Foot - Sole (8) Flashcards
superficial fascia
mostly made of fat for cushioning weight bearing areas
+not many large veins
+more lymphatic vessels than dorsum
skin ligaments
vertical collagenous CT septa from skin to deep fascia
-compartmentailizes to improve pressure/shock absorption
-anchors skin to improve grip
plantar fascia
- medial- superficial to abductor hallucis
- lateral- superficial to abductor digiti minimi
- aponeurosis- thickest, longitudinal collagen fibers (>deeper flexor sheaths)
plantar aponeurosis
calcaneal tuberosity > splits distally into 5 parts
-protect from injury
-help hold foot together
-support longitudinal arches of foot so not spread when weight bearing (tensile force)
plantar fasciitis
inflamm/pain mainly @ aponeurosis mainly
-do not see WBCs so more irritant than inflam
-standing/walking/running/stairs (dorsiflexed)
pain worse in morning/resting then dissipates 5-10 min later walking
overuse injury usually esp if improper footwear OR chronically tight calves OR obesity OR high arches OR achilles injury
compartments
- medial- deep to medial plantar fascia
- central- deep to aponeurosis
- lateral- deep to lateral plantar fascia
- interosseous- b/t sole and dorsum, only in forefoot b/t MTs
-sep from central by horizontal deep plantar fascia
divided by intermuscular septa from aponeurosis
foot infections
if deep to plantar fascia then localize w/i single compartment or @CT b/t muscle layers
will spread if get to bloodstream or superficial fascia
retinacula
- superior fibular
- inferior fibular
- flexor (roof of tarsal tunnel)
both fibular keep lateral compart tendons in place
extrinsic muscles
general
og @ leg (lat or deep post)
in @ sole as tendons
plantar muscles function
generally stabilize the foot and grip the ground when standing and moving
-stabilize arches when move heel-toe or side-side
-stabilize when pushing off
-adjust pressure
usually no fine motor but is possible
1st layer muscles
- abductor hallucis (medial)
- flexor digitorum brevis (middle)
- abductor digiti minimi (lateral)
all flex or abduct toes
all og @ calcaneal tuberosity + plantar ap
abd/adduction
toes
I, III, IV, V = adduct and abduct
II = abduct in either direction, no adduction bc midline
abductor hallucis
og @ calcaneal tuberosity/plantar ap
in @ medial side of proximal phalanx I
inn: medial plantar N
vasc: medial plantar A + 1st plantar metatarsal A
flexor digitorum brevis
og @ calcaneal tuberosity/plantar ap
in @ both sides of middle phalanx II-V
inn: medial plantar N
vasc: medial + lateral plantar A
extensor digitorum brevis @dorsum only II-IV
abductor digiti minimi
og @ calcaneal tub/plantar ap
in @ lateral side of base proximal phalanx V
inn: lateral plantar N
vasc: lateral plantar A + 10th digital A
weak flexor too
2nd layer muscles
2 intrinsic:
1. quadratus plantae
2. lumbricals
2 extrinsic:
1. flexor digitorum longus (FDL)
2. flexor hallucis longus
intrinsic connect to FDL
quadratus plantae
og @ medial or lateral plantar suface calcaneus (medial + lateral heads)
in @ posterior edge FDL together
inn: lateral plantar N
vasc: medial + lateral plantar A
quadratus plantae
function
assists FDL in flexing II-V:
relaxed = FDL tendons oblique angle
contracts = pulls FDL tendons straight to flex toes
lumbricals
function
- flex II-V at MP joints
- extend II-v at PIP and DIP joints
lumbricals
og @ anterior/medial edge of FDL tendon
in @ medial side flexor sheaths II-V
inn: medial plantar (most med lumb II) + lateral plantar (lat 3 lumb III-V)
vasc: plantar metatarsal A main + lateral plantar A
flexor sheaths
enclose flexor tendons + bursae @toes
lumbricals insert of medial sides of II-V
3rd layer muscles
- flexor hallucis brevis
- adductor hallucis
- flexor digiti minimi
all in @ bases of proximal phalanges I or V to move MP joint
prox = articulates with head of a MT
flexor hallucis brevis
og @ plantar surface of cuboid + lat cuneiform
in @ split both sides of base I proximal phalanx
sesamoid bones w/i tendon
inn: medial plantar N
vasc: 1st plantar MT A main + medial plantar A
flexor digiti minimi
og @ base MT 5
in @ base V proximal phalanx
inn: superficial branch lateral plantar N
vasc: 10th plantar digital A main + lateral plantar A
adductor hallucis
og @ oblique (base MT II-IV) + transverse heads (plantar lig of MP joints)
in @ lateral sides base of I proximal phalanx
inn: deep branch lateral plantar N
vasc: medial plantar A + plantar MT A’s
4th layer muscle
2 extrinsic:
1. fibularis longus (lat compartment)
2. tibialis posterior (deep posterior comp)
2 intrinsic: @ interosseous comp
1. plantar interossei (PAD)
2. dorsal interossei (DAB)
plantar interossei
PAD
og @ shaft of MT III-V inferomedial
in @ medial base III-V proximal phalanx
adduct + assist flex III-V @ MP joints
inn: lateral plantar N
vasc: dorsal + plantar MT A main + arcuate A
3 PADs
dorsal interossei
DAB
og @ adj sides shaft MT I-V
in @ medial side II prox phalanx + lateral side II-IV
abduct II-IV + assist flexing @ MP joint
inn: lateral plantar N
vasc: dorsal + plantar MT A + arcuate A
4 DABs
tibial N
from ant div LSP so plantar flex ankle + toes
> medial calcaneal N proximal (before) tarsal tunnel (cutaneous to skin of heel)
> terminal branches= medial/lateral plantar N distal to tunnel, both enter medial compartment then travel b/t 1st and 2nd layers
medial plantar N
motor = medial sole muscles
-abductor hal, FDB, FHB, 1st lumbrical
cutaneous = plantar skin of medial 3-1/2 digits
>1st proper digital N
>common plantar digital N
larger branch of tibial
superficial lateral plantar N
branches
- common plantar digital- splits into 2 proper plantar digital
- 10th proper plantar digitial N
most lateral 1-1/2 digits
lateral plantar N
divide to deep and superficial branch @lat compart
-deep = motor to intrinsic muscles
-superficial = motor to flexor digiti minimi only + cut to lateral 1-1/2 digits
only motor = remaining intrinsic muscles
posterior tibial A
splits into medial/lateral plantar in or distal to tarsal tunnel
enter medial compart sole then travel w/ medial and lateral plantar nerves to sole
important for anastomoses
medial plantar A
digit I muscles + skin of medial sole
> deep branch = primarily I muscles
superficial = skin of medial sole, ends as 1st plantar digital A
smaller branch of post tibial A
medial plantar anastomose
superficial branch may anastomose w/ deep plantar arch OR lateral plantar A = superficial plantar arch
lateral plantar A
most sole muscles + skin lat sole
>deep plantar arch to anastomose w/ lateral plantar and deep plantar A from dorsalis pedis
venous drainage
all deep V of sole drain to posterior tibial V
-all are deep to plantar fascia as comitantes
superficial V drain to medial or lateral marginal
deep plantar arch branches
- perforating branches (3) travel superior to anast w/ arcuate
- plantar metatarsal A (4) each div into 2 plantar digital a
- 10th plantar digital A
