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1. Dr. Eiman Sumayyah
DPT, MSPT(NEUROLOGY)
SOLE OF THE FOOT

2.  Pay attention to two of the joint areas in
the sole of the foot because they are the
major joints for eversion and inversion of
the foot:
 subtalar joint (ST)
 transverse talar joint (TT)

3.  Once the skin of the sole of
the foot has been removed,
there is a very dense
organized layer of deep fascia
that runs down the middle of
the sole; this is the PLANTAR
APONEUROSIS.
 The plantar aponeurosis is
thought to help maintain the
medial longitudinal arch of
the foot.

4.  After the plantar aponeurosis has been removed you can
see the muscles that make up the first layer of the sole
of the foot and the arteries and nerves entering the foot.
 The muscles of the first layer are:
 abductor hallucis
 flexor digitorum brevis
 abductor digiti minimi
 The nerves are the:
 medial plantar
 lateral plantar
 The arteries are branches of the posterior tibial artery
and include the:
 medial plantar
 lateral plantar

5.  The medial and
lateral plantar nerves
supply the muscles
as well as the skin on
the sole of the foot.
They are branches of
the tibial nerve.
 The medial plantar
nerve supplies the:
 abductor hallucis
muscle
 flexor digitorum
brevis
 flexor hallucis brevis
(in the third layer)
 1st lumbrical

6.  The lateral plantar nerve supplies
the remaining muscles in the sole
of the foot. In a way, it is similar to
the ulnar which supplies most of
the small muscles of the hand. The
muscles supplied are the:
 abductor digiti minimi
 accessory flexor (quadratus
plantae)
 adductor hallucis
 flexor digiti minimi brevis
 interossei
 lumbricals 3, 4, 5

7.  When the flexor digitorum brevis is
removed, the muscles of the
second layer can be seen:
 accessory flexor (quadratus
plantae)
 lumbricals
 tendons of the flexor digitorum
longus from which the lumbricals
arise
SECOND LAYER

8.  The muscles of the third
layer include the:
 flexor hallucis brevis
 adductor hallucis
 oblique head
 transverse head
 flexor digiti minimi brevis
THIRD LAYER

9.  The fourth layer of muscles
are the:
 dorsal interossei (dab)
meaning dorsal abduct
 plantar interossei (pad)
meaning plantar adduct
 At this level, you can also see
the tendon of the peroneus
longus crossing the sole of
the foot.
FOURTH LAYER

10.  The medial and lateral plantar nerves
supply muscles and skin of the sole of the
foot.
 The medial plantar nerve gives rise to
digital branches which then give rise to
common digital branches and finally, the
terminal branches. This nerve supplies the
skin of the medial three and one half
digits.
 The lateral plantar nerve gives rise to
motor branches, a deep branch and finally
branches to the skin of the lateral one and
one-half digits.
NERVES OF THE SOLE OF THE FOOT

11.  The arteries of the sole of the foot are
derived from the posterior tibial
artery. It splits into the medial and
lateral plantar arteries.
 The medial plantar artery passes
along the medial part of the sole of
the foot and terminates by branching
into digital branches.
 The lateral plantar artery becomes the
plantar arterial arch which
anastomoses by way of a perforating
artery with the dorsal pedis artery.
The arch gives rise to several
metatarsal branches which split into
digital branches.
ARTERIES OF THE SOLE OF THE FOOT

12.  The long plantar ligament and the plantar
calcaneocuboid ligament lie deep to the muscles
of the fourth layer.
 The long plantar ligament stretches from the
calcaneum to the cuboid and to the bases of the
second, third and fourth metatarsal bones.
 The plantar calcaneocuboid ligament, reaches the
calcaneum to the cuboid on the deep aspect of
the long plantar ligament.
 The plantar calcaneonavicular ligament extends
from the calcaneus to the navicular bone and
prevents the head of the talus from pushing down
between the calcaneus and the navicular bones.
This ligament is also know as the spring ligament
since it is believed to give a spring-like action the
the foot when walking.
LIGAMENTS OF THE SOLE OF THE FOOT

13.  All of the bones of the foot are held together by ligaments but
there are three that are strongly implicated in maintaining the
arches of the foot:
 long plantar ligament
 calcaneocuboid ligament
 calcaneonavicular ligament
ARCHES OF THE FOOT

16.  The muscles of the foot have two primary functions. They are
responsible for the movement which is made during walking,
and they also help to maintain the arches of the foot.
 The arches are arranged both longitudinally and transversely,
and are caused primarily by the conformation of the bones of
the foot and the ligaments which bind them together, and
secondarily by the muscles which act upon the bones.

17.  The medial arch is the higher of the two longitudinal arches.
It is formed by the calcaneus, talus, navicular, three
cuneiforms and first three metatarsal bones. It is supported
by:
• Muscular support: Tibialis anterior and posterior, fibularis
longus, flexor digitorum longus, flexor hallucis, and the
intrinsic foot muscles
• Ligamentous support: Plantar ligaments (in particular the
long plantar, short plantar and plantar calcaneonavicular
ligaments), medial ligament of the ankle joint.
• Bony support: Shape of the bones of the arch.
• Other: Plantar aponeurosis.
MEDIAL ARCH

18.  The lateral arch is the flatter of the two longitudinal arches,
and lies on the ground in the standing position. It is formed by
the calcaneus, cuboid and 4th and 5th metatarsal bones. It is
supported by:
 Muscular support: Fibularis longus, flexor digitorum longus,
flexor hallucis, and the intrinsic foot muscles.
 Ligamentous support: Plantar ligaments (in particular the long
plantar, short plantar and plantar calcaneonavicular
ligaments).
 Bony support: Shape of the bones of the arch.
 Other: Plantar aponeurosis.
LATERAL ARCH

20.  The transverse arch is located in the coronal plane of the foot.
It is formed by the metatarsal bases, the cuboid and the three
cuneiform bones. It has:
 Muscular support: Fibularis longus and tibialis posterior.
 Ligamentous support: Plantar ligaments (in particular the long
plantar, short plantar and plantar calcaneonavicular
ligaments) and deep transverse metatarsal ligaments.
 Other support: Plantar aponeurosis.
 Bony support: The wedged shape of the bones of the arch.
TRANSVERSE ARCH

21.  Pes cavus is a foot condition characterised by an unusually high medial
longitudinal arch. It can appear in early life and become symptomatic with
increasing age. Due to the higher arch, the ability to shock absorb during
walking is diminished and an increased degree of stress is placed on the
ball and heel of the foot.
 Consequently, symptoms will generally include pain in the foot, which can
radiate to the ankle, leg, thigh and hip. This pain is transmitted up the
lower limb from the foot due to the unusually high stress placed on the
hindfoot during the heel strike of the gait cycle.
 Causes of pes cavus can be idiopathic, hereditary, due to an underlying
congenital foot problem such as club foot, or secondary to neuromuscular
damage such as in poliomyelitis.
 The condition is generally managed by supporting the foot through the use
of special shoes or sole cushioning inserts. Reducing the amount of weight
the foot has to bear can also be advantageous. This can be achieved
through weight loss.
CLINICAL RELEVANCE – PES CAVUS (HIGH
ARCHES)

23.  Pes planus is a common condition in which the longitudinal
arches have been lost. Arches do not develop until about 2-3
years of age, meaning flat feet during infancy is normal.
 Because the arches are formed, in part, by the tight tendons of
the foot, damage to these tissues through direct injury or trauma
can cause pes planus. However in some people, the arches never
form.
 For most individuals, being flat-footed causes few, if any,
symptoms. In children it may result in foot and ankle pain, whilst
in adults the feet may ache after prolonged activity.
 Treatment, if indicated, generally involves the use of arch-
supporting inserts for shoes.
CLINICAL RELEVANCE: PES PLANUS (FLAT
FOOTED)

25. TABLES
Muscles on the Dorsum of Foot
extensor
digitorum
brevis
calcaneum
by four tendons
into the proximal
phalanx of big toe
and long extensor
tendons to 2nd,
3rd and 4th toes
deep
peroneal
nerve
extends toes
Muscles of the Sole of the Foot (First Layer)
abductor
hallucis
medial tubercle
of calcaneum;
flexor
retinaculum
medial side, base
of proximal
phalanx of big toe
medial
plantar
nerve
flexes, abducts
big toe; supports
medial arch
flexor
digitorum
brevis
medial tubercle
of calcaneum
middle phalanx of
four lateral toes
medial
plantar
nerve
flexes lateral four
toes; supports
medial & lateral
longitudinal
arches
abductor
digiti
minimi
medial & lateral
tubercles of
calcaneum
lateral side base of
proximal phalanx
5th toe
lateral
plantar
nerve
flexes, abducts
5th toe; supports
lateral
longitudinal arch

26. muscles of Sole of Foot (Second Layer)
flexor
accessorius
(quadratus
plantae)
medial and
lateral sides
of
calcaneum
tendons
flexor
digitorum
longus
lateral plantar
nerve
aids long flexor
tendon to flex
lateral four toes
flexor
digitorum
longus
tendon
shaft of
tibia
base of
distal
phalanx of
lateral four
toes
tibial nerve
flexes distal
phalanges of lateral
four toes; plantar
flexes foot;
supports
longitudinal arch
lumbricals
tendons of
flexor
digitorum
longus
dorsal
extensor
expansion
of lateral
four toes
1st lumbrical
from medial
plantar;
remainder
lumbricals from
deep branch of
lateral plantar
nerve
extends toes at
interphalangeal
joints
flexor
hallucis
longus
shaft of
fibula
base of
distal
phalanx of
big toe
tibial nerve
flexes distal
phalanx of big toe;
plantar flexes foot;
supports medial
longitudinal arch

27. Muscles of Sole of Foot (Third Layer)
flexor
hallucis
brevis
cuboid, lateral
cuneiform
bones; tibialis
posterior
insertion
medial &
lateral sides
of base of
proximal
phalanx of
big toe
medial
plantar
nerve
flexes
metatarsophalangeal
joint of big toe;
supports medial
longitudinal arch
adductor
hallucis
(oblique
head)
bases of 2nd,
3rd & 4th
metatarsal
bones
lateral side
base of
proximal
phalanx big
toe
deep
branch of
lateral
plantar
flexes big toe,
supports transverse
arch
adductor
hallucis
(transverse
head)
plantar
ligaments
lateral side
of base of
proximal
phalanx big
toe
deep
branch of
lateral
plantar
nerve
flexes big toe;
supports transverse
arch
flexor digiti
minimi brevis
base of 5th
metatarsal
bone
lateral side
of base of
proximal
phalanx of
big toe
superior
branch of
lateral
plantar
nerve
flexes little toe

28. Muscles of Sole of Foot (Fourth Layer)
dorsal
interossei
(4)
adjacent
sides of
metatarsal
bones
bases of phalanges
and dorsal
expansion of
corresponding toes
lateral
plantar
nerve
abduct toes with
2nd toe as the
reference; flex
metatarsophalangeal
joints; extend
interphalangeal joint
plantar
interossei
(3)
3rd, 4th, and
5th
metatarsal
bones
bases of phalanges
& dorsal expansion
of corresponding
toes
lateral
plantar
nerve
adduct toes with
2nd toe as
reference; flex
metatarsophalangeal
joints; extend
interphalangeal
joints
tendon of
peroneus
longus
see above see above
see
above
see above
tendon of
tibialis
posterior
see above see above
see
above
see above

29.  ???
PLANTAR FASCIITIS