Lower limb

1. Arches of the foot
Dr. S. Prabhu
1st year PG
Anatomy
PIMS

2.  Supports body weight
 Serves as lever to propel
Basically

3.  Is formed by single bone
 Cannot adopt itself for uneven surfaces
 Propulsion depends completely on gastrocnemius
plantaris & soleus.
If the foot

4.  It is composed of small
bones and multiple joints
 Helps in adapting on
uneven surfaces
 Long & small flexor muscles
of foot assists in propulsive
movement
But

5.  Proportional distribution of body weight
 Acts as segmented level
 Protects vessels and nerves from compression
 Acts as spring board
Why there are arches

6.  120 lbs  60 lbs each foot.
 60lbs  talus  30lbs calcaneus – posteriorly
 30lbs head of 5 metatarsal bones – anteriorly
 6 bearing points in metatarsal bones
 1st has 2 sesamoid bones, 5lbs each
 5lbs each on 2nd to 5th metatarsal bones
Body weight distribution

7.  Longitudinal arch – medial & lateral
 Transverse arch
Arches

8.  Longitudinal arch – medial and lateral
Longitudinal arches

9.  Summit – trochlear
upper surface of talus
 Post. Pillar – medial
tubercle of calcaneus
 Ant. Pillar – heads of
medial 3 mts bones.
 Kye bone – head of talus
Medial longitudinal arch

10.  Summit – subtalar
joint
 Post. Pillar – medial
tubercle of calcaneus
 Ant. Pillar – heads of
4th & 5th mts bones
Lateral longitudinal arch

11.  Approximation of
medial borders of
both foot.
 It is only half of the
arch.
Transverse arch

12.  Shape of bones
 Strength of ligaments
 Muscle tone
Factors maintaining arches of foot

13.  Medial longitudinal arch
 Head of talus – centre of
arch – “keystone”
 Front – by navicular bone
 Rests on – sustentaculum
tali of calcaneus.
Shapes of bones

14. Lateral longitudinal arch
•Calcanean angle of cuboid
•Triangular projection
•Upward tilt of long axis of
calcaneus
 Transverse arch
• Wedge shaped nature of
intermediate cuneiform
bone(key stone)

15.  Medial longitudinal arch
• Supported by Plantar calcaneo –
navicular(spring) ligament.
• Itself is supported by slip of tibialis
posterior tendon.
• On permanent stretch, culminates
to flat foot formation
Ligaments
Lateral longitudinal arch
•Supported by long & short plantar ligament.
Transverse arch
•Deep transverse ligament
•Plantar ligaments
•Dorsal interossei
•Adductor hallucis muscle

16. Medial longitudinal
arch
Lateral longitudinal
arch
Transverse arch
• Plantar aponeurosis
• Abductor hallucis
• Flexor hallucis
longus
• Medial part of flexor
digitorum brevis
• Medial part of
tendon of flexor
digitorum longus
• Tendon of flexor
hallucis longus
• Plantar aponeurosis
• Abductor digiti
minimi
• Lateral part of flexor
digitorum brevis &
longus tendon
• Flexor digiti minimi
brevis
• Tendons of
peroneus longus &
peroneus brevis
• Tibialis posterior
Muscles (tie beams)

17. Medial longitudinal
arch
Lateral longitudinal
arch
Transverse arch
• Tendon of tibialis
anterior
• Superficial fibres of
deltoid ligament
• Tendons of
peroneus brevis
• & peroneus tertius
• Peroneus tertius
• Peroneus brevis
• Tibialis anterior
Suspenders

18.  1700-1800 foot steps every mile
 70,000 miles in life-time
 Swing phase (off the ground) &
 Stance phase (strike ground)
 Heel-strike of one foot to the heel-strike of the same
foot.
Walking cycle

19. Walking cycle

20.  On each cycle
 Head displaces upward twice in stance phase
 Corresponding downward movement in swing phase
 “bobbing of the head”
 Vertical displacement is about 5cm

21.  Lateral displacement is about 5cm
 When viewed from front or behind during locomotion
 Swing phase – trunk bends on balancing side
 Simultaneously arm alternately swings forward with
opposite leg

22. 1st part of swing phase
• Hip, knee & ankle are flexed
• The limb fully extends on advancing foot strikes
ground
• Hip flexors, dorsi-flexors of foot are highly active in
swing phase
Swing phase

23. • Knee flexes slightly, full extension on its end phase.
• Foot is then bent at metatarsao-phelangeal joints.
• Plantar flexors are most active(take off)
• End – toe flexes & grip the ground(long extensors &
intrinsic muscles)
• Invertors & evertors of foot are important stabilisers
in this phase
• Produce shift of weight to metstarsals
Stance phase

24.  Downward pelvic tilt on unsupported side due to
gravity is minimised by abductors of hip on stance
phase.
 Slight rotation of hip & knee takes place
On walking

25.  Femur rotates medially on tibia when foot is on the
ground
 Reverses when foot is off the ground
 As limb advances, femur rotates laterally at hip joint
to keep foot straight ahead.

26. Regulated by variety of sensory information from
nerve endings of
• Tactile
• Ligamentous
• Articular
• Musculo–tendinous
Walking reflexes

27. Altered by
• Individual style
• Poor posture
• Over weight
• Foot wear
Pattern of walking

28.  Important sign in many disorders of CNS
 Encountered in various conditions
Disturbances of gait

29.  Observed in tabes dorsalis
 Degeneration of posterior white funiculi of spinal
cord
 Loss of proprioception
 Walk on wide base
Ataxic gait

30.  Lift advancing leg too high
 Slap feet on ground
 Fix eye on ground
 Worsen when eye closed

31.  Affected leg is rigid
 Swung from hip in semicircle by
moving trunk
 Lean to affected side
 Arm of that side is held in semi
flexed position
Hemiplegic gait

32.  Seen in spastic paraplegia
 Legs are abducted
 Crossing alternately in front of
one another
 With knees scraping together
Scissors gait

33.  Observed in drunken state or
drug poisoning or flocculo-
nodular lobe syndrome
 Balancing of trunk is disturbed
 Unable to walk on straight line
Staggering gait

34.  Results from dislocation of hip or muscular
dystrophies
 Difficulty in maintaining pelvis in proper angle to the
weight bearing side
Waddling gait

35.  Downward tilt of
unsupported side
 Which produces exaggerated
compensatory sway of trunk
towards weight bearing side

36.  Marked irregularity and
unsteadiness with vertigo
 Tendency to reel to one side
Cerebellar gait

37.  Seen in parkinsonism
 Lesion in basal ganglia
 Pt. have stooped posture
 Short & quick steps
 Chasing their centre of gravity
 Slow in beginning
 Unable to stop when needed
Propulsion gait

38.  Patient experiencing pain by
weight bearing on affected
side
 Takes short steps to get rid of
weight from affected limb
 Sound limb brought forward
quickly to land
 Thus limping is produced
Limping gait

39. Deformities of foot
Flat foot- pes planus –commonest -
disappearance of arch of foot
• Causes – abnormal weight
distribution, loss of muscle tone on
prolonged standing.
• Predisposing factors – faulty foot
wear, bad walking, long slender
rapidly growing foot

41.  Pes cavus – claw foot exaggeration
of longitudinal arch
• plantar flexion at transverse tarsal
joint
• Anterior part of foot drops below
level of posterior part
• Toes are dorsiflexed at metatarso-
phalangeal joint
• Plantar flexed at inter phalangeal
joint

42.  Club foot- talipes
• Talipes equinus – foot fixed in plantar
flexion
• Talipes calcaneus – toes upturned-
dorsiflexed
• Talipes varus – foot fixed in inversion &
adduction
• Talipes valgus – eversion & abduction

43. March foot –
• Commonly seen in soldiers
• Sometimes the neck of intermediate metatarsal
undergo decalcification
• Minor injury can lead to pathological fracture

44. Hallux valgus
• Great toe is adducted towards
midline of foot
• Wearing of narrow pointed
shoes

45. Hammer toe
• Affects 2nd or 3rd toe
• Distal interphalangeal joints
are hyperextended
• Proximal IP joints are flexed.

46.  Datta, A.K. (2012) 'Arches of the foot', in Datta, A.K., Roy, S.,
Bhanu, C., Amith, H. (ed.) Essentials of human anatomy superior
and inferior extremities. 60, Lenin Saranee, Kolkata: Current book
international, pp. 250-256.
 Sinnatamby, C.S. (2011) 'Lower limb', in Sinnatamby, C.S.
(ed.)Last's anatomy regional and applied. Edinburgh London:
Churchill Livingstone Elsevier, pp. 160-162.
 Versfeld, G.A. (1999) 'The ankle foot complex', in Decker, G.A.G
(ed.) Lee McGregor's synopsis of surgical anatomy. Dadar,
Bombay: Varghese publishing house, pp. 538-543.
References

47. Thank you