Slideshow: The Foot

Slideshow: The Foot

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1. The Foot

2. The foot has two surfaces
Plantar Surface
sole of the foot
Dorsal Surface
upper part of the
foot

3. The Dorsal Surface

4. The tendons of the muscles of the
anterior compartment of the leg
are situated on the
dorsal aspect of the foot

5. Tendon of Tendon of
Tibialis AnteriorTibialis Anterior
Tibialis Anterior
•Dorsiflexes Ankle Joint
•Inverts the foot

6. Tendons of Extensor Tendons of Extensor
Digitorum LongusDigitorum Longus
Extensor Digitorum
Longus
•Extends the Toes 2-5
•Dorsiflexes Ankle Joint

7. Tendon of
Peroneus Tertius
Peroneus Tertius
•Dorsiflexes Ankle Joint
•Everts Foot

8. Tendon of
Extensor Hallucis Longus
Extensor Hallucis
Longus
•Extends Big Toe
•Dorsiflexes Ankle Joint

9. Extensor Digitorum
Brevis
This is an intrinsic muscle of
foot (ie: it originates and
inserts within the foot)

10. Extensor Digitorum
Brevis
Originates from the superior
surface of the anterior calcaneum
Inserts via 4 tendons
to toes 1-4

11. Extensor Digitorum
Brevis
Extends the toes when the
foot is fully dorsiflexed
Originates from the superior
surface of the anterior calcaneum
Inserts via 4 tendons
to toes 1-4

12. The Dorsalis Pedis Artery
supplies the foot and is a direct
continuation of the
Anterior Tibial Artery
Dorsalis
Pedis Artery
Anterior Tibial
Artery

13. The Dorsalis Pedis Artery
supplies the foot and is a direct
continuation of the
Anterior Tibial Artery
Anterior Tibial
Artery
The pulse may be felt
between the medial and
lateral Malleoli
Dorsalis
Pedis Artery

14. The Plantar Surface

15. The Plantar Surface of the foot
is also known as the sole of
the foot
sole of right foot

16. It is covered in a layer of thick
cornified skin that is
nevertheless sensitive
sole of right foot

17. Under the skin is a layer of
loculated subcutaneous fat
sole of right foot

18. Under the subcutaneous fat is
a thick fascial layer that covers
all the muscles in the foot –
the Plantar Aponeurosis or
Plantar Fascia
sole of right foot

19. There are four layers of
Intrinsic Muscles
that are present in the foot
sole of right foot

20. 1
st
Layer
Consists of 3 muscles
sole of right foot

21. 1
st
Layer
Consists of 3 muscles
Abductor Digiti Minimi
sole of right foot

22. 1
st
Layer
Consists of 3 muscles
Abductor Digiti Minimi
Flexor Digitorum Brevis
sole of right foot

23. 1
st
Layer
Consists of 3 muscles
Abductor Digiti Minimi
Flexor Digitorum Brevis
Abductor Hallucis
sole of right foot

24. 1
st
Layer
Abductor Hallucis
sole of right foot

25. 1
st
Layer
Abductor Hallucis
Originates from
•Medial process of the Calcaneum
•Flexor retinaculum
•Plantar aponeurosis
sole of right foot

26. 1
st
Layer
Abductor Hallucis
Originates from
•Medial process of the Calcaneum
•Flexor retinaculum
•Plantar aponeurosis
Inserts onto medial side of base of
Proximal Phalanx of Great Toe
sole of right foot

27. 1
st
Layer
Abductor Hallucis
Originates from
•Medial process of the Calcaneum
•Flexor retinaculum
•Plantar aponeurosis
Inserts onto medial side of base of
Proximal Phalanx of Great Toe
Abducts the Great Toe
sole of right foot

28. 1
st
Layer
Flexor Digitorum Brevis
This muscle is similar to
Flexor Digitorum Superficialis
in the hand
sole of right foot

29. 1
st
Layer
Flexor Digitorum Brevis
Originates from
•Medial process of the Calcaneum
•Plantar aponeurosis
sole of right foot

30. 1
st
Layer
Flexor Digitorum Brevis
Splits into 4 tendons that enter the
tendon sheaths of toes 2-5
Each tendon splits into two slips at the base of the
proximal phalanx to allow the tendon of Flexor
Digitorum Longus to pass through
The slips then reunite and insert onto the sides of
the shaft of the
middle phalanx of toes 2-5
sole of right foot

31. 1
st
Layer
Abductor Digiti Minimi
Originates from
•Lateral and medial Calcaneal tubercles
•Plantar aponeurosis
sole of right foot

32. 1
st
Layer
Abductor Digiti Minimi
Inserts onto the lateral aspect of the base
of the proximal phalanx of the little toe
sole of right foot
Originates from
•Lateral and medial Calcaneal tubercles
•Plantar aponeurosis

33. 1
st
Layer
Abductor Digiti Minimi
Originates from
•Calcaneal tuberosity
•Plantar aponeurosis
Inserts onto the lateral aspect of the base
of the proximal phalanx of the little toe
Abducts the little toe
sole of right foot

34. 2
nd
Layer
Consists of the Long Flexor Tendons
and
intrinsic muscles (lumbricals and flexor
accessorious)
sole of right foot

35. 2
nd
Layer
Flexor Digitorum Longus tendons
sole of right foot

36. 2
nd
Layer
Flexor Digitorum Longus tendons
Flexor Hallucis Longus tendon
sole of right foot

37. 2
nd
Layer
Flexor Digitorum Longus tendons
Flexor Hallucis Longus tendon
Lumbricals
sole of right foot

38. 2
nd
Layer
Flexor Digitorum Longus tendons
Flexor Hallucis Longus tendon
Lumbricals
Flexor Accessorius
sole of right foot

39. 2
nd
Layer
Flexor Tendon Sheaths
sole of right foot

40. 2
nd
Layer
Flexor Tendon Sheaths
Contains tendons of
Flexor Digitorum Longus
sole of right foot

41. 2
nd
Layer
Flexor Tendon Sheaths
Contains tendon of
•Flexor Digitorum Longus
•Flexor Hallucis Longus
sole of right foot

42. 2
nd
Layer
Lumbricals
4 small muscles similar to the
Lumbricals in the Hand
sole of right foot

43. 2
nd
Layer
Lumbricals
Originate from the Tendons of
Flexor Digitorum Longus
sole of right foot

44. 2
nd
Layer
Lumbricals
Originate from the Tendons of
Flexor Digitorum Longus
Lumbrical Tendons insert onto the medial
aspect of the dorsal digital expansions of
toes 2-5
sole of right foot

45. 2
nd
Layer
Lumbricals
Assist in maintaining extension of
IP joints of the toes
sole of right foot
Originate from the Tendons of
Flexor Digitorum Longus
Lumbrical Tendons insert onto the medial
aspect of the dorsal digital expansions of
toes 2-5

46. 2
nd
Layer
Flexor Accessorius
Deeply placed muscle also known as
Quadratus Plantae
sole of right foot

47. 2
nd
Layer
Flexor Digitorum Accessorius
Originates from the
Calcaneum with 2 heads
sole of right foot

48. 2
nd
Layer
Flexor Digitorum Accessorius
Originates from the
Calcaneum by 2 heads
Inserts onto the tendon of
Flexor Digitorum Longus
sole of right foot

49. 2
nd
Layer
Flexor Digitorum Accessorius
Originates from the
Calcaneum by 2 heads
Inserts onto the tendon of
Flexor Digitorum Longus
Assists Flexor Digitorum Longus
in flexing the toes 2-5
sole of right foot

50. 3
rd
Layer
Consists of 3 muscles
sole of right foot

51. 3
rd
Layer
Flexor Hallucis Brevis
sole of right foot

52. 3
rd
Layer
Flexor Hallucis Brevis
Adductor Hallucis
sole of right foot

53. 3
rd
Layer
Flexor Hallucis Brevis
Adductor Hallucis
Flexor Digiti Minimi Brevis
sole of right foot

54. 3
rd
Layer
Flexor Hallucis Brevis
sole of right foot

55. 3
rd
Layer
Flexor Hallucis Brevis
Originates in 2 parts:
•Medial limb from the medial and
intermediate cuneiforms and from
the tendon of Tibialis Posterior
•Lateral limb from the Cuboid and
Lateral Cuneiform
sole of right foot

56. 3
rd
Layer
Flexor Hallucis Brevis
Inserts onto either side of the base
of the Proximal Phalanx of Big Toe
sole of right foot
Originates in 2 parts:
•Medial limb from the medial and
intermediate cuneiforms and from
the tendon of Tibialis Posterior
•Lateral limb from the Cuboid and
Lateral Cuneiform

57. 3
rd
Layer
Flexor Hallucis Brevis
sole of right foot
Originates in 2 parts:
•Medial limb from the medial and
intermediate cuneiforms and from
the tendon of Tibialis Posterior
•Lateral limb from the Cuboid and
Lateral Cuneiform
Inserts onto either side of the base
of the Proximal Phalanx of Big Toe
which it flexes

58. 3
rd
Layer
Adductor Hallucis
Very deeply placed and awkward to demonstrate
Similar to Adductor Pollicis in the hand
sole of right foot

59. 3
rd
Layer
Adductor Hallucis
Originates by 2 heads:
•Oblique Head - bases of 2,3,4 metatarsals
•Transverse head – from plantar
metatarsophalangeal ligaments of 3,4,5 toes
sole of right foot

60. 3
rd
Layer
Adductor Hallucis
Inserts onto:
•Lateral Sesamoid
•Base of the Proximal Phalanx
Originates by 2 heads:
•Oblique Head - bases of 2,3,4 metatarsals
•Transverse head – from plantar
metatarsophalangeal ligaments of 3,4,5 toes
sole of right foot

61. 3
rd
Layer
Adductor Hallucis
Adducts the Proximal Phalanx of the Big Toe
Stabilizes the Metatarsal Heads
sole of right foot

62. 3
rd
Layer
Flexor Digiti Minimi Brevis
Originates from medial part of plantar
surface of base of the 5
th
Metatarsal
sole of right foot

63. 3
rd
Layer
Flexor Digiti Minimi Brevis
Originates from medial part of plantar
surface of base of the 5
th
Metatarsal
Inserts onto lateral side of base of
Proximal Phalanx of Little Toe
sole of right foot

64. 3
rd
Layer
Flexor Digiti Minimi Brevis
Originates from medial part of plantar
surface of base of the 5
th
Metatarsal
Inserts onto lateral side of base of
Proximal Phalanx of Little Toe
Flexes Metatarso-phalangeal Joint
(MTPJ) of Little Toe
sole of right foot

65. 4th Layer
The Interossei
sole of right foot

66. 4th Layer
Similar to the Hand there are
Dorsal Interossei
sole of right foot

67. 4th Layer
Similar to the Hand there are
Dorsal Interossei
Plantar Interossei
sole of right foot

68. 4
th
Layer
Dorsal Interossei
There are 4 bipennate dorsal interossei that
arise by two heads from adjacent
metatarsals
sole of right foot

69. 4
th
Layer
Dorsal Interossei
Insertion
1
st
dorsal interossei inserts onto the medial
aspect of proximal phalanx of the second toe
The other three insert onto the lateral aspect
of proximal phalanges of toes 2,3,4
respectively
sole of right foot

70. 4
th
Layer
Dorsal Interossei
Abduct the toes relative to the 2
nd
toe
sole of right foot

71. 4
th
Layer
Plantar Interossei
There are 3 Plantar Interossei
3
rd
plantar interosseous
sole of right foot

72. 4
th
Layer
Plantar Interossei
There are 3 Plantar Interossei
They are unipennate muscles.
3
rd
plantar interosseous
sole of right foot

73. 4
th
Layer
Plantar Interossei
3
rd
plantar interosseous
sole of right foot
There are 3 Plantar Interossei
They are unipennate muscles.
Originate from medial sides of
3, 4, 5 metatarsals

74. 4
th
Layer
Plantar Interossei
sole of right foot
There are 3 Plantar Interossei
They are unipennate muscles.
Originate from medial sides of
3, 4, 5 metatarsals
Adduct toes 3, 4, 5 (towards the 2nd toe)
Flex MTP joints
Extend IP joints

75. In Summary
1
st
Layer
• Abductor Hallucis
• Flexor Digitorum Brevis
• Abductor Digiti Minimi
2
nd
Layer
• Flexor Hallucis Longus
• Flexor Digitorum Longus
• Flexor Accessorius
• Lumbricals
3
rd
Layer
• Flexor Hallucis Brevis
• Adductor Hallucis
• Flexor Digiti Minimi Brevis
4
th
Layer
•Plantar Interossei
•Dorsal Interossei
(also included in the fourth
layer are the tendons of
Tibialis Posterior and
Peroneus Longus)

76. To try and remember the layers think of
1
st
layer – 1 Flexor between 2 Abductors
2
nd
Layer – All the long flexors and their accessories
3
rd
layer – 1 adductor between 2 Flexors
4
th
Layer – the Interossei

77. To try and remember the layers think of
1
st
layer – 1 Flexor between 2 Abductors
Abductor Hallucis - Flexor Digitorum Brevis - Abductor Digiti Minimi
2
nd
Layer – All the long flexors and their accessories
Flexor Hallucis Longus - Flexor Digitorum Longus – Flexor Accessorius -
Lumbricals
3
rd
layer – 1 Adductor between 2 Flexors
Flexor Hallucis Brevis - Adductor Hallucis - Flexor Digiti Minimi Brevis
4
th
Layer – the Interossei
Plantar Interossei - Dorsal Interossei

78. Neurovascular Supply

79. Tibial Tibial
NerveNerve
Medial Medial
Plantar Plantar
NerveNerve
Lateral Lateral
Plantar Plantar
NerveNerve
It passes behind the
Medial Malleolus, crosses the
Tarsal Tunnel and divides into
•Medial Plantar Nerve
•Lateral Plantar Nerve
The Tibial Nerve innervates all the muscles
in the foot
sole of right foot

80. Lateral Plantar Nerve Branches Medial Plantar Nerve Branches
sole of right foot

81. Posterior Posterior
Tibial ArteryTibial Artery
Medial Medial
PlantarPlantar
ArteryArtery
Lateral Lateral
Plantar Plantar
ArteryArtery
The Posterior Tibial Artery accompanies the Tibial Nerve
and passes behind the Medial Malleolus through the
Tarsal Tunnel
It divides into two branches
•Medial Plantar Artery
•Lateral Plantar Artery
sole of right foot

82. The Posterior Tibial Artery accompanies the Tibial Nerve
and passes behind the Medial Malleolus through the
Tarsal Tunnel
It divides into
•Medial Plantar Artery
•Lateral Plantar Artery
Lateral Plantar
Artery
sole of right foot

83. Muscle Summaries

84. Extensor Digitorum Longus
Origin Lateral condyle of Tibia, upper
2/3 anterior fibular shaft,
interosseous membrane
Insertion Splits into 4 tendons, inserts via
extensor expansions onto dorsum
of middle and distal phalanges.
Part of extensor expansion
complex
Action Extend toes 2 - 5 and dorsiflexes
ankle
Nerve SupplyDeep peroneal nerve (L5, S1)
Blood SupplyAnterior tibial artery
Anterior Leg

85. Extensor Hallucis Longus
Origin Anterior surface of the fibula,
interosseous membrane
Insertion Base of distal phalanx great toe
Action Extends great toe and dorsiflexes
ankle
Nerve SupplyDeep peroneal nerve (L5, S1)
Blood SupplyAnterior tibial artery
Anterior Leg

86. Tibialis Anterior
Origin Lateral condyle of tibia, proximal
2/3rds lateral surface tibia,
interosseous membrane
Insertion Medial and plantar surfaces of
medial cuneiform and base of
first metatarsal
Action Dorsiflexor of ankle, invertor of
foot
Nerve SupplyDeep peroneal nerve (L4, L5)
Blood SupplyAnterior tibial artery
Anterior Leg

87. Fibularis Tertius
Origin Distal 1/3
rd
anterior surface of
fibula
Insertion Base of dorsal aspect 5
th

metatarsal
Action Dorsiflexes foot;
everts foot weakly
Nerve SupplyDeep peroneal nerve (L5, S1)
Blood SupplyAnterior tibial artery
Anterior Leg

88. Abductor Digiti Minimi
Origin Medial and lateral processes of
calcaneal tuberosity and
intervening plantar surface of
calcaneum. Plantar aponeurosis
Insertion Lateral side of base of proximal
phalanx of 5
th
toe and head of 5
th

metatarsal
Action Flexes and abducts 5
th
toe
Supports lateral longitudinal arch
Nerve SupplyLateral plantar nerve
Blood SupplyMedial and lateral plantar
arteries
1
st
Layer Foot

89. Flexor Digitorum Brevis
Origin Medial process of calcaneal
tuberosity
Insertion Splits into four tendons that
insert onto the sides of the shaft
of the middle phalanx of toes 2-5
(Each tendon splits into two at
the base of the proximal phalanx
and then reunites to form a
tunnel allowing the tendon of
Flexor Digitorum Longus to pass)
Action Flexes toes 2-5, supports medial
arch
Nerve SupplyMedial plantar nerve
Blood SupplyMedial and lateral plantar
arteries
1
st
Layer Foot

90. Abductor Hallucis
Origin Medial process of calcaneal
tuberosity, and flexor
retinaculum
Insertion Medial sesamoid and medial
aspect base of proximal phalanx
of big toe
Action Flexes and abducts big toe,
supports medial longitudinal arch
Nerve SupplyMedial plantar nerve
Blood SupplyMedial and lateral plantar
arteries
1
st
Layer Foot

91. Lumbricals
Origin Lateral 3 are bipennate between the
tendons of flexor digitorum longus.
Medial lumbrical is from the medial
aspect of the medial tendon of FDL
Insertion Dorsal extensor expansion
Action Extends toes at IP joints and flexes
MTP joints
Nerve Supply 1
st
lumbrical – medial plantar nerve
2-4 lumbricals - lateral plantar nerve
Blood Supply Medial and lateral plantar arteries
2
nd
Layer Foot

92. Flexor Accessorius
(Quadratus Plantae)
Origin Medial and lateral sides of
calcaneus
Insertion Tendons of flexor digitorum longus
Action Assists flexor digitorum longus to
flex toes 2-5 when ankle joint is
plantarflexed
Nerve SupplyLateral plantar nerve
Blood SupplyMedial and lateral plantar arteries
2
nd
Layer Foot

93. Flexor Digiti Minimi Brevis
Origin Base of the 5
th
metatarsal and the
sheath of peroneus longus
Insertion Lateral side of the base of the
proximal phalanx of 5
th
toe
Action Flexes MTP joint of 5
th
toe
Nerve SupplyLateral plantar nerve
Blood SupplyLateral plantar artery
3rd Layer Foot

94. Adductor Hallucis
Origin Oblique head: base of 2,3, 4
metatarsals
Transverse head: plantar
metatarsal ligaments, deep
transverse ligament
Insertion Lateral sesamoid and lateral side
of base of proximal phalanx of big
toe
Action Adducts and flexes MTP joint of
big toe
Nerve SupplyLateral plantar nerve
Blood SupplyMedial and lateral plantar arteries
3rd Layer Foot

95. Flexor Hallucis Brevis
Origin Arises by medial and lateral
tendons from cuboid, cuneiforms
and tendon of tibialis posterior
Insertion Medial slip to medial side, and
lateral slip to lateral side of base of
proximal phalanx of big toe
Action Flexes MTP joint of big toe and
supports medial longitudinal arch
Nerve SupplyMedial plantar nerve
Blood SupplyMedial and lateral plantar arteries
3rd Layer Foot

96. Plantar Interossei
Origin Lower medial aspects of the shafts
of metatarsals 3, 4, 5
Insertion Medial side of bases of proximal
phalanges of toes 3, 4, 5 and
corresponding dorsal extensor
expansions
Action Adducts 3, 4, 5 toes to axis of 2
nd

toe. Assists lumbricals in extending
IP joints whilst flexing MTP joints
Nerve SupplyLateral plantar nerve
Blood SupplyLateral plantar artery
4
th
Layer Foot

97. Dorsal Interossei
Origin 4 bipennate muscles from the
inner aspects of all 5 metatarsals
Insertion Base of proximal phalanges and
dorsal extensor expansions of
medial side of 2
nd
toe and lateral
side of toes 2, 3, 4
Action Abducts toes 2,3,4 away from axis
of 2
nd
toe. Assists lumbricals in
extending IP joints whilst flexing
MTP joints
Nerve SupplyLateral plantar nerve
Blood SupplyLateral plantar artery
4
th
Layer Foot