Foot

Dr. Heba Kalbouneh

Associate Professor of Anatomy and Histology

Dorsum of the Foot Sole of the Foot

Plantar aponeurosis

It is a triangular thickening of deep

fascia in the sole of the foot

Attachments:

Apex: is attached to calcaneus

Base: divides into five slips that

pass into the toes.

Function: protects the deeper

structures and supports the

longitudinal arches of the foot

Plantar view

Plantar aponeurosis

First layer:

1-Abductor hallucis

2-Flexor digitorum brevis

3-Abductor digiti minimi

Muscles of the Sole of the Foot

The muscles of the sole are conveniently

described in four layers from the inferior

layer superiorly

Unlike the small muscles of the hand, the sole

muscles have few delicate functions and are

chiefly concerned with supporting the arches of

the foot. Although their names would suggest

control of individual toes, this function is rarely

used in most people

Plantar view

Second layer:

1-Quadratus plantae

2-Lumbricals

3-Flexor digitorum longus tendon

4-Flexor hallucis longus tendon

Plantar view

Third layer:

1-Flexor hallucis brevis

2-Adductor hallucis

3-Flexor digiti minimi brevis

Plantar view

Fourth layer:

1-Interossei

2- Fibularis longus tendon

3-Tibialis posterior tendon

Plantar view

Medial Plantar Artery

Is the smaller of the terminal branches of the

posterior tibial artery

Ends by supplying the medial side of the big

toe

Lateral Plantar Artery

Is the larger of the terminal branches of

the posterior tibial artery

Forms the plantar arch

At the proximal end of the first

intermetatarsal space joins the dorsalis pedis

artery

Arteries of the Sole of the Foot Posterior

tibial artery

Lateral

Plantar Artery

Medial

Plantar Artery

Plantar view

Dorsalis Pedis Artery

(the Dorsal Artery of the Foot)

Starts as a continuation of anterior tibial

artery

Enters the sole of the foot (between the

two heads of the first dorsal interosseous

muscle) and joins the lateral plantar artery

Dorsal view

Anterior tibial artery

Arteries of the Dorsum of the Foot

Surface anatomy

Tibial nerve

Lateral

Plantar

Nerve

Medial

Plantar

Nerve

Medial Plantar Nerve

Is a terminal branch of the tibial nerve

Supplies the medial 2/3 of sole and medial

three and a half toes

Lateral Plantar Nerve

Is a terminal branch of the tibial nerve

Supplies lateral 1/3 of sole and lateral

one and a half toes

Nerves of the Sole of the Foot

The nerves extend onto the dorsum and

supply the nail beds and the tips of the toes

These nerves supply most intrinsic

muscles of the foot

Plantar view

Nerves of the Dorsum of the Foot

Dorsal view

Deep fibular nerve

Superficial fibular nerve

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The Arches of the Foot

A segmented structure can hold up weight only if it is built in the form of an arch

The foot has three such arches:

1. Medial Longitudinal Arch

2. Lateral Longitudinal Arch

3.Transverse Arch

Function of arches of the foot

Protect the soft tissues of the sole

Distribution of the body weight

Note

The bones of the foot do not lie in a horizontal

plane. They form longitudinal and transverse

arches relative to the ground, which absorb and

distribute downward forces from the body

during standing and moving on different planes

Normally, the ball of the foot

carries about 40% of the weight and the

heel carries about 60%.

Lateral view

Body weight

50% on

the right

side

50% on

the left

side

The ball

of the foot

The heel

Arches of the Foot

The bones of the foot are arranged in

two arches that are held in position

by ligaments and tendons

Usually, the arches are fully

developed by age 12 or 13.

In the newborn and young child, the foot

appears to be flat because of the presence

of a large amount of subcutaneous fat on

the sole of the foot

Arches do not develop

until about 2-3 years of

age, meaning flat feet

during infancy is normal

When a person wears high-heeled shoes, the

distribution of weight changes so that the

ball of the foot may carry up to 80% and the

heel 20%. As a result, the fat pads at the ball

of the foot are damaged,

joint pain develops, and structural changes in

bones may occur.

Plantar surface showing

the surface of contact with

the ground when standing

Calcaneus

Talus

Navicular

Cuneiforms Cuboid

1st 2nd 3rd 4th

5th

Plantar view

Plantar view

Medial Longitudinal Arch Lateral Longitudinal Arch

It is formed by the calcaneus, talus,

navicular, three cuneiforms and first

three metatarsal bones

It is formed by the

calcaneus, cuboid and

4th and 5th metatarsal

bones

Note: The

lateral arch is the

flatter and lies on

the ground in the

standing position

Transverse Arch

It is formed by the metatarsal

bases, the cuboid and the three

cuneiform bones

Muscles that provide dynamic

support for the arches during

walking include:

Tibialis anterior

Tibialis posterior

Fibularis longus

Ligaments that support the arches include:

Plantar calcaneonavicular (spring ligament)

Ahort plantar ligament (Plantar calcaneocuboid)

Long plantar ligament

Plantar aponeurosis

Long plantar ligament runs from

calcaneus and cuboid to the bases of

the lateral metatarsal bones

Plantar view

Calcaneus

Cuboid

Long plantar ligament

Plantar view

Calcaneus

Cuboid

Short plantar ligament

(Plantar calcaneocuboid )

Sustentaculum tali

Medial view

Calcaneus

Medial

cuniform

Calcaneus Navicular

Talus

Plantar calcaneonavicular (spring ligament)

Medial view

Flat foot (pes planus)

Is a condition in which the medial

longitudinal arch is depressed or collapsed.

As a result,

1-The foot is everted

2-The head of the talus is no longer

supported by calcaneus

3-The body weight forces the talus

downward and medially

Pes: foot

Pes cavus (claw foot)

Is a condition in which the

medial longitudinal arch is

excessively high

Most cases are caused by

muscle imbalance, as in

poliomyelitis

Plantar fasciitis

It happens to person who is standing or

walking for long time

It causes pain and tenderness of the sole

of the foot

Repeated attacks of this condition induce

ossification in the posterior attachment of

the aponeurosis

Tarsal tunnel syndrome

Due to compression of tibial nerve as it

travels through the tarsal tunnel.

Manifestation :

Motor

Sensory

Tarsal tunnel syndrome: distribution of sensory loss

Tarsal tunnel syndrome due to ganglion

Tibial nerve in tarsal tunnel