2. Muscles:
Extensor digitorum brevis :
Origin :
-superior surface of calcaneus.
-stem of the inferior extensor retinaculum
Insertion :
lateral three slips of muscle into 2nd 3rd 4th
toes into the lateral side of the tendons of the
extensor digitorum longus .
Nerve supply :lateral terminal branch of the
anterior tibial nerve
Action : extends the proximal phalanges of
the 2nd 3rd 4th toes
Dorsum of the foot
3. Extensor hallucis brevis :
Origin: it`s the medial slip of th
extensor digitorum brevis
Insertion : dorsum of the base of the
proximal phalanx of the big toe .
Nerve supply: the same
Action : extend the proximal phalanx of
big toe
4. Dorsal interossei :
4 in number
Each one arise from the 2 adjacent
metatarsal bones
- 1st arises from 1st and 2nd metatarsal
bones but acts on the 2nd toe
-2nd arises from the 2nd and 3rd
metatarsal bones and acts on 2nd toe
-3rd …………… the 3rd and 4th
………………………….. 3rd toe
-4th ……………the 4th and 5th
…………………………….4th toe
Nerve supply : - 1st 2nd 3rd are supplied
by the deep division of the lateral planter
nerve
- The 4th is supplied by
the superficial division of the lateral
planter nerve
Action : abduct the 3rd 4th toe from the
line of the 2nd toe
5. Innervation:
Anterior tibial nerve and its terminal branches :
1.Lateral terminal branch : deviate laterally deep to extensor digitorum brevis . it ends in
gangiliform expantion from this supply this muscle < intertarsal and tarsometatarsal
joints .
2. medial terminal branch :
ends by dividing into branches to
the cleft between 1st , 2nd toes .
6. Cutaneous nerves :
1.saphenous nerve : medial side of
dorsum of foot
2. medial terminal branch of
superficial peroneal N : medial side of
big toe and cleft between 2nd and 3rd
toees
3. medial terminal branch of anterior
tibial N : cleft between 1st and 2nd
toes
4.lateral termina branch of superficial
peroneal N : cleft between 3rd , 4th
toes and cleft between 4th , 5th toes
5. sural N : lateral side of dorsum of
foot except the little toe
6 . medial planter N : medial 3.5 toes
7. lateral planter N : lateral 1.5 toes
7. Arterial supply:
"Dorsalis pedis artery "
Beginning: in front of ankle joint as a continuation of anterior tibial artery.
Course: the proximal part is crossed by the inferior extensor retinaculum
& the distal part is crossed by the extensor hallucis brevis
End: at the proximal end of the 1st interosseous space ( space between the
2 heads of the 1st dorsal interosseous muscle ) reaches the sole of the foot
& ends by anastomosis with the end of plantar arch.
8. Branches:
1) medial tarsal artery: shares in the anatosomosis around ankle joint.
2) lateral tarsal artery: shares in the anatosomosis around the ankle joint.
3) first dorsal metatarsal artery.
4) first planter metatarsal artery: arises in the sole from the end of dorsalis
pedis artery.
5) arcuate artery: passes laterally & gives the 2nd,3rd & 4th dorsal metatarsal
arteries.
9. Venous drainage :
1- dorsal digital vein
2- dorsal metatarsal vein
3- dorsal venous arch
4- small saphenpus vein on the
lateral side
5- great saphenous vein on the
medial side
Great saphenous
vein
Dorsal venous
arch
Small
saphenous vein
11. Sole of the foot:-
Coverings:-
1-skin 2-superficial fascia 3- deep
fascia
Plantar Aponeurosis:-
- Thickened deep fascia of the sole.
- Attached to * posteriorly calcanean tubercles
* anterioly it is divided to five
slips; one for each toe
- Function: * fixes the skin of the sole
* Protects the deeper structures
* Maintain the longitudinal arches
of the foot
12. 1-Abductor hallucis
*Origin: calcaneal tuberosity at
the back of the planter surface
of the calcaneus
*Insertion: medial side of the
base of the first phalanx of the
big toe
*Nerve supply: medial plantar
nerve
*Action: Abduction of the big
toe
Muscles of the 1st layer
13. Muscles of the 1st layer
2-Flexor digitorum brevis
*Origin: calcaneal tuberosity
at the back of the planter
surface of the calcaneus
*Insertion: 4 tendons to the
lateral 4 toes
*Nerve supply: medial
planter nerve
*Action: flexion of the lateral
four toes
14. Muscles of the 1st layer
3-Abductor digiti minimi
*Origin: calcaneal tuberosity at
the back of the planter surface
of the calcaneus
*Insertion: lateral side of the
base of the first phalanx of the
little toe
*Nerve supply: lateral plantar
nerve
*Action: abduction of the little
toe
15. Muscles of the 2nd layer
)2 tendons + 5 muscles)
1-Flexor hallucis longus tendon
*Origin: lower 2/3 of the back of the
fibula (below the origin of the
soleus)
*Insertion: base of the distal phalanx
of the big toe
*Nerve supply: post. tibial nerve
*Action: a) flexes the
interphalangeal & metatarso-
phalangeal joints of the big toe
b) helps in planter-flextion of the
foot
c) supports the med. longitudinal
arch of the foot
16. Muscles of the 2nd layer
2-Flexor digitorum longus tendon
*Origin: area on the post. surface of
the tibia limited above & med. by the
origin of the soleus and lat. by the
origin of tibialis post.
*Insertion: 4 tendons each is inserted
into the distal phalanx of the
corresponding toe
*Nerve supply: post. tibial nerve
*Action: a) flexes the interphalangeal
& metatarso-phalangeal joints of the
lat. 4 toes
b) helps in planter-flexion & inversion
of the foot
17. Muscles of the 2nd layer
3-Flexor digitorum accessorius
*Origin: two heads (med. & lat.)
from the med. & lat. surface of the
calcaneus and the long planter
ligament
*Insertion: in the tendon of the
flexor digitorum longus in the
middle of the sole
*Nerve supply: lateral plantar nerve
*Action: corrects the oblique
direction of the tendons of flexor
digitorum longus & brings these
tendons in line with the toes upon
which they act
18. Muscles of the 2nd layer
4-The four lumbrical ms.
*Origin: tendons of flexor digitorum
longus
*Insertion: med. sides of the bases
of proximal phalanges of lat. 4 toes
& extensor expansions of tendons of
flexor digitorum longus
*Nerve supply:
1st > medial plantar n.
2nd , 3rd , 4th > lateral plantar n.
*Action: flex proximal phalanges &
extend middle & distal phalanges of
lat. 4 toes
3rd
4th
1st
2nd
19. Muscles of the 3rd layer
1-Adductor hallucis
*Origin: a) Oblique head > bases of
2nd,3rd and 4th metatarsal bones
b) Transverse head > capsules of lat.
4 metatarso-phalangeal joints
*Insertion: lateral side of the base of
the proximal phalanx of the big toe
*Nerve supply: deep branch of lateral
plantar nerve
*Action: a) Olique head > Adduct the
big toe
b) Transverse head > draw the roots
of the toes closer---accentuate the
transverse arch of the foot
T.H
O.H
20. Muscles of the 3rd layer
2-Flexor hallucis brevis
*Origin: from cuboid bone &
ligaments in the region of the
base of the 1st metatarsal
*Insertion: both sides of base of
proximal phalanx of the big toe
*Nerve supply: medial plantar
nerve
*Action: Flexes the metatarso-
phalangeal joint of the big toe
21. Muscles of the 3rd layer
3-Flexor digiti minimi brevis
*Origin: base of the 5th
metatarsal bone
*Insertion: base of first
phalanx of the little toe
*Nerve supply: superficial
branch of lateral plantar n.
*Action: flexes the metatarso-
phalangeal joint of the little toe
22. Muscles of the 4th layer
1-Three Planter interossei
*Origin: Bases & med. Sides of
metatarsal bones (3,4,5)
*Insertion: med. Sides of bones of
proximal phalanges of digits
(3,4,5)
*Nerve Supply: lateral planter n.
*Action: adduct 3,4,5 digits & flex
metatarsophalangeal joints
23. Muscles of the 4th layer
2-Four Dorsal interossei
*Origin: adjacent sides of metatarsal
bones ( 1 : 5 )
*Insertion: 1st > med. side of proximal
phalanx of 2nd digit
2nd,3rd,4th > lat. sides of digits 2,3,4
*Nerve Supply: lateral planter n.
*Action: abduct 2,3,4 digits & flex
metatarsophalangeal joints
24. Blood supply of the sole of the foot
A) Arterial supply
1-Lateral planter artery
2-Planter arch
3-Medial planter artery
4-1st planter metatarsal a. from
dorsalis pedis a.
B) Venous Drainage
>Great Saphenous v.
25. Lateral planter artery
*Begins: deep to the flexor
retinaculum as one of the two
terminal branches of the
posterior tibial artery.
*Course: passes forward and
laterally between the 1st and
2nd layers of the sole towards
the base of 5th metatarsal bone
*Ends: by turning medially to
form the planter arch.
Arteries
26. Planter arch
*Begins: from the lateral planter artery as it turns medially across the sole.
*End: at the proximal end of the 1st interosseous space by passing upwards to
join the dorslais pedis artery.
*Postion: between the 3rd & 4th
layers of the sole of the foot.
*Branches:
1) 2nd, 3rd & 4th planter metatarsal
arteries : run in the lateral 3
metatarsal spaces > each divides
into 2 planter digital arteries >
supplies the adjacent sides of the
toes.
2) Palnter digital artery for the
lateral side of the big toe.
27. Medial planter artery
*Begins: deep to the flexor
retinaculum as one of the two
terminal branches of posterior tibial
artery
*Course: it passes distally on the
med. side of the foot between
abductor hallucis & flexor digitorum
brevis ms. then runs med. to the
medial planter n.
*End: by joining the artery that
supplies the medial side of the big
toe (1st planter metatarsal artery)
28. Veins
Great saphenous vein
*Begins: from the end of the dorsal venous arch of the foot
*Course: passes backwards on the medial of the foot > ascends in front of the
medial malleolus > ascends on the medial border of the tibia (accompanied by
saphenous nerve) > ascends on the posterior part of the medial aspect of the
knee (10 cm behind the medial border of the patella) > ascends in the superficial
fascia on the medial aspect of the thigh > reaches saphenous opening >
perforates the cribriform fascia
*Ends: in the femoral vein.
Dorsal venous arch
Med. malleolus
Saphenous n.
29. Innervationof thesoleof the foot
Medial planter nerve
*Begins: deep to the flexor
retinaculum as the larger of the two
terminal branches of posterior tibial
nerve.
*Course: runs under cover of
abductor hallucis > runs forward
between abductor hallucis and flexor
digitorum brevis.
*End: at the bases of the metatarsal
bones by dividing into 3 planter digital
nerves.
30. *Branches:
1) muscular:
-From the main trunk > abductor hallucis & flexor digitorum brevis
-From the planter digital banches > 1st lumbrical & flexor hallucis brevis
2) articular: to intertarsal &
tarso-metatarsal joint
3)cutaneous:
-skin of the medial part of the
sole
-the planter aspect of the medial
3.5 toes (by planter digital
nerves)
31. Lateral planter nerve
*Begins: deep to the flexor retinaculum as the
smaller of the two terminal branches of posterior tibial nerve
*Course: runs forward & laterally between flexor digitorum
brevis and flexor digitorum acessorius .
*Ends: at the base of the
5th metatarsal bone
dividing into superficial
and deep branches.
32. *Branches:
1) muscular:
-From the main trunk > flexor
digitorum accessorius & abductor
digiti minimi
-From the superficial & deep
branches > adductor hallucis ,
flexor digiti minimi brevis ,
2nd/3rd/4th lumbricals & planter and
dorsal interossei
2) articular: to intertarsal & tarso-
metatarsal joint
3) cutaneous:
-skin of the lateral part of the sole
-the planter aspect of the lateral
1.5 toes (by planter digital
branches)
33. Cutaneous innnervation of
the sole of the foot
1) Medial planter nerve
2) Lateral planter nerve
3) Sural nerve
4) Saphenous nerve
5) Med. Calcanean
branches of post. Tibial
nerve
1
2
3
4
5
34. Joints
Mid tarsal joint
*ARTICULATION: formed of two separate joints
1-Talocalcaneo-navicular joint:
-ball and socket shape
>Ball formed of head of the talus
>Socket is formed by ant. part of calcaneous and
post. part of navicular bone
-It allows the gliding movement.
2-Calcaneo-cuboid joint :
-between ant. Surface of calcaneous and post.
surface of cuboid bone
-synovial joint of plane variety
-It allows slightly gliding and rotational
movement.
*MOVEMENT:
1-Inversion: tibialis ant. / tibialis post.
2-Eversion: peroneus longus / peroneus brevis /
peroneus tertius.
35. Subtalar joint
*ARTICULATION: inf. surface of body of the talus and sup.
surface of calcaneus.
*MOVEMENT: allow inversion and eversion of the foot.
Talus
Calcaneus
37. Metatarsophalangeal joints
*ARTICULATION: the sphere-
shaped heads of the metatarsals
and the corresponding bases of the
proximal phalanges of the digits
*TYPE: ellipsoid synovial joints
*MOVEMENT: allow extension and
flexion, and limited abduction,
adduction, rotation, and
circumduction
*The joint capsules are reinforced by
medial and lateral collateral
ligaments, and by plantar
ligaments
38. Interphalangeal joints
*TYPE: The interphalangeal joints are hinge joints
*MOVEMENT: allow mainly flexion and extension.
*They are reinforced by medial and lateral collateral ligaments and by
plantar ligaments .
39. Arches of the foot
(1) medial longitudinal arch
*Bones: calcaneus ,talus, navicular bone, the 3 cuniform bones, medial 3
metatarsal bones
*Ligaments: A) spring ligament = planter calcaneo-navicular ligament.
B) deltoid ligament.
C) medial half of planter aponeurosis.
*Muscles:
1-tibialis anterior.
2-tibialis posterior.
3-short and long muscles of the big toe
4-medial half of flexor digitorum longus and brevis.
Cal
T
N
Cu
40. lateral longitudinal arch
*Bones: calcenus , cuboid , lateral 2 metatarsal bones.
*Ligaments:
A) long planter ligament
B) short planter ligament = calceno-cuboid ligament.
C)lateral half of planter aponeurosis.
*Muscles:
1-peroneus longus
2-peroneus brevis.
3-short muscles of the little toe
4-lateral half of flexor digitorum longus and brevis.
41. Transverse arch
*Bones: the bases of the 5 metatarsal bones.
*Ligaments: dorsal and planter interosseus ligaments
*Muscles:
1-peroneus longus.
2-transverse head of adductor hallucis.
42. ClinicalHints:-
Flat foot ( fallen arches or pes planus):-
Definition
- Absence of an arch in the sole of the foot that causes the foot to
lie flat when the person is standing .
- It is normal in infants, partly due to "baby fat" which masks the
developing arch and partly because the arch has not yet fully
developed.
- The human arch develops in
infancy and early childhood as
part of normal muscle, tendon,
ligament and bone growth.
43. 1-Family history
2- Weak arch as in jobs requiring
long time of walking or carrying
heavy objects .
3-Injury
4-Arthritis
5-Pregnancy
6-Nervous system or muscle
diseases
7-Tarsal Coalition - the bones of the
foot fuse together in an unusual
way
8- Diabetes
9-Age and wear and tear
10- Hypertension
Causes & risk factors of adult acquired
flatfoot
44. Treatment
1-wear supportive well-fitted shoes.
2-Fitted insoles or orthotics (custom-
designed arch supports)
3-Rest
4-A combination of an insole and some
kind of painkiller for patients with a
ruptured tendon or arthritis
5-surgical intervention (rare)
6-Bodyweight management
Symptoms
Many people have flat feet -- and notice no problems and require no treatment.
But others may experience the following symptoms:
Feet tire easily
Painful or achy feet, especially in the areas of the arches and heels
The inside bottom of your feet become swollen
Foot movement, such as standing on your toes, is difficult
Back and leg pain
45.
46. Prepared by:
Fady Boles
Anton Ishak
Roweis Adel
Kerollos Alfi
Kerollos Rofail
Kerollos Reyad
Charle Joseph
Thomas Safwat
