Anatomy of the foot

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  • 1. ANATOMY OF THE FOOT MOHAMED ELADL
  • 2. SENSORY NERVE SUPPLY OF THE SKIN DORSUM OF THE FOOT Dr M Eladl  Derived from superficial peroneal nerve, assisted by deep peroneal, saphenous, & sural nerves.  Superficial peroneal nerve:  Divides into medial & lateral cutaneous branches that supply the skin on the dorsum of the foot; the medial side of the big toe; and the adjacent sides of the 2nd, 3rd, 4th, & 5th toes.  Deep peroneal nerve:  Supplies the skin of the adjacent sides of the big and second toes.
  • 3. SENSORY NERVE SUPPLY OF THE SKIN DORSUM OF THE FOOT Dr M Eladl  Saphenous nerve:  Passes onto the dorsum of the foot in front of medial malleolus  Supplies the skin along the medial side of the foot as far forward as the head of 1st metatarsal bone.  Sural nerve:  Enters the foot behind the lateral malleolus and supplies the skin along the lateral margin of the foot and the lateral side of the little toe.  The nail beds & the skin covering the dorsal surfaces of the terminal phalanges are supplied by the medial and lateral plantar nerves.
  • 4. DORSALIS PEDIS ARTERY Dr M Eladl  Origin:  It is the continuation of the anterior tibial artery.  Beginning  On the front of the ankle joint at a point midway between the medial and lateral malleoli  Course:  Runs forwards on the dorsum of the foot accompanied by two venae comitants.
  • 5. DORSALIS PEDIS ARTERY Dr M Eladl  Origin:  It is the continuation of the anterior tibial artery.  Beginning  On the front of the ankle joint at a point midway between the medial and lateral malleoli  Course:  Runs forwards on the dorsum of the foot accompanied by two venae comitants.  Termination:  At the proximal end of the first interosseous space, the artery turns towards the sole between the two heads of the first dorsal interosseous muscle to anastomose with the end of the planter arch.
  • 6. DORSALIS PEDIS ARTERY Dr M Eladl  Branches. 1. Medial and lateral tarsal arteries:  They arise just distal to the ankle joint  Supply the joint of the tarsus  Share in the anastomosis around the ankle joint 2. Arcuate artery:  Origin: arises opposite the bases of metatarsal bones  Course: runs laterally with an arched course  Branches:  It gives off the 2nd, 3rd and 4th dorsal metatarsal arteries. Each dorsal metatarsal divides into two dorsal digital arteries to the sides of the adjoining toes.  The 4th dorsal metatarsal artery gives off a branch, which supplies the lateral side of the little toe.
  • 7. DORSALIS PEDIS ARTERY Dr M Eladl  Branches. 3. 1st dorsal metatarsal artery:  Arises from the termination of the dorsalis pedis immediately before it pierces the 1st interosseous space.  Runs forwards on the 1st dorsal interosseus muscle & divided into two branches:  Medial branch: to the medial border of the big toe.  Lateral branch: divides into two dorsal digital branches, which supply the adjoining sides of the big & second toes.
  • 8. DORSALIS PEDIS ARTERY Dr M Eladl  Branches. 4. 1st planter metatarsal artery:  Arises from the ends of the dorsalis pedis in the sole.  Branches:  Planter digital branch to the medial side of the big toe.  Common planter digital branch, which divided into two planter digital branches supplies the adjoining sides of the big & 2nd toe.
  • 9. SURFACE ANATOMY & PULSATIONS OF DORSALIS PEDIS ARTERY Dr M Eladl  It is superficial in position and is crossed by the inferior extensor retinaculum and the first tendon of extensor digitorum brevis  Its course can be indicated by a line extends from  Point mid way between the 2 malleoli to;  Point at the proximal end of the first intermetatarsal space.  Pulsations can be easily felt lateral to the tendon of extensor hallucis longus.
  • 10. EXTENSOR DIGITORUM BREVIS Dr M Eladl  Origin:  Anterior part of the dorsal surface of the calcaneus.  Stem of the inferior extensor retinaculum  Insertion:  It forms four tendons. The most medial is the extensor hallucis brevis inserted into the base of the proximal phalanx of the big toe.  The remaining 3 tendons join the long extensor tendons of the 2nd, 3rd & 4th toes.  Nerve Supply:  Deep peroneal nerve.  Action:  Extension of metatarsophalangeal joints of the medial four toes.  Extension of interphalangeal joints of the second, third and fourth toes.
  • 11. SOLE OF THE FOOT Dr M Eladl  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  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.
  • 12. PLANTAR APONEUROSIS Dr M Eladl  Definition:  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.  Functions:  Protects the underlying nerves and vessels.  Maintains the longitudinal arches of the foot.
  • 13. LAYERS OF THE SOLE Dr M Eladl  The muscles of the sole are conveniently described in four layers from the inferior layer superiorly.  First layer:  Abductor hallucis, flexor digitorum brevis, abductor digiti minimi  Second layer:  Quadratus plantae, lumbricals, flexor digitorum longus tendon, flexor hallucis longus tendon  Third layer:  Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis  Fourth layer:  Interossei, peroneus longus tendon, tibialis posterior tendon  Unlike the small muscles of the hand, the sole muscles have few delicate functions and are chiefly concerned with supporting the arches of the foot.
  • 14. 1ST LAYER Dr M Eladl  Three Muscles: 1) Abductor hallucis 2) Flexor digitorum brevis 3) Abductor digiti minimi
  • 15. 2ND LAYER Dr M Eladl  Two Tendons: 1) Flexor halusis longus 2) Flexor digitorum longus  Two Muscles: 1) Quadratus Plantae (Flexor digitorum accessorius) 2) 4 Lumbricals muscles
  • 16. 1ST & 2ND LAYERS Dr M Eladl
  • 17. 3RD LAYER Dr M Eladl  Three Muscles: 1) Flexor hallucis brevis. 2) Adductor hallucis 3) Flexor digiti minimi brevis
  • 18. 4TH LAYER Dr M Eladl  Two Tendons: 1) Tibialis posterior 2) Peroneus Longus  Two Muscles: 1) 3 Planter Interossei 2) 4 Dorsal Interossei
  • 19. 3RD & 4TH LAYERS Dr M Eladl
  • 20. EXTENSOR EXPANSION OF LATERAL 4 TOES Dr M Eladl  Origin:  Fibrous expansion on the dorsal surface of the proximal phalanx.  Formation:  Tendons of the extensor digitorum longus for 2nd, 3rd, 4th & 5th toes.  Tendon of the extensor digitorum brevis for 2nd, 3rd & 4th toes.  Tendons of lumbricals muscle for 2nd, 3rd, 4th & 5th toes.  Tendons of dorsal interossei 2 for 2nd toe and one for each of 3rd and 4th toe.  The tendons of planter interossei for 3rd, 4th & 5th toes.
  • 21. EXTENSOR EXPANSION OF LATERAL 4 TOES Dr M Eladl  Origin:  Fibrous expansion on the dorsal surface of the proximal phalanx.  Formation: All these tendons unite on the dorsum of the proximal phalanx to form this expansion. The expansion is divided into three slips. 1) The thick central part of the expansion is inserted into the dorsal surface of the base of the middle phalanx. 2) The lateral and medial parts joint each other to be inserted into the base of the terminal phalanx.
  • 22. MEDIAL PLANTAR NERVE Dr M Eladl  Origin:  The larger of the two terminal branches of the posterior tibial nerve.  Course:  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.  Pass between the abductor hallucis and flexor digitorum brevis muscle.  The medial planter vessels run along its medial side  Termination:  At the bases of the metatarsal bones by dividing into 3 planter digital nerves.
  • 23. MEDIAL PLANTAR NERVE Dr M Eladl  Branches:  Muscular (to four muscles) to: 1) Abductor hallucis. 2) Flexor digitorum brevis. 3) Flexor hallucis brevis 4) 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.
  • 24. LATERAL PLANTAR NERVE Dr M Eladl  Origin:  The smaller of the two terminal branches of the posterior tibial nerve.  Course:  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.  Passes between flexor digitorum brevis & flexor digitoum accessorius.  The lateral planter vessels rum along its lateral side.  Termination:  At the base of the 5th metatarsal bone, by dividing into a superficial and a deep branches.
  • 25. LATERAL PLANTAR NERVE Dr M Eladl  Branches:  Muscular : 1) Flexor digitoum accessorius muscle 2) Abductor digiti minimi 3) Flexor digiti minimi brevis 4) Adductor halucis muscle. 5) Interossei 6) 2nd, 3rd & 4th lumbricals.  Cutaneous: 1) Skin of the lateral 1/3 of the sole 2) Skin on the lateral side of the planter surface of the little toe and the adjoining sides of the 4th & 5th toes. 3) The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.
  • 26. MEDIAL PLANTAR ARTERY Dr M Eladl  Origin:  One of the two terminal branches of the posterior tibial nerve.  Course:  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 between the abductor hallucis and flexor digitorum brevis.  It is accompanied by two venae comitantes.  The medial planter nerve runs along its lateral side.  Termination:  By anastmosing with the 1st planter metatarsal artery.
  • 27. MEDIAL PLANTAR ARTERY Dr M Eladl  Branches:  Muscular:  to the surrounding muscles.  Digital:  These are 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.
  • 28. LATERAL PLANTAR ARTERY Dr M Eladl  Origin:  One of the two terminal branches of the posterior tibial nerve.  Course:  At first between the 1st and 2nd layers, then curves medially between the 3rd and 4th layers of the sole.  The 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 3rd & 4th layers of muscles.
  • 29. LATERAL PLANTAR ARTERY Dr M Eladl  Branches:  Muscular: to the surrounding muscles.  Anastomotic branches:  Anastomosis with branches of arcuate & lateral tarsal arteries of the dorsalis pedis artery.  Posterior perforating arteries:  3 branches which ascend through the proximal ends of the 2nd, 3rd & 4th interosseous spaces to anastomose with the dorsal metatarsal arteries.  Planter digital artery: to the lateral side of the little toe. From the beginning of the arch.  Three planter metatarsal arteries:  Each divides into two planter digital arteries which supply the adjacent sides of two toes. These planter metatarsal arteries supply the adjacent sides between the 2nd, 3rd, 4th toes. Before it division into planter digital arteries, each planter metatarsal artery sends an anterior perforating artery to joint the corresponding dorsal metatarsal artery.
  • 30. THANK YOU