3SkinSkin 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
5CUTANEOUS NERVES Medial calcaneal branch of the tibial nerve Medial plantar nerveLateral plantar nerveSural & saphenous nerve
6DEEP FASCIA Planter Aponeurosis Deep transverse metatarsal Ligament Fibrous flexor sheathSeptae
7Plantar aponeurosis Definition: Attachment: Thickened band of deep fascia in the sole of the foot.Attachment:Posteriorly: Medial tubercle of calcaneus.Anteriorly: Divides into 5 slips which pass to the 5 toes.On each side: Attached to the metatarsal bones by medial and lateral intermuscular septa.
8Plantar aponeurosis Functions: Protects the underlying nerves and vessels.Maintains the longitudinal arches of the foot.
26Medial Plantar NerveIt 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.
27Medial Plantar Nerve Branches: Muscular (to four muscles) to: Abductor hallucis.Flexor digitorum brevis.Flexor hallucis brevisFirst lumbrical muscleCutaneous: Planter cutaneous branches:To the skin of the medial 2/3 of the sole of the foot.Planter digital nervesArticular branches: To intertarsal and tarso-metatarsal joints.
28Lateral Plantar NerveIt 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 5th metatarsal bone, by dividing into a superficial and a deep branches.
29Lateral Plantar Nerve Branches: Muscular : Cutaneous: Flexor digitoum accessorius muscleAbductor digiti minimiFlexor digiti minimi brevisAdductor halucis muscle.Interossei2nd, 3rd & 4th lumbricals.Cutaneous:Skin of the lat. 1/3 of the soleSkin on the lat.side of the planter surface of the little toe and the adjoining sides of the 4th & 5th toes.The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.
33Medial Plantar ArteryOne 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.
34Medial Plantar Artery Muscular Termination: By anastmosing with the 1st planter metatarsal artery.Branches:MuscularDigital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.
35Lateral Plantar Artery One of the two terminal branches of the posterior tibial artery.At first between the 1st and 2nd layers, then curves medially between the 3rd and 4th 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 3rd & 4th layers of muscles.
36Lateral Plantar Artery Branches:MuscularAnastomotic branches: b/w arcuate & lateral tarsal arteries of the dorsalis pedis artery.Posterior perforating arteries:3 branches which anastomose with the dorsal metatarsal arteries.Planter digital artery: to the lateral side of the little toe.Three planter metatarsal arteries
37Transverse section through sole of right foot 3 Prox. Perforating ADorsalis Pedis A.4th layerMetatarsal - 1Metatarsal - 53nd layer2nd layerDeep Br. OfLat. Plantar art.1st layerTrunk of LateralPlantar art.
47QUESTION-1 Which dermatome is mainly stimulated in plantar reflex: A) L 4B) L 5 C) S 1D) S 2
48QUESTION-2All of the following belong to 3rd layer of muscles in sole except:A) Flexor hallucis brevisB) Abductor hallucisC) Adductor hallucisD) Flexor digiti minimi brevis
49QUESTION-3During 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 accessoriousB) Extensor digitorum longusC) LumbriclesD) Interossei
50QUESTION-4Plantar arch mainly formed by medial plantar artery – True/ false
51QUESTION-5In tarsal tunnel syndrome the sensory supply to which area of the sole is Mainly affected:A) HeelB) Medial margin of soleC) Middle part of soleD) Lateral part of sole