LEA Plantar Foot Part 3 Flashcards
Medial and lateral plantar nerves
- Branch from tibial nerve in the tarsal tunnel, deep to flexor retinaculum
- Passes through tarsal tunnel and porta pedis to enter foot
Lateral Plantar Nerve
Found between layers 1 and 2
Medial to lateral plantar artery
motor innervation of lateral plantar nerve
- Abductor digiti minimi
- Quadratus Plantae
- Lumbricals (2-4),
- Adductor hallucis
- Flexor digiti minimi brevis
- Opponens digiti minimi
- Plantar and dorsal interossei
Cutaneous innervation of lateral plantar nerve
- Lateral 1/3 of midfoot and forefoot
- Plantar aspect of lateral 1 ½ toes and dorsal nailbeds
Articular innervation of lateral plantar nerves
- Calcaneocuboid, lateral cuneonavicular, 3rd cuneometatarsal, lateral intercuneiform (between intermediate and lateral cuneiform), cuneocuboid and cuboidonavicular
- 2-5th MTP
- 2-4th intermetatarsal and 5th IP joints
Lateral Plantar Nerve Branching Pattern:
- Branch to ADM muscle (inferior calcaneal nerve; “Baxters nerve)
- Branch to QP muscle
- Divides into Superficial and Deep Branches around base of 5th met
Superficial branch of lateral plantar nerve muscular innervation
-FDMB
-3rd plantar interosseous and 4th dorsal (interosseous
interossei in the 4th intermetatarsal space)
Superficial branch of lateral plantar nerve cutaneous innervation
to lateral plantar foot, lateral and medial plantar 5th toe and lateral plantar 4th toe
Deep branch of lateral plantar nerve passes
deep to adductor hallucis (between layers 3 and 4)
Deep branch of lateral plantar nerve muscular innervation
-lumbricals 2-4
-adductor hallucis
-plantar interossei 1-2 and dorsal interossei 1-3
(Interossei in the 1st – 3rd intermetatarsal spaces)
Deep branch of lateral plantar nerve articular branches to
- 2nd and 3rd intermetatarsal joints (between 2nd and 3rd and 3rd and 4th metatarsal bases)
- 2-4 MTP joints
branches of the superficial branch of lateral plantar nerve
- Proper plantar digital nerve 10 (lateral plantar cutaneous of 5th digit
- 4th common plantar digital nerve (4 intermetatarsal space)
- Communicating branch (connects with 3rd common digital plantar nerve from medial plantar)
The proper plantar digital nerves innervate
the nailbeds and dorsum of the distal digits
Proper plantar digital nerve 10
Supplies cutaneous to plantar lateral 5th toe, digital tuft, nail
Motor to FDMB, 3rd plantar and 4th dorsal interossei
4th common plantar digital nerve
- Passes plantar to deep transverse metatarsal ligament, becomes cutaneous near MTP joint
- 8th proper plantar digital nerve (lateral plantar 4th toe)
- 9th proper plantar digital nerve (medial plantar 5th toe)
Medial Plantar Nerve
-Larger than lateral plantar nerve
-Lateral to medial plantar artery
-Passes within the 1st layer between abductor hallucis and FDB muscles (deep to abductor hallucis)
[Some also say between layers 1 and 2]
Medial Plantar Nerve motor innervation
Abductor hallucis
FDB
FHB
1st lumbrical
Medial Plantar Nerve motor innervation
- Abductor hallucis
- FDB
- FHB
- 1st lumbrical
Medial Plantar Nerve cutaneous innervation
- Medial 2/3 of midfoot and forefoot
- Plantar aspect medial 3 ½ toes and dorsal nailbeds
Medial Plantar Nerve articular innervation
- Talonavicular, cuneonavicular (medial and intermediate cuneiforms), medial intercuneiform (between medial and intermediate)
- Joint between medial cuneiform and base of 2nd metatarsal
- IP joints of digits 1-4
- 1st MTP joint
Proper plantar digital nerve 1 (of hallux)
- cutaneous of plantar medial hallux
- Also called the medial branch of the medial plantar nerve
- Also supplies motor branch to FHB
1st – 3rd Common plantar digital nerves travel in
their respective metatarsal spaces
plantar pass plantar to deep transverse metatarsal ligament, becomes cutaneous near
MTP joint. Arise from the lateral branch of medial plantar nerve.
Give off proper digital plantar nerves
1st – 3rd Common plantar digital nerves
1st Common plantar digital nerve (1st intermetatarsal space)
- Supplies motor to: FHB and 1st lumbrical
- Proper plantar digital nerve 2: cutaneous lateral plantar aspect of hallux
- Proper plantar digital nerve 3: cutaneous medial plantar aspect of 2nd toe
2nd Common plantar digital nerve (2nd intermetatarsal space)
- Proper plantar digital nerve 4: supplies cutaneous lateral plantar aspect of 2nd toe
- Proper plantar digital nerve 5 supplies cutaneous medial plantar aspect of 3rd toe
3rd Common plantar digital nerve (3rd intermetatarsal space)
- Proper plantar digital nerve 6: cutaneous lateral plantar aspect of 3rd toe
- Proper plantar digital nerve 7: cutaneous medial plantar aspect of 4th toe
- Receives communicating branch from lateral plantar nerve
The proper plantar digital nerves give off articular branches to
MTPJ and IPJ of their respective digits
Proper digital nerves can also be called
by what they innervate
(-Medial plantar cutaneous nerve of the hallux
-Lateral plantar cutaneous nerve of the hallux
-Medial plantar cutaneous nerve of the 2nd toe/digit
-Lateral plantar cutaneous nerve of the 2nd toe/digit)
other names for the dorsal digital nerve
- Medial dorsal cutaneous nerve of the 2nd toe
- Medial dorsal digital nerve of the 2nd toe
nerves can also be named for what they branch from
Ex:
- Lateral branch of the 2nd common plantar digital nerve
- Medial branch of the 4th common plantar digital nerve
What is the medial branch of the intermediate dorsal cutaneous nerve?
?
What is the lateral branch of the 3rd common dorsal digital nerve?
?
Arterial Supply to Plantar Foot
- Lateral and medial plantar arteries
- Branch from posterior tibial within tarsal tunnel
Lateral Plantar Artery
- Larger than medial plantar artery
- Passes thorough porta pedis
Lateral Plantar Artery passes between muscle layers
- 1 and 2 through the calcaneal compartment
- angled toward 5th met styloid process
Branches of Lateral Plantar artery
- Calcaneal branches
- Anastomotic branches to lateral tarsal and lateral malleolar plexus
- Proper plantar digital artery 10 (of the 5th digit): supplies lateral plantar 5th digit
- Deep Plantar Arch
Deep Plantar Arch
is a Continuation of
lateral plantar artery at 5th met base
Deep Plantar Arch passes along met bases medially between
- oblique head adductor hallucis and plantar interossei
- between layers 3,4
Anastomoses with deep plantar artery (terminal branch of dorsalis pedis)
deep plantar arch
deep plantar arch gives off
4 plantar metatarsal arteries that travel in intermetatarsal space in the interosseous compartment (gives rise to 8 plantar digital proper arteries)
__ proximal and __ distal perforating artery per intermetatarsal space
1 , 1 (sometimes absent)
proximal and distal perforating artery both anatamose with
dorsal metatarsal artery counterpart
The __ connects with deep plantar arch
proximal perforating artery
4th plantar metatarsal artery
- Proper plantar digital artery 9
- Proper plantar digital artery 8
3rd plantar metatarsal artery
- Proper plantar digital artery 7
- Proper plantar digital artery 6
2nd plantar metatarsal artery
- Proper plantar digital artery 5
- Proper plantar digital artery 4
1st plantar metatarsal artery (Arises at the anastomosis between ___)
deep plantar and deep plantar arch
1st plantar metatarsal artery
- Proper plantar digital artery 3
- Proper plantar digital artery 2
- Anastomosing branch branch to 1st proper plantar digital
Anterior branch of posterior tibial artery
medial plantar artery
the medial plantar artery is __ than the lateral plantar artery
smaller
medial plantar artery passes through
the porta pedis
medial plantar artery passes between
abductor hallucis and FDB within the 1st layer
Superficial medial branch: 1st Proper plantar digital artery (of hallux):
supplies medial plantar hallux
Anastomotic connection from 1st plantar metatarsal artery
Passes dorsal to FHL tendon
Superficial medial branch
Superficial lateral branch
- Superficial plantar digital branches
- Anastomoses with 1st – 3rd plantar metatarsal arteries
deep branch of medial plantar artery forms anastomoses with
deep plantar arch and dorsal circulation
malleolar arterial plexuses is formed
around the malleoli
malleolar arterial plexuses each formed by
5-6 arteries
the malleolar arterial plexuses supply
the ankle
Medial malleolar arterial plexus
- Anterior medial malleolar artery
- Posterior medial malleolar artery
- Branch from medial tarsal artery
- Branch from medial plantar artery
- Branch from medial calcaneal artery
Lateral malleolar arterial plexus
- Anterior lateral malleolar artery
- Posterior lateral malleolar artery
- Branch from lateral tarsal artery
- Branch from lateral plantar artery
- Branch from lateral calcaneal artery
- (The perforating fibular artery can also be included)
Ankle supply is derived from:
Fibular, posterior tibial, anterior tibial, dorsalis pedis, medial plantar and lateral plantar arteries