Sole Of The Foot Dr Rakesh Kumar Verma

Sole Of The Foot Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow

SKIN Thick Nerve Supply

Skin Thick and hairless. Firmly bound down to the underlying deep fascia by numerous fibrous bands. Shows a few flexure creases at the sites of skin movement. Sweat glands are present in large numbers. The sensory nerve supply to the skin of the sole of the foot

SUPERFICIAL FASCIA Cutaneous Nerves Cutaneus Arteries

CUTANEOUS NERVES üMedial calcaneal branch of the tibial nerve üMedial plantar nerve üLateral plantar nerve üSural & saphenous nerve

DEEP FASCIA Planter Aponeurosis Deep transverse metatarsal Ligament Fibrous flexor sheath Septae

Plantar aponeurosis • Definition: ü Thickened band of deep fascia in the sole of the foot. • Attachment: ü Posteriorly: Medial tubercle of calcaneus. ü Anteriorly: Divides into 5 slips which pass to the 5 toes. ü On each side: Attached to the metatarsal bones by medial and lateral intermuscular septa.

Plantar aponeurosis • Functions: üProtects the underlying nerves and vessels. üMaintains the longitudinal arches of the foot.

MUSCLES FOUR LAYERS FIRST(SUPERFICIAL) SECOND THIRD FOURTH

1 st Layer • Three Muscles: 1)Abductor hallucis 2)Flexor digitorum brevis 3)Abductor digiti minimi

1 st Layer

SECOND LAYER • 1. QUADRATUS PLANTAE/FLEXOR DIGITORUM ACCESSORIOUS • 2. LUMBRICALS • 3. TENDON OF FLEXOR DIGITORUM LONGUS • 4. TENDON OF FLEXOR HALLUCIS LONGUS

2 nd Layer • Two Tendons: 1) Flexor halusis longus 2) Flexor digitorum longus • Two Muscles: 1) Quadratus Plantae (Flexor digitorum accessorius) 2) 4 Lumbricals muscles

1 st & 2 nd Layers

rd 3 Layer • Three Muscles: 1)Flexor hallucis brevis. 2)Adductor hallucis 3)Flexor digiti minimi brevis

FOURTH LAYER • 1. DORSAL INTEROSSEI (4) 2. PLANTER INTEROSSEI(3) • 3. TENDON OF PERONEUS LONGUS • 4. TENDON OF TIBIALIS POSTERIOR

th 4 • Two Tendons: 1)Tibialis posterior 2)Peroneus Longus • Two Muscles: 1)3 Planter Interossei 2)4 Dorsal Interossei Layer

3 rd & 4 th Layers

NERVES MEDIAL PLANTER LATERAL PLANTER

Medial Plantar Nerve It is larger of the two terminal branch of the posterior tibial nerve. Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle. Terminate at the bases of the metatarsal bones by dividing into 3 planter digital nerves.

Medial Plantar Nerve • Branches: ü Muscular (to four muscles) to: Abductor hallucis. 1) Flexor digitorum brevis. 2) Flexor hallucis brevis 3) First lumbrical muscle ü Cutaneous: Planter branches: cutaneous 1) To the skin of the medial 2/3 of the sole of the foot. 2) Planter digital nerves ü Articular branches: To intertarsal and tarsometatarsal joints.

Lateral Plantar Nerve It is smaller of the two terminal branches of the posterior tibial nerve. Enters the foot midway between the medial malleolus and the medial tubercle of the calcaneus under cover the flexor retinaculum. Passes forwards and laterally deep to abductor hallusis. Terminate at the base of the 5 th metatarsal bone, by dividing into a superficial and a deep branches.

Lateral Plantar Nerve Branches: Muscular : 1) Flexor digitoum accessorius muscle 2) Abductor digiti minimi 3) Flexor digiti minimi brevis 4) Adductor halucis muscle. 5) Interossei 6) 2 nd, 3 rd & 4 th lumbricals. ü Cutaneous: 1) Skin of the lat. 1/3 of the sole 2) Skin on the lat. side of the planter surface of the little toe and the adjoining sides of the 4 th & 5 th toes. 3) The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.

Tibial nerve Med. Plantar Nerve Br. to Abd. Hallucis Lat. Plantar Nerve NERVES OF SOLE To Flex. Dig. Accessorius To Abd. Digiti Minimi Br. to Flex. Dig. Brevis Deep Branch Superficial Branch Br. to Flex. Hal. Brevis 1 st Lumbrical 2 nd Lumbrical To Flex. Dig. Min. Brevis & Muscles of 4 th interos. space

Medial Plantar Artery One of the two terminal branches of the posterior tibial artery. Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle. Passes b/w the abd. hallucis and flexor digitorum brevis.

Medial Plantar Artery Termination: By anastmosing with the 1 st planter metatarsal artery. Branches: Muscular Digital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.

Lateral Plantar Artery • One of the two terminal branches of the posterior tibial artery. • At first between the 1 st and 2 nd layers, then curves medially between the 3 rd and 4 th layers of the sole. • Turns medially with the deep branch of the lateral planter nerve with slight forward convexity to from the plantar arch between the 3 rd & 4 th layers of muscles.

Lateral Plantar Artery • Branches: ü Muscular ü Anastomotic branches: b/w arcuate & lateral tarsal arteries of the dorsalis pedis artery. ü Posterior perforating arteries: ü 3 branches which anastomose with the dorsal metatarsal arteries. ü Planter digital artery: to the lateral side of the little toe. ü Three planter metatarsal arteries

Transverse section through sole of right foot 3 Prox. Perforating A Dorsalis Pedis A. 4 th layer Metatarsal - 1 Metatarsal - 5 3 nd layer 2 nd layer Deep Br. Of Lat. Plantar art. 1 st layer Trunk of Lateral Plantar art.

APPLIED ANATOMY • ARCHES OF FOOT • PAIN • MTEATARSALGIA • PLANTAR FASCITIS • INFECTION • INJURY • DIABETIC FOOT • CALCANEAL SPUR

QUESTION-1 • Which dermatome is mainly stimulated in plantar reflex: • A) L 4 • B) L 5 C) S 1 • D) S 2

QUESTION-2 • All of the following belong to 3 rd layer of muscles in sole except: • A) Flexor hallucis brevis • B) Abductor hallucis • C) Adductor hallucis • D) Flexor digiti minimi brevis

QUESTION-3 • During walking though the flexor digitorum longus contracting strongly, the toes do not buckle because of action of all the following muscles except: • A) flexor digitorum accessorious • B) Extensor digitorum longus • C) Lumbricles • D) Interossei

QUESTION-4 • Plantar arch mainly formed by medial plantar artery – True/ false

QUESTION-5 • In tarsal tunnel syndrome the sensory supply to which area of the sole is Mainly affected: • A) Heel • B) Medial margin of sole • C) Middle part of sole • D) Lateral part of sole