the of anterior border of the fibula medially to the anterior border of the tibia Str. passing deep Tendons of Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus & Fibularis Tertius Abinatlerior Ti Vessels & Deep Fibular Nerve Str. Passing superficial Superficial fibular nerve

17. Inferior Extensor Retinacula Y- shaped band At tached to the upper surface of the calcaneus Passes medially enclosing tendons of fibularis tertius and extensor digitorum longus Proximal limb Deep layer passes deep to the tendons of EHL & TA , but superficial to the anterior tibial vessels & deep fibular N Superficial layer crosses superficial to the tendons of EHL & TA Both adhere and attach to medial malleolus Distal limb Extends downwards and medially to blend with the plantar aponeurosis Superficial to the tendons of EHL & TA

18. MEDIAL SIDE OF LEG

19. pes anserinus

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