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

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

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

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