Plantar Foot: Part 3 Flashcards
Nerve supply to plantar foot
- Medial/lateral plantar nerves
Lateral plantar nerve location
- Found between layers 1 and 2
- Medial to lateral plantar artery
Lateral plantar nerve motor innervation
- Abductor digiti minimi
- Quadratus Plantae
- Lumbricals (2-4)
- Adductor hallucis
- Flexor digiti minimi brevis
- Opponens digiti minimi
- Plantar and dorsal interossei
Lateran plantar nerve cutaneous innervation
- Lateral 1/3 of midfoot and forefoot
- Plantar aspect of lateral 1 ½ toes and dorsal nailbeds
Lateral plantar nerve articular innervation
- Calcaneocuboid
- Lateral cuneonavicular
- 3rd cuneometatarsal
- Lateral intercuneiform (between intermediate and lateral cuneiform)
- Cuneocuboid
- Cuboidonavicular
- 2-5th MTP joint
- 2-4th intermetatarsal joint
- 5th IP joint
Lateral plantar nerve branches to
- ADM muscle (inferior calcaneal nerve; “Baxters nerve”)
- QP muscle
Superficial branch (lateral plantar nerve) muscular innervation
- FDMB
- 3rd plantar interosseous
- 4th dorsal interosseous
- (Interossei in the 4th intermetatarsal space)
Superficial branch (lateral plantar nerve) articular innervation
- 4th and 5th MTP
- 4th intermetatarsal joint (between 4th and 5th met bases)
- 4th and 5th IP joints
Superficial branch (lateral plantar nerve) cutaneous innervation
- Lateral plantar foot
- Lateral and medial plantar 5th toe
- Lateral plantar 4th toe
Deep branch (lateral plantar nerve) pathway
- Passes deep to adductor hallucis
- Between layers 3 and 4
Deep branch (lateral plantar nerve) muscular innervation
- Lumbricals 2-4
- Adductor hallucis
- Plantar interossei 1-2
- Dorsal interossei 1-3
- (Interossei in the 1st – 3rd intermetatarsal spaces)
Deep branch (lateral plantar nerve) articular innervation
- 2nd and 3rd intermetatarsal joints (between 2nd and 3rd and 3rd and 4th metatarsal bases)
- 2-4 MTP joints
Branches of superficial branch
- Proper plantar digital nerve 10
- 4th common plantar digital nerve
- Communicating branch
Proper plantar digital nerve 10
- Lateral plantar cutaneous of 5th digit
4th common plantar digital nerve pathway
- 4th intermetatarsal space
- Passes plantar to deep transverse metatarsal ligament
- Becomes cutaneous near MTP joint
Communicating branch
- Connects with 3rd common digital plantar nerve from medial plantar
Proper plantar digital nerves innervate
- Nailbeds and dorsum of the distal digits
Medial plantar nerve pathway
- 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 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
Medial plantar nerve innervation and branching
- Abductor hallucis
- FDB
- Branches into medial and lateral branches
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 pathway
- 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 common plantar digital nerve (1st metatarsal space) motor supply
- FHB
- 1st lumbrical
2nd Common plantar digital nerve (2nd intermetatarsal space) cutaneous supply
- Proper plantar digital nerve 4: lateral plantar aspect of 2nd toe
- Proper plantar digital nerve 5: medial plantar aspect of 3rd toe
3rd common plantar digital nerve (3rd intermetatarsal space) cutaneous supply
- Proper plantar digital nerve 6: lateral plantar aspect of 3rd toe
- Proper plantar digital nerve 7: 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
- Etc…….
Dorsal digital nerves can also be called by what they innervate
- Medial dorsal cutaneous nerve of the 2nd toe
- Medial dorsal digital nerve of the 2nd toe
Dorsal digital nerves can also be called by what they branch from
- Lateral branch of the 2nd common plantar digital nerve
- Medial branch of the 4th common plantar 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
- 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
- Continuation of lateral plantar artery at 5th met base
- Passes along met bases medially between oblique head adductor hallucis and plantar interossei
- Between layers 3 and 4
Deep plantar arch anastomoses with
- Deep plantar artery (terminal branch of dorsalis pedis)
Deep plantar arch gives off (plantar)
- 4 plantar metatarsal arteries that travel in intermetatarsal space in the interosseous compartment
- Gives rise to 8 plantar digital proper arteries
Deep plantar arch gives off (perforating)
- 1 proximal and 1 distal perforating artery per intermetatarsal space
- Both anastomose with dorsal metatarsal artery counterpart
- The proximal connects with deep plantar arch
- Sometimes absent
4th plantar metatarsal artery branches
- Proper plantar digital artery 9
- Proper plantar digital artery 8
3rd plantar metatarsal artery branches
- Proper plantar digital artery 7
- Proper plantar digital artery 6
2nd plantar metatarsal artery branches
- 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 branches
- Proper plantar digital artery 3
- Proper plantar digital artery 2
- Anastomosing branch branch to 1st proper plantar digital
Medial plantar artery pathway
- Anterior branch of posterior tibial artery
- Smaller than lateral plantar
- Pass through porta pedis
- Passes between abductor hallucis and FDB within the 1st layer
Superficial medial branch (medial plantar artery) pathway
- 1st Proper plantar digital artery (of hallux): supplies medial plantar hallux
- Anastomotic connection from 1st plantar metatarsal artery
- Passes dorsal to FHL tendon
Superficial lateral branch (medial plantar artery) pathway
- 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
- Arterial plexuses formed around the malleoli
- Each formed by 5 (6) arteries
Supplies 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
- Perforating fibular artery can also be included
Ankle blood supply is derived from
- Fibular
- Anterior/posterior tibial
- Dorsalis pedis
- Medial/lateral plantar plantar arteries
Medial/lateral planter nerve pathway
- Branch in the tarsal tunnel (from tibial, deep to flexor retinaculum)
- Passes through tarsal tunnel
- Exits porta pedis to enter foot
Lateral plantar nerve divides into
- Superficial/deep branches
- Around base of 5th met
Proper planter digital nerve 10 cutaneous innervation
- Plantar lateral 5th toe
- Digital tuft
- Nail
Proper plantar digital nerve 10 motor innervation
- FDMB
- 3rd plantar interosseous
- 4th dorsal interosseous
4th common plantar digital nerve branches
- 8th proper plantar digital nerve (lateral plantar 4th toe)
- 9th proper plantar digital nerve (medial plantar 5th toe)
1st common plantar digital nerve (1st metatarsal space) cutaneous
- Proper plantar digital nerve 2: lateral plantar aspect of hallux
- Proper plantar digital nerve 3: medial plantar aspect of 2nd toe
