Sole of the Foot Dr Qudsia Sultana Skin

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Sole of the Foot Dr. Qudsia Sultana

Sole of the Foot Dr. Qudsia Sultana

 • Skin is thick & hairless, lacks pigmentation • The subcutaneous tissue contains

• Skin is thick & hairless, lacks pigmentation • The subcutaneous tissue contains a lot of fat, especially in the heel • Extremely sensitive to touch due to a high concentration of nerve endings.

Cutaneous Nerve Supply v Medial plantar nerve v Lateral plantar nerve v Saphenous nerve

Cutaneous Nerve Supply v Medial plantar nerve v Lateral plantar nerve v Saphenous nerve v Sural nerve v Medial calcaneal branch of the tibial nerve

DEEP FASCIA ØPlanter aponeurosis ØDeep transverse metatarsal ligament ØFibrous flexor sheath ØSeptae

DEEP FASCIA ØPlanter aponeurosis ØDeep transverse metatarsal ligament ØFibrous flexor sheath ØSeptae

Deep Fascia • Lies beneath the subcutaneous tissue • Much thicker in the central

Deep Fascia • Lies beneath the subcutaneous tissue • Much thicker in the central part and thinner at the margins • The central thicker part forms triangular plantar aponeurosis

Plantar Aponeurosis • Protects the underlying nerves, blood vessels, and muscles. • Maintains the

Plantar Aponeurosis • Protects the underlying nerves, blood vessels, and muscles. • Maintains the longitudinal arches of the foot. • Origin –muscles first layer of sole

Plantar Aponeurosis • Apex is attached to the medial and lateral tubercles of the

Plantar Aponeurosis • Apex is attached to the medial and lateral tubercles of the calcaneum. • Base divides into five slips that pass into the toe • Each slip further divides into the: • Superficial band • Deep band

Muscles of the Sole • The sole contains both Extrinsic & Intrinsic muscles •

Muscles of the Sole • The sole contains both Extrinsic & Intrinsic muscles • These muscles: § Help to flex, extend, abduct, and adduct the toes § Support the arches of the foot § Are supplied by branches of tibial nerve § Are supplied by branches of posterior tibial artery § Are arranged in four layers

 • The muscles of the first layer are: § Abductor hallucis § Flexor

• The muscles of the first layer are: § Abductor hallucis § Flexor digitorum brevis § Abductor digiti minimi

 • The muscles of the second layer are: • Tendons of the flexor

• The muscles of the second layer are: • Tendons of the flexor hallucis longus • Tendons of the flexor digitorum longus from which the lumbricals arise • flexor digitorum Accessorius (quadratus plantae) • Lumbricals

 • The muscles of the third layer are: • Flexor hallucis brevis •

• The muscles of the third layer are: • Flexor hallucis brevis • Adductor hallucis § oblique head § transverse head • Flexor digiti minimi brevis

 • The muscles of the fourth layer are: • Dorsal interossei • Plantar

• The muscles of the fourth layer are: • Dorsal interossei • Plantar interossei • Tendon of the peroneus longus • Tendon of the tibialis posterior

The muscles of the fourth layer • 4 Dorsal interossei • 3 Plantar interossei

The muscles of the fourth layer • 4 Dorsal interossei • 3 Plantar interossei

APPLIED ANATOMY • PLANTAR FASCITIS: -strainining & inflammation of plantar aponeurosis -pain over heel

APPLIED ANATOMY • PLANTAR FASCITIS: -strainining & inflammation of plantar aponeurosis -pain over heel & med. aspect of foot; increases with passive extension of great toe& by dorsiflexion of ankle jt. -results from running & high-impact aerobics (most common hindfoot problem in runners). -calcaneal spur

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Arteries of the Sole of the Foot

Arteries of the Sole of the Foot

 • Posterior tibial artery enters the foot: § Medially under the medial malleolus

• Posterior tibial artery enters the foot: § Medially under the medial malleolus § Deeper to flexor retinaculum • Divides to give the medial and lateral plantar arteries which supply the sole

Medial Plantar Artery • Arises beneath the flexor retinaculum and passes forward deep to

Medial Plantar Artery • Arises beneath the flexor retinaculum and passes forward deep to the abductor hallucis • Ends by supplying the medial side of the big toe Gives numerous muscular, cutaneous & articular branches

Lateral Plantar Artery • Arises beneath the flexor retinaculum • Passes forward deep to

Lateral Plantar Artery • Arises beneath the flexor retinaculum • Passes forward deep to the abductor hallucis and the flexor digitorum brevis • On reaching the base of the fifth metatarsal bone, the artery curves medially to form the plantar arch • At the proximal end of the first joins with the dorsalis pedis artery Gives numerous muscular, cutaneous & articular branches and plantar digital arteries

Planter Arch • Formed by lateral plantar artery and dorsal pedis artery • The

Planter Arch • Formed by lateral plantar artery and dorsal pedis artery • The arch gives rise four plantar metatarsal arteries • Three proximal perforators

Veins of the Sole of the Foot • Medial and lateral plantar veins accompany

Veins of the Sole of the Foot • Medial and lateral plantar veins accompany the corresponding arteries, and they unite behind the medial malleolus to form the posterior tibial venae comitantes.

Nerves of the Sole of the Foot • Tibial nerve enters the foot medially

Nerves of the Sole of the Foot • Tibial nerve enters the foot medially § Deeper to flexor retinaculum • Divides to give the medial and lateral plantar nerves which supply the sole

Medial Plantar Nerve • Runs forward deep to the abductor hallucis, with the medial

Medial Plantar Nerve • Runs forward deep to the abductor hallucis, with the medial plantar artery • Comes to lie in the interval between the abductor hallucis and the flexor digitorum brevis muscles

Branches • Muscular branches : § Abductor hallucis § Flexor digitorum brevis § Flexor

Branches • Muscular branches : § Abductor hallucis § Flexor digitorum brevis § Flexor hallucis brevis § First lumbrical muscle • Cutaneous branches: § Plantar digital nerves- medial 3½ toes § The nerves extend onto the dorsum and supply the nail beds and the tips of the toes.

Lateral Plantar Nerve • Runs forward deep to the abductor hallucis and the flexor

Lateral Plantar Nerve • Runs forward deep to the abductor hallucis and the flexor digitorum brevis, in company with the lateral plantar artery • On reaching the base of the fifth metatarsal bone, it divides into: § Superficial § Deep branches

Branches From the main trunk § Muscular branches: § Quadratus plantae § Abductor digiti

Branches From the main trunk § Muscular branches: § Quadratus plantae § Abductor digiti minimi § Cutaneous branches: § skin of the lateral part of the sole

 • From the superficial terminal branch § Muscular branches to the: § Flexor

• From the superficial terminal branch § Muscular branches to the: § Flexor digiti minimi brevis § Interosseous muscles of the fourth intermetatarsal space § Cutaneous branches § Skin lining the fourth interdigital cleft.

 • From the deep terminal branch § Muscular branches to the: • Adductor

• From the deep terminal branch § Muscular branches to the: • Adductor hallucis • Second, third, and fourth lumbricals • All the interossei, except those in the fourth intermetatarsal space

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