sole of foot& arches of the foot anatomy.pptx

anatomy of foot muscles, nerves and arches

1. Anatomy Department Sole and arches of the foot Dr. Shaimaa Hafez [email protected] AL AZHAR UNIVERSITY Faculty of Medicine for Girls Year 1- Semester II Academic year: 2021/ 2022 Module Name : Musculoskeletal and skin Course code: IMP 07- 10212 Credit hours: 8 crh

2. OBJECTIVES : At the end of the lecture, students should be able to:

3. Deep fascia of the foot plantar aponeurosis Definition: It is thickened sheet of the deep fascia in the center of the sole. Shape: It is triangular having: Apex: is directed proximally attached to the calcaneum Base: is directed distally and divided into 5 slips at the bases of the toes. Medial margin: covers the abductor hallucis muscle. Lateral margin: covers the abductor digiti minimi muscle

4. Structures undercover of plantar aponeurosis: Muscles. Superficial plantar arch and its branches Medial and lateral plantar nerves. Function of the plantar aponeurosis : 1. Protection of underlying tendon, vessels and nerves. 2. Give firm attachment to the overlying skin 3. Assist in maintaining the arches of the foot Septa: At each border, fibrous septa pass superiorly to form fascial spaces of the sole. Fibrous flexor sheaths : They are thickening of the deep fascia on the plantar surfaces of the toes

5. Muscles of the foot It is presented in 4 layers Muscles of the 1 st layer: they are 3 muscles 1 st layer of plantar muscles 1) Abductor hallucis 3) Abductor digiti minimi 2) Flexor digitorum brevis

6. 2 nd layer of plantar muscles Quadratus plantae (Flexor digitorum accessories) 3) Flexor digitorum longus tendon . 2) 4 Lumbricals II- Muscles of the 2 nd layer: they are 3 muscles & 2 tendons: 4) Flexor hallucis longus tendon

7. 3 rd layer of plantar muscles 1) Flexor hallucis brevis 3) Flexor digiti minimi brevis . 2) Adductor hallucis III- Muscles of the 3 rd layer: they are 3 muscles:

8. 1) 3 plantar interossei 2) Tendon of Peroneus longus 4) 4 Dorsal interossei IV Muscles of the 4 th layer 2 muscles & 2 tendons: 3) Tendon of Tibialis posterior

9. Nerve supply of the sole of foot 1- Medial plantar nerve - It is a terminal branch of the posterior tibial nerve. - It enters the foot midway between the medial malleolus and the calcaneus. - It runs forward deep to the abductor hallucis and lateral to the medial plantar artery. - It ends by dividing into 3 digital branches. Branches: 1- Muscular 2- Cutaneous 3- Articular branches to intertarsal and tarsometatarsal joints.

10. 2- Lateral plantar nerve It is a terminal branch of the posterior tibial nerve. It arises beneath the flexor retinaculum. It runs forward and laterally between the flexor digitorum brevis and quadratus plantae. It ends at the base of the 5 th metatarsal bone by dividing into superficial and deep branches. Branches: 1- Muscular 2- Cutaneous 3- Articular branches to intertarsal and tarsometatarsal joints.

11. Cutaneous innervation of the foot: Sole of foot Dorsum of foot

12. What is the sensory nerve supply of the plantar surface of the big toe? Lateral plantar nerve Medial plantar nerve. Tibial nerve. Superficial peroneal nerve. Which of the following muscles is one of the first layer of the foot? Adductor hallucis. Flexor digiti minimi. Planter interossei. Abductor hallucis.

13. 1-Medial plantar artery: It is the smaller of the terminal branches of the posterior tibial artery . It arises between the medial malleolus and the heel. It ends by supplying the medial side of the big toe and by joining the digital branch to medial side of the big toe which arises from the dorsalis pedis artery. Arteries of the sole

14. 2. Superficial plantar arch: - It is formed by the anastomosis between the superficial branch of medial plantar artery and the deep plantar artery of dorsalis pedis artery 3- Lateral plantar artery It is the larger of the terminal branches of the posterior tibial artery . It arises beneath the flexor retinaculum and passes forward. On reaching the base of the 5 th metatarsal, it curves medially with the deep branch of the lateral plantar nerve.

15. 4. Deep plantar arch: It is formed by the anastomosis between the medial plantar artery ,after it curves medially, and the deep plantar artery of dorsalis pedis artery in the 4 th layer of the sole

16. Arches of the foot 1- They are formed by the  tarsal  and  metatarsal  bones, strengthened by tendons and ligaments   . 2- Allow the  foot to support the weight of the body in the erect posture with the least weight. Functions of the arches of the foot: Distribution of the body weight on the bones of the foot: 1/2 of the body weight reaching the talus is delivered to calcaneum while the other ½ is transmitted forward from talus to be distributed to Lateral 4 metatarsal . They provide elasticity of movement. They provide space in the sole of the foot to contain and protect muscles, nerves and vessels of the sole. Adaptation of the foot to irregular or sloping surfaces They allow walking and running without felling of pain Absorption of shocks when falling on the feet

17. The foot has 3 arches I- Medial Longitudinal arch II- Lateral Longitudinal arch III-Transversal Arch

18. I- Medial Longitudinal Arch It is formed by the calcaneum, talus, navicular, 3 cuniform bones and medial 3 metatarsal bones. Shape: It is arched upwards and having 1) Posterior point: formed by the calcaneus 2)Anterior point formed by the head of the medial 3 metatarsal bones. 3)Apex: The highest point of the arch: formed by the talus. -Function: It is concerned with the elasticity of the foot during walking

19. 1)Bones forming the arch . 2) Tendons of Tibialis anterior, - Tibialis posterior. Flexor hallucis longus - Flexor hallucis brevis muscles 3)Ligaments: as a)Spring ligament. b)Deltoid ligament. c)The interosseous ligaments. d)The long plantar ligament and planter aponeurosis. Factor maintaining the medial longitudinal arch:

20. II- Lateral Longitudinal Arch - It is formed by the calcaneum, cuboid and the lateral 2 metatarsal bones - Shape : Posterior point: is formed by calcaneus Anterior point: is formed by the bases of the 4th & 5th metatarsal bone 3) Apex: is formed by cuboid. -Function: It support the body in erect position.

21. 1) Bones forming the arch. 2) Tendons of: - Peroneus longus, - Peroneus brevis Factor maintaining the lateral longitudinal arch: 3) Ligaments : a)The interosseous ligaments. b)The short plantar ligament. c) The long plantar ligament.

22. III- Transverse Arch - It runs from side to side It lies at the level of tarsometatarsal joints. It is formed by the tarsal bones (cuboid & 3 cuniform) and the base of all metatarsal bones. Shape: a)Proximal: It is formed by cuboid 3 cuniform and the base of all metatarsal bones. It is maintained by the tendon of peroneus longus muscle. b) Distal arch: It is formed by the head of all metatarsal bones. - It is maintained by the transverse head of adductor hallucis.

23. 1)Bony Factor: the wedge shape of cuniform bones, having wide surface dorsally and narrow surface ventrally. 2) Tendon of: Peroneus longus (the most important). 3)Ligaments: The strong planter interosseous ligaments. Factor maintaining the transverse arch:

24. References : Allam , H.N. : Synopsis of Human Embryology. Devi, V.S. (2018 ):“ Inderbir Singh’s Human Embryology”.11th ed. The Health Sciences Publisher, New Delhi, London Panama. Drake, R. A. Wayne Vogl , W. and Mitchell, A. (2017): Gray's Anatomy for Students. Elsevier. Kadasne , D.K. (2011 ):“ Kadasne’s Textbook of Embryology”.1st ed. Jaypee Brothers Medical Publishers. Moore, K. L.; Persaud , T.V.N.; Torchia , M. G. (2013 ):“The Developing Human”. Clinically Oriented Embryology. 8th ed. Saunders Elsevier. Philadelphia. Moore, K. L.; Dalley , A. F. and Agur , A. M. R. (2010): Clinically Oriented Anatomy.6th Edition, Lippincott Williams & Wilkins, Philadelphia. Romanes, G. J.: Cunning hams Manual of Practical Anatomy.13th ed. London, Oxford University Press. New York, Bombay. Ronald W. Dudek , R. W. (2014 ):“BRS Embryology”. 6th ed. Lippincott Williams & Wilkins. Singh, V. (2017): “Textbook of Clinical Embryology”.2nd ed. Elsevier, Relx India Pvt. Ltd. Snell, R.S. (2008): “Clinical Anatomy by Regions”. 8th ed. Lippincott Williams& Wilkins. Philadelphia, New York, London, Hong Kong, Sydney, Tokyo. P. 253

25. How many arches present in the foot? 1 2 3 4 The lateral planter artery is branch of which of the following arteries? Posterior tibial artery. Dorsalis pedis artery. Anterior tibial artery. Superficial planter arch. Which of the following muscles present in the first layer of the foot? Planter interossei. Abductor digiti minimi. Adductor digiti minimi. 4 lumbricals. 4 ) What is meant by flat foot? The medial longitudinal arch become depressed. The medial longitudinal arch become too high. The lateral longitudinal arch become too high. There is no transverse arch of the foot.

26. 5) Which of the following factors maintain the medial longitudinal arch? calcaneum, cuboid and the lateral 2 metatarsal bones cuboid, 3 cuniform and the base of all metatarsal bones. Tendons of Tibialis anterior and Tibialis posterior muscles. Tendon of Peroneus longus. Short essay questions: List cutaneous nerves suppling the dorsal and planter surfaces of the foot. Name arches of the foot. Enumerate muscles of the first layer of the foot? Enumerate muscles of the second layer of the foot? Enumerate muscles of the third layer of the foot? Enumerate muscles of the fourth layer of the foot? Name arteries suppling the planter surface of the foot. List 4 functions of the arches of the foot. What are the factor maintaining the transverse arch. What are the factor maintaining the medial longitudinal arch.