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Kin191 A. Ch.4. Foot. Toes. Anatomy. Fall 2007
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Kin191 A. Ch.4. Foot. Toes. Anatomy. Fall 2007

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  • 1. FOOT/TOES ANATOMY KIN 191A Advanced Assessment of Lower Extremity Injuries
  • 2. INTRODUCTION
    • ANATOMY
      • BONY STRUCTURES
      • ARTICULATIONS
      • MUSCULATURE
      • ARCHES OF THE FOOT
      • NEUROANATOMY
      • ARTERIES AND BURSA
  • 3. BONY STRUCTURES
    • 26 bones + 2 sesamoids
    • Three sections
      • Rearfoot (hindfoot)
        • Calcaneus
        • Talus
      • Midfoot
        • Navicular
        • Cuboid
        • 3 Cuneiforms
      • Forefoot
        • 5 Metatarsals
        • 14 Phalanges
  • 4.
    • 7 Tarsals (Rear+Mid Foot)
      • Calcanues
      • Talus
      • Navicular
      • Cuboid
      • 3 cuneiforms
  • 5.
    • Forefoot
      • 5 metatarsal s
      • Each toe
        • 3 phalanges (w/ exception of the great toe)
          • Distal
          • Middle
          • Proximal
  • 6. Calcaneus
    • The largest of the tarsal bones
    • Calcaneal tubercle
      • Posterior projection
    • Sustentaculum tali
      • The anterior superior medial surface of the calcaneus body
      • Inferior groove
        • Flexor hallucis longus tendon
    Medial view Posterior view
  • 7.
      • Lateral potion of the anterior calcaneus
        • Articulates with the cuboid
      • Peroneal tubercle
        • Lateral side projection of the calcaneus
          • Peroneus longus: inferior to the tubercle
          • Peroneus brevis: superior to the tubercle
    Lateral view
  • 8.
    • Head
      • Articulates with navicular
    • Medial tubercle
      • Attachment site for deltoid ligament
    • Neck
      • Projects head anteriorly
    • Dome
      • Articulates with distal tibia and fibular in ankle mortise
    Talus
  • 9.
    • Ankle mortise
      • The distal tibia and fibular form
      • The talus sits
        • Mortise : a rectangular cavity in a piece of wood, stone, or other material, prepared to receive a tenon
  • 10.
    • Inferior surface of the talus
      • Anterior facet
      • Middle facet
      • Posterior facet
      • 5 functional articulations
        • Superiorly: the distal end of the tibia
        • Medially: the medial malleous
        • Laterally: the lateral malleolus
        • Inferiorly: the calcaneus
        • Anteriorly: the navicular
      • No muscle attachments
  • 11. Midfoot
    • Formed by navicular, 3 cuneiforms, and cuboid
    • Navicular
      • Anteriorly articulates with the 3 cuneiforms
      • Laterally articulates with the cuboid
      • Posteriorly articulates with the talus
      • Navicular tuberosity
        • Medial aspect
        • Primarily insertion for the tibialis posterior muscle
  • 12.
    • Cuboid
      • Medially articulates with the third (lateral) cuneiform and navicular
      • Anteriorly articulates the 4 th and 5 th Metatarsals
      • Posteriorly articulates with the calcaneus
      • Sulcus
        • Formed anterior to the cuboid tuberosity and posterior to the base of the 5 th metatarsal
  • 13.
    • Cuneiforms
      • Medial (1 st )
      • Intermediate (2 nd )
      • Lateral (3 rd )
      • Posteriorly articulates with the navicular
      • Each cuneiform articulates with the corresponding metatarsal anteriorly
      • Lateral border of the 3 rd cuneiform
        • Articulates with the medial aspect of the cuboid
  • 14.
    • Forefoot and Toes
      • 5 Metatarsals
        • Head (distal)
        • Body (shaft)
        • Base (proximal)
      • 14 phalanges
        • Head (distal)
        • Body (shaft)
        • Base (proximal)
  • 15. ARTICULATIONS
    • Subtalar Joint
    • Midfoot Joints
      • Talocalcaneonavicular joint
      • Calcaneocuboid joint
      • Midtarsal joints
    • Forefoot Joints
      • Tarsometatarsal joints (Lisfranc joint)
      • Intermetarsals joints
      • Metatarsophalangeal (MTP) joints
      • Interphalangeal (IP) joints
  • 16. Subtalar Joint
    • Articulation between calcaneus and talus
    • No muscle attach to the talus, the stability of the subtalar joint is derived from ligamentous and bony restraints
  • 17. Triplanar Motions
  • 18. Midfoot Joints
    • Talocalcaneonavicular joint and the calcaneocuboid joint  the junction between the rearfoot and midfoot
      • TCN joint
        • Plantar calcaneonavicular (Spring) ligament
    • Midtarsal joints
  • 19. Forefoot Joints
    • Tarsometatarsal joints (Lisfranc joint)
    • Intermetatarsal joints
    • Metatarsophalangeal (MTP) joints
    • Interphalangeal (IP) joints
  • 20. Forefoot Joints
    • Tarsometatarsal joints (Lisfranc joint)
    • Intermetatarsal joints
    • Metatarsophalangeal (MTP) joints
    • Interphalangeal (IP) joints
      • 1 IP joint
      • 4 PIP joints
      • 4 DIP joints
  • 21. MUSCULATURE
    • Intrinsic
      • Originate on one of the bones of the foot and directly influence the motion of the foot or toes
    • Extrinsic
      • Originate on the leg or distal femur and influence motion at the knee and ankle in addition to the foot and toes
  • 22. Intrinsic Musculature
    • 2(1) dorsal surface superficial muscle(s)
    • 4 (3+) layers of plantar surface muscles
      • Layer I (Superficial)
      • Layer II (Middle)
      • Layer III (Deep)
      • Layer IV (Deep to deep)
  • 23. DORSAL SURFACE
    • Extensor digitorum brevis (MTP, PIP, DIP)
    • Extensor hallucis brevis (MTP)
  • 24. Extensor Digitorum Brevis
    • Sinus tarsi – site of muscle belly/origin of EDB
    • O: Superolateral calcaneus
    • I: Dorsal base of proximal phalanx of 2 nd (1 st ) - 4 th toes
    • N: Deep peroneal n.
    • A: Secondary extensor of the toes (MTP, PIP, DIP)
  • 25. Extensor Hallucis Brevis
    • O: Superolateral calcaneus
    • I: Dorsal base of proximal phalanx of big toe
    • N: Deep peroneal n.
    • A: Secondary extensor of the big toe (MTP)
  • 26. PLANTAR SURFACE – Layer I
    • Abductor hallucis (MTP)
    • Abductor digiti minimi pedis (MTP)
    • Flexor digitorum brevis (MTP,
    • PIP)
  • 27. Abductor Hallucis
    • O: Medial calcaneal tuberosity/Flexor retinaculum and plantar fascia
    • I: Plantar base of proximal phalanx of the big toe
    • N: Medial plantar n.
    • A: Primary abductor of the big toe (MTP)
  • 28. Abductor Digiti Minimi Pedis
    • O: Proximal lateral calcaneus/Plantar fascia
    • I: Lateral portion of the base of proximal phalanx of the 5 th toe
    • N: Lateral plantar n.
    • A: Primary abductor of the 5 th toe (MTP)
  • 29. Flexor Digitorum Brevis
    • O: Medial calcaneal tuberosity
    • I: Proximal (medial and lateral sides) phalanges of 2 nd -5 th toes
    • N: Medial plantar n.
    • A: Secondary flexor of the 2 nd through 5 th toes (MTP/PIP)
  • 30. PLANTRAR SURFACE – Layer II
    • Quadratus plantae: Flexes 2-5 th toes (MTP, PIP, DIP)
    • Lumbricals pedis: Flexes 2-5 th toes (MTP)
    • Extends 2-5 th toes (PIP, DIP)
  • 31. Quadratus Plantae
    • Changes the angle of pull for the FDL when contracted
    • O: Medial/lateral heads from med/lat calcaneus
    • I: Dorsal/plantar FDL
    • N: Lateral plantar n.
    • A: Flexes 2-5 th toes (MTP, PIP, DIP)
  • 32. Lumbricals Pedis
    • O: Tendons of FDL
    • I: Posterior surface of the 2 nd -5 th toes via FDL tendons
    • N: 1 st – Medial plantar n. 2 nd -4 th – Lateral plantar n.
    • A: Flexes 2-5 th toes (MTP) Extends 2-5 th toes (PIP, DIP)
  • 33. PLANTAR SURFACE – Layer III
    • Flexor hallucis brevis (MTP)
    • Flexor digiti minimi pedis (MTP)
    • Adductor hallucis (MTP)
  • 34. Flexor Hallucis Brevis
    • O: Medial plantar surface of cuboid
    • I: Medial/lateral sides of proximal phalanx of the big toe
    • N: Medial plantar n.
    • A: Secondary flexor of the big toe (MTP)
  • 35. Flexor Digiti Minimi Pedis
    • O: Plantar surface of cuboid and base of 5 th metatarsal
    • I: Plantar surface of proximal phalanx of the 5 th toe
    • N: Lateral plantar n.
    • A: Secondary flexor of the 5 th toe (MTP)
  • 36. Adductor Hallucis
    • O: O blique head – bases of 2 nd -4 th metatarsals T ransverse head – plantar surface of 3 rd -5 th metatarsal heads
    • I: Lateral base of proximal phalanx of great toe
    • N: Lateral plantar n.
    • A: Adducts the big toe (MTP)
  • 37. PLANTAR SURFACE – Layer IV
    • P lantar interossei : ad ducts toes 3-5 th (MTP)
    • D orsal interossei pedis: ab ducts 2-4 th (MTP)
    PAD DAB
  • 38. P lantar Interossei
    • O: Medial side of the metatarsals
    • I: Sides of phalanges and distal tendon of EDL
    • N: Lateral plantar n.
    • A: Ad ducts 3 rd -5 th toes (PAD)
  • 39. D orsal Interossei Pedis
    • O: Adjacent sides of the two metatarsals
    • I: Sides of phalanges and distal tendon of EDL
    • N: Lateral plantar n.
    • A: Ab ducts 2 nd -4 th toes (DAB)
  • 40. Extrinsic Musculature
    • Tibialis anterior
    • Extensor digitorum longus
    • Extensor hallucis longus
    • Peroneus tertius
    • Peroneus longus
    • Peroneus brevis
    • Gastrocnemius
    • Soleus
    • Plantaris
    • Tibialis posterior
    • Flexor digitorum longus
    • Flexor hallucis longus
  • 41. ARCHES OF THE FOOT Anterior Metatarsal Medial Longitudinal Lateral Longitudinal Transverse
  • 42. Soft Tissue Support of the Medial Longitudinal Arch
    • A: Tibialis anterior
    • B: Tibialis posterior
    • C: Flexor hallucis longus
  • 43. NEUROANTOMY
    • Plantar neuro structures
    • Dorsal neuro structures
    • Dermatomes
  • 44. Plantar Neuro Structures
    • Tibial nerve branches into medial and lateral plantar nerves which in turn branch into digital nerves
  • 45. Dorsal Neuro Structures
    • Superficial peroneal nerve and its branches – lateral
    • Deep peroneal nerve and its branches – dorsal/medial
  • 46. DORSALIS PEDIS ARTERY
    • Dorsal surface of foot and branches terminating as digital branches
    • Dorsalis pedis pulse located between extensor digitorum and hallucis longus tendons on dorsal aspect of foot
  • 47. POTERIOR TIBIAL ARTERY
    • On plantar surface of foot branches into
      • Medal and Lateral plantar arteries which in turn branch into
        • Digital arteries
    • Posterior tibial pulse located behind medial malleolus along Achilles tendon
  • 48. DORSALIS PEDIS PULSE POTERIOR TIBIAL PULSE