Lab 6-13: Plantar Surface of the Foot Flashcards
plantar aponeurosis extends from __________ to the _____ and from there via ______ slips to the digits
- from the calcaneal tuberosity
- ball of the foot
- five
- it is also connected to the skin via connective tissue septa
at its origin, the plantar aponeurosis is _____ cm wide
1-2 cm
- it widens considerably as the fibers proceed longitudinally towards the toes
lateral extension of the plantar aponeurosis is known as …
calcaneometatarsal ligament
- extending between the calcaneus to the base of the 5th metatarsal
near the superficial ball of the foot a band of transverse fibers should be observed longitudinally. what are they?
superficial transverse metatarsal ligament
what structures are you trying to expose when you clean between the digital slips?
- terminal branches of superficial plantar arch and its branches - superficial plantar digital arteries
there are usually ___ superficial plantar arteries
three
what artery and nerve run together emerging from the medial groove close to the ball of the foot?
- 1st proper plantar digital nerve
- superficial tibial plantar artery
what artery and nerve are found in the distal part of the lateral groove?
- 10th proper plantar digital artery and nerve
where is the superficial branch of the medial plantar a. located relative to the plantar aponeurosis?
medial side
what are the terminal branches of the superficial branch of the medial plantar a?
- superficial tibial plantar a.
- common plantar digital (branch of medial plantar a.)
at the medial side of the 1st toe, the superficial tibial plantar a. becomes the …
1st proper plantar digital a.
what courses with the 1st proper plantar digital a. ?
1st proper plantar digital nerve.
a large superficial tibial plantar a. often replaces the …
1st plantar metatarsal a.
tracing the superficial tibial artery proximally you locate the …
common plantar digital a.
the superficial plantar arch has ______ superficial plantar digital arteries branching off it
three
what forms most of the superficial plantar arch?
common plantar digital branch of the medial plantar artery
the superficial plantar arch is completed on the lateral side by anastomosis with ____________
superficial branch of the lateral plantar artery
the superficial plantar arch is ________ to the distal end of the plantar aponeurosis and ___________ to the tendons of the flexor digitorum brevis muscle
- deep
- superficial
the superficial plantar digital arteries anastomose with …
plantar metatarsal arteries of deep plantar arch
at their termination, the deep layers of the digital slips blend with …
fibrous digital sheaths of each toe
what divides the muscle of the sole of the foot into three compartments?
the two intermuscular septa of the plantar aponeurosis
flexor retinaculum aka
lacinate ligament
the flexor retinaculum extends between
calaneus and medial malleolus
what n. pierces the retinaculum?
medial calaneal n. (branch of tibial n.)
the flexor retinaculum is divided into 4 compartments. what is in each?
anterior/first = tendon of tibialis posterior
second =tendon o fflexor digitorum longus
third = posterior tibial vessels and tibial n.
fourth = tendon of flexor hallucis longus
what are the two terminal branches of the tibial n.?
medial and lateral plantar nn.
_____ to the superior border of the flexor retinaculum identify the posterior tibial artery and its venae comitantes
proximal
what are the two terminal branches of the posterior tibial artery?
medial and lateral plantar arteries
which is bigger? medial or lateral plantar aa
lateral plantar a.
which is bigger? medial or lateral plantar nn
medial plantar n.
where is the medial calcaneal a. located?
- piercing the flexor retinaculum
- can also originate from the lateral plantar a and on occasion there can be more than one branch
where is the peroneal retinaculi located?
- along the lateral side of the foot inferior to the lateral malleolus
- there is a superior and inferior peroneal retinaculi
- both are thickenings of the deep fascia of the foot
the superior peroneal retincauli extends from …
lateral malleolus to the lateral surface of the calcaneus
the inferior peroneal retinaculum is continuous with …
- the stem of the inferior extensor retinaculum
the inferior peroneal retinaculum expands over _______ and attaches to …
- over the tendons of peroneus longus and brevis
- attaches to calcaneus (tarsal sinus) inferior to the tendon of peroneus longus
- deep fibers of the retinaculum attach to the peroneal trochlea between the tendons of the peroneus longus and brevis
where does the tendon of the peroneus brevis insert?
at the tuberosity of the 5th metatarsal
true or false: peroneus longus and peroneus brevis share a common tendon sheath
true
what are the three muscles of the first layer?
abductor hallucis
flexor digitorum brevis
abductor digiti minimi
proximal attachment of flexor digitorum brevis
medial process of calcaneal tuberosity
insertion of the tendons of flexor digitorum brevis
middle phalanx of lateral four toes
which tendon of the flexor digitorum brevis might be missing?
tendon to the 5th toe
nerve supply to flexor digitorum brevis
medial plantar nerve (enters proximal part of muscle)
what m underlies the abductor digiti minimi?
flexor digiti minimi brevis
origin of abductor digiti minimi?
medial and lateral processes of the calcaneal tuberosity
insertion of abductor digiti minimi
proximal phalanx of 5th toe
nerve supply to the abductor digiti minimi
branch of lateral plantar n.
the medial plantar a. lies _________ to the medial plantar nerve
medial
what originates from the medial plantar nerve?
(3) common plantar digital nerves
what nn. arise from the first common plantar digital nerve?
2nd and 3rd proper plantar digital nerves
the nerve to the first lumbrical originates from what n?
first common plantar digital nerve
where does the seventh proper plantar digital n. originate from?
3rd common plantar digital n.
describe the termination of the proper plantar digital nerves
terminate at distal ends of the toes where they curl around the tip of the toes to innervate the nail beds
the medial calcaneal a. is a branch off of the …
posterior tibial a.
what are the main branches off the medial plantar a?
- superficial branch and deep branch (ramus profundus)
what are the main branches off the superficial branch of the medial plantar a. ?
- common plantar digital
- superficial plantar tibial branches
- it also has branches to the abductor halucis and flexor digitorum brevis
how does the common plantar digital a. end?
- dividing into three superficial plantar digital arteries
- each branch joins a plantar metatarsal a.
you are carefully cleaning the are between the abductor digiti minimi and flexor digitorum brevis near the base of the 5th metatarsal - what do you identify?
lateral plantar artery and nerve - entering this space from the medial side of the foot
the lateral plantar nerve lies ________ to the lateral plantar artery
medial
where does the muscular branch to the abductor digiti minimi n. come from?
lateral plantar n.
- the lateral plantar n divides into a superficial and deep division after giving off this branch
which division of the lateral plantar n. follow the deep plantar arterial arch?
deep division of lateral plantar n.
what n. supplies the muscular branches to the flexor digiti minimi brevis?
superficial division of the lateral plantar n.
- it also provides branches to the most lateral plantar and dorsal interossei muscles
starting at the proximal phalanx of the 5th toe, the superficial division of the lateral plantar nerve is known as…
10th proper plantar digital n.
where does the 4th common plantar digital branch come from?
superficial division of the lateral plantar n.
what are the terminal branches of the 4th common plantar digital branch of the superficial division of the lateral plantar n?
8th and 9th proper plantar digital nerves
you notice that some fibers from the abductor digiti minimi attach to the fifth metatarsal, what is the part of the muscle known as?
abductor os metatarsi digiti minimi
which layer is the quadratus plantae (flexor accessorius) m located in?
second layer
where do the lateral and medial heads of the quadratus plantae arise from/
medial : medial surface of calcaneus, inferior to the groove for the flexor hallucis longus tendon
lateral: lateral surface and lateral edge of the plantar surface of the calcaneus and from the long plantar ligament
where does the quadratus platae insert?
into the tendon of the flexor digitorum longus
the lateral plantar artery is _________ to the lateral plantar n. as it course obliquely from medial to lateral across the belly of the quadratus plantae
lateral
what n. courses laterally across the proximal part of the quadratus plantae muscle?
nerve to abductor digiti minimi
what is the origin of the four lumbricals?
tendon of flexorr digitroum longus
what forms the inferior and lateral walls that house the tendons of the flexor muscles?
fibrous flexor sheaths
each flexor digitorum brevis tendon splits just ______ to the metatarsophalangeal joint to surround the tendon of the flexor digitorum longus
proximal
- the two split ends unite deep to the tendon of the flexor digitorum longus and then divide again to attach to the sides of the middle phalanx
fibrous, membrane-like structures that connect the bony phalanges with the distal ends of the flexor digitorum longus and brevis tendons
short vincula
- the long vincula are located proximal to the short
- each vincula has a proximal and distal part
- usually cord-like structures that attach to the dorsal aspect of the tendons
- both the long and short carry blood vessels to the tendons
this large branch passes laterally across the proximal end of quadratus plantae to reach the abductor digiti minimi m. near its origin
branch of the lateral n. that supplies the abductor digiti minimi
this artery follows the course oft he superficial branch of the lateral plantar n.
superficial fibular plantar a.
the lateral plantar a. dives deep below the _____________ as the deep plantar arch
oblique head of the adductor hallucis
distal branches of the deep branch of the medial plantar artery (ramus profundus)
tibial and lateral branches
at the base of the 1st metatarsal bone, the tibial branch of the ramus profundus anastomoses with…
1st plantar metatarsal a.
- the lateral branch of the ramus profundus will join with the deep plantar arch
what is the innervation tot he flexor digiti quinti brevis
superficial division of the lateral plantar n.
the posterior/proximal perforating branches are usually _____ in number
3
originate from the deep arterial arch
join with the dorsal metatarsal arteries
reflecting the oblique head of the adductor hallucis, what do you observe?
- deep plantar arterial arch and deep division of the lateral plantar n .
at the 1st interosseous space, the deep plantar artery from the __________ joins with the arch to complete it
dorsalis pedis a
- the lateral branch of the ramus profundus joins the arch close to where the deep plantar joins the arch
what originates from the deep plantar arterial arch?
four plantar metatarsal arteries and their anterior/distal perforating branches
the plantar metatarsal arteries course ____________ to the metatarsal bones
distally superficial
not in the interosseous spaces ***
arteries remain superficial to the interosseous muscles
distal to the anterior perforating arteries, the plantar metatarsal arteries become known as the _______
common plantar digital arteries
each common plantar digital artery gives rise to ….
two proper plantar digital arteries
what is the origin of the 1st proper plantar digital artery?
- from the superficial tibial branch of the medial plantar OR from the 1st plantar metatarsal artery
the three plantar interossei originate from the ______ side of metatarsals _________-
medial side
metatarsals 3-5
the dorsal interossei originate from _______ of metatarsals
adjacent sides of all metatarsal bones
where does the tibialis posterior tendon attach? ***
- tuberosity of navicular bone
- 2nd, 3rd, 4th metatarsals
- all other tarsals EXCEPT for the talus