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Sole of foot
- 1. Sole Of Foot Introduction Skinof the Sole Superficial Fascia Deep Fascia Muscles of the 1st Layer Muscles of the 2nd Layer Prepared By: Dr. Mateen Reference: BD Chaurasia’s Human Anatomy
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- 3. Introduction Foot andHand are homologous Parts However Foot is an organ of support and locomotion so structures of the foot are modified accordingly. For Example ◦ The great toe has lost its mobility and its power of prehension (gripping) ◦ The Lesser four toes are markedly reduced in size ◦ And the Tarsal Bones and the first metatarsal are enlarged to form a broad base for better support
- 4. Skin of theSole Skin of the sole is 1. Thick for protection 2. Firmly adherent to the underlying aponeurosis 3. Creased
- 5. Skin of theSole Cutaneous nerve supply a) The Medial Calcanean Branches of Tibial Nerve supply the posterior and medial portion b) Branches from the medial plantar nerve supply the larger antero-medial portion including the medial three and a half digits c) Branches from the Lateral Plantar Nerve supply the smaller antero-lateral portion including the lateral one and a half digits.
- 6. These nervesare derived from spinal nerves L4, L5 and S1. In eliciting the plantar reflex, the area supplied by segment S1 is stimulated.
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- 8. Superficial Fascia Thesuperficial fascia of the sole is fibrous and dense. Fibrous band bind the skin to the deep fascia or plantar Aponeurosis They divide the subcutaneous fat into small tight compartments which serve as water-cushions and reinforce the spring-effect of the arches of the foot The fascia is very thick and dense over the weight-bearing points. It contains cutaneous nerves and vessels. Thickened bands of superficial fascia stretch across the roots of the toes forming the superficial transverse metatarsal ligaments
- 9. Deep Fascia The deepfascia of the sole is specialized to form The Plantar Aponeurosis in the sole The Deep Transverse Metatarsal Ligaments. The Fibrous Flexor Sheaths in the toes.
- 10. Plantar Aponeurosis Thedeep fascia covering the sole is thick in the centre and thin at the sides. The thickened central part known as the Plantar Aponeurosis The Aponeurosis is triangular in shape. The apex is proximal and attached to the medial tubercle of the calcaneum, proximal to the attachment of the flexor digitorum brevis. The base is distal. It divides into five processes near the heads of the metatarsal bones. The digital nerves and vessels pass through the intervals between the processes.
- 11. Each processsplits, opposite the metatarso- phalangeal joints, into a superficial and a deep slip. The superficial slip is attached to skin. The deep slip divides into two parts which embrace the flexor tendons, and blend with the fibrous flexor sheaths and with the deep transverse metatarsal ligaments. From the margins of the aponeurosis, lateral and medial vertical intermuscular septa pass deeply, and divide the sole into three compartments. Thinner transverse septa arise from the vertical septa and divide the muscles of the sole into four layers.
- 12. Functions 1.It fixes the skin of the sole. 2. It protects deeper structures. 3. It helps in maintaining the longitudinal arches of the foot. 4. It gives origin to muscles of the first layer of the sole. The plantar aponeurosis gives off an additional process to the great toe, which restricts its movement.
- 13. Deep Transverse Metatarsal Ligaments These are four short, flat bands which connect the plantar ligaments of the adjoining metatars-o-phalangeal joints. They are related dorsally to the interossei, and ventrally to the lumbricals and the digital vessels and nerves.
- 14. Flexor Sheaths Theseare made up of the deep fascia of the toes. Their structure is similar to that of the fibrous flexor sheaths of the fingers. They retain the flexor tendons in position during flexion of the toes
- 15. Muscles Of TheFirst Layer of Foot
- 16. MUSCLES OF THEFIRST LAYER OF THE SOLE The muscles of the sole are arranged in four layers, which will be considered one by one. ◦The muscles of the first layer are the Flexor Digitorum Brevis The Abductor Hallucis and The Abductor Digiti Minimi
- 17. Flexor Digitorum Brevis ThisMuscle Lies deep to the plantar aponeurosis Origin ◦ Medial Tubercle of Calcaneum ◦ Plantar Aponeurosis ◦ Medial and Lateral Intermuscular Septa Insertion ◦ It Ends in Four Tendons for the lateral four toes ◦ Opposite the Base of the proximal phalanx each tendon divides into two slips The tendon of the flexor digitorum longus passes through the gap between the two slips. The two slips unite and partailly decussate to from a grooved surface for the long flexor tendon ◦ Finally the tendon again divides into two parts that are inserted into the margins of the middle phalanx.
- 18. Nerve Supply ◦Medial Plantar Nerve Actions ◦ Flexion of the toes at the proximal interphalangeal joints and metatarsophalangeal joints.
- 19. Abductor Hallucis This MuscleLies Along the Medial border of the foot and covers the origin of the plantar vessels and nerves Origin: Medial Tubercle of Calcanium Flexor Retinaculum and its deep fascia Medial Intermuscular Septum Insertion: The Tendon Fuses with the Medial Portion of the flexor hallucis brevis It is inserted on to the medial side of the base of the great toe
- 20. Abductor Hallucis NerveSupply: ◦ Medial Plantar Nerve Action: ◦ Abduction of the great toe away from the second toe Trigger Point
- 21. Abductor Digiti Minimi ThisMuscle lies along the lateral border of foot Origin: ◦ Medial and Lateral tubercles of calcaneum ◦ Lateral Intermuscular Septum ◦ Deep Fascia covering it Insertion: ◦ The tendon fuses with the tendon of the flexor digitiminimi brevis. ◦ It is inserted into the lateral side of the base of the proximal phalanx of little toe
- 22. Abductor Digiti Minimi Nevrve Supply: ◦ Main Trunk of the Lateral Plantar Nerve Action: ◦ Abduction of little toe
- 23. Muscles of theSecond Layer of Foot and the tendons of the muscle of leg that insert on foot
- 24. Quadratus Plantae It isalso called as “flexor digitorum accessorius” as it is accessory to the flexor digitorum longus. Origin: It arises by two heads ◦ Medial head is large and fleshy; It arises from the medial concave surface of the calcaneum and from its medial tubercle. ◦ Lateral head is smaller and tendinous; it arises form the calcaneum in front of the lateral tubercle and from the long plantar ligament. ◦ The two heads unite at an acute angle.
- 25. Insertion: ◦ Themuscle fibres are inserted into the lateral side of the tendon of the flexor digitorum longus Nerve supply: ◦ Main trunk of the lateral plantar nerve Action: ◦ Straightens the pull of long flexor tendons ◦ Flexes the toes through the long tendons
- 26. Lumbricals There arefour Lumbricals, numbered from medial to lateral side Origin: ◦ They arise from the tendons of the flexor digitorum longus. The first lumbrical is unipennate, and the others are bipennate Insertion: ◦ Their tendons pass forwards on the medial sides of the metatarsophalangeal joints of the lateral four toes, and then dorsally for insertion into the extensor expansion
- 27. Nerve Supply: ◦The first muscle by the medial plantar nerve; and the other three by the deep branch of lateral plantar nerve Actions: ◦ They maintain extension of the digits at the interphalangeal joints so that in walking and running the toes do not buckle under
- 29. Introduction contd. TheArches of the Foot serve as elastic springs for efficient walking, running, jumping and supporting of body CLASSIFICATION OF ARCHES ◦I A. Longitudinal 1. Medial 2. Lateral ◦B. Transverse 1. Anterior 2. Posterior
Editor's Notes
- #7 Dermatome: an area of the skin supplied by nerves from a single spinal root.