SOLE OF THE FOOT Dr. Jyoti Chopra Professor Department of Anatomy KGMU UP Lucknow Dr. Jyoti Chopra Professor Department of Anatomy KGMU UP Lucknow

Skin Skin 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.

CUTANEOUS NERVES CUTANEOUS NERVES Medial calcaneal branch of the tibial nerve, which innervates the medial side of the heel; Medial plantar nerve, which innervate the medial two thirds of the sole; Lateral plantar nerve, which innervate the lateral third of the sole.

DEEP FASCIA  Planter aponeurosis  Deep transverse metatarsal ligament  Fibrous flexor sheath  Septae

PLANTAR APONEUROSIS Definition: Definition: Thickened band of deep fascia in the sole of the foot. Attachment: 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.

PLANTAR APONEUROSIS Functions: Functions: Protects the underlying nerves and vessels. Maintains the longitudinal arches of the foot.

1 ST LAYER Three Muscles: Three Muscles: 1)Abductor hallucis 2)Flexor digitorum brevis 3)Abductor digiti minimi

1 ST LAYER Dr M Eladl

2 ND LAYER Dr M Eladl Two Tendons: Two Tendons: 1)Flexor halusis longus 2)Flexor digitorum longus Two Muscles: Two Muscles: 1)Quadratus Plantae (Flexor digitorum accessorius) 2)4 Lumbricals muscles

1 ST & 2 ND LAYERS Dr M Eladl

3 RD LAYER Dr M Eladl Three Muscles: Three Muscles: 1)Flexor hallucis brevis. 2)Adductor hallucis 3)Flexor digiti minimi brevis

4 TH LAYER Dr M Eladl Two Tendons: Two Tendons: 1)Tibialis posterior 2)Peroneus Longus Two Muscles: Two Muscles: 1)3 Planter Interossei 2)4 Dorsal Interossei

3 RD & 4 TH LAYERS Dr M Eladl

MEDIAL PLANTAR NERVE Dr M Eladl Origin: Origin: The larger of the two terminal branches of the posterior tibial nerve. Course: Course: Enter the foot midway between medial malleolus and medial tubercle of calcaneus under cover the flexor retinaculum Passes deep to the abductor hallucis Pass between the abductor hallucis and flexor digitorum brevis Medial planter vessels along its medial side Termination: Termination: At the bases of the metatarsal bones by dividing into 3 planter digital nerves.

MEDIAL PLANTAR NERVE Dr M Eladl Branches: Branches: Muscular (to four muscles) to: Abductor hallucis. 1)Flexor digitorum brevis. 2)Flexor hallucis brevis 3)First lumbrical muscle Cutaneous: Planter cutaneous branches: 1)To the skin of the medial 2/3 of the sole of the foot. 2)Planter digital nerves Articular branches: To intertarsal and tarso- metatarsal joints.

LATERAL PLANTAR NERVE Dr M Eladl Origin: Origin: The smaller of the two terminal branches of the posterior tibial nerve. Course: P asses Course: P asses between medial malleolus and medial tubercle of the calcaneus under flexor retinaculum Passes deep to abductor hallusis Passes between flexor digitorum brevis & flexor digitoum accessorius Lateral planter vessels run along its lateral side. Termination: Termination: At the base of the 5 th metatarsal bone, by dividing into a superficial and a deep branches.

LATERAL PLANTAR NERVE Dr M Eladl Branches: 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. 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.

MEDIAL PLANTAR ARTERY Dr M Eladl Origin: Origin: T erminal branch of posterior tibial arteryCourse: Enter the foot midway between medial malleolus and medial tubercle of calcaneus, under flexor retinaculum Passes deep to abductor hallucis Runs b/w abd.hallucis and flexor digitorum brevis Accompanied by two venae comitantes Med.planter nerve runs along its lat. side

MEDIAL PLANTAR ARTERY Dr M Eladl BranchesCutaneous Muscular Digital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.

LATERAL PLANTAR ARTERY Dr M Eladl Origin: Origin: One of the two terminal branches of the posterior tibial artery Course: Course: At first between the 1 st and 2 nd layers Curves medially between the 3 rd and 4 th layer Lateral planter nerve lies along its medial side

Termination: 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 and joins medially with dorsalis pedis artery (Plantar Arch).

LATERAL PLANTAR ARTERY Dr M Eladl Branches: Branches: Muscular Cutaneous Anastomotic branches: Anastomosis with branches of arcuate & lateral tarsal arteries of the dorsalis pedis artery. Planter digital artery: to the lateral side of the little toe Four planter metatarsal arteries Proximal & distal perforating arteries: 3 PP & 4 DP ascend through the proximal and distal ends of interosseous spaces to anastomose with the dorsal metatarsal arteries.

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

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

CLINICAL CASES DIBETIC FOOT WARTS DEFORMITIES INFECTIONS

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

QUESTION-1 Which dermatome is 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 contracts 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