Posterior leg and sole of the foot Flashcards
Up: Dorsum of the foot (bridge)
Down: Plantar surface of the foot (sole)
Ball of the foot
Heel of the foot
- Common fibular nerve via lateral sural cutaneous nerve
- Superficial peroneal nerve
- Medial sural cutaneous nerve (from sciatic nerve)
- Sural nerve (from sciatic nerve)
- Tibial nerve via medial calcaneal branches
Green: Medial cutaneous branches from tibial nerve
Red: Sural nerve
Yellow: Lateral plantar nerve from tibial nerve
Pink: Medial plantar nerve
Blue: Saphenous nerve
Positive Babiski reflex is a sign of upper motor neuron disease.
Draw a line on the foot
We expect flexion of the foot if it extends
2 fascias of the foot
Superficial and deep fascia
Superficial fascia of the foot
On the plantar surface fat pads act as shock absorber
Deep fascia of the foot
- On dorsum of the foot a thin deep fascia.
- On plantar side- Plantar fascia (thick deep fascia).
- Mid thickening of plantar fascia (plantar aponeurosis).
Right: Plantar aponeurosis (ligament strong structure)
Left: Plantar fascia
What happens if the plantar aponeurosis gets inflamed
Plantar fasciitis
Calcaneal spur (point where plantar aponeurosis attaches and calcification occurs at attachment)
It is the result of an inflmmation
Calcaneal spur treatment
Relax plantar fascia by stretching exercises and ice
Is there a superficial fascia in dorsum of the foot?
No
Posterior Superficialis muscles
Triceps surae
Gastrocnemius muscle origin
2 heads
Lateral and medial condyles of femur
Gastrocnemius muscle insertion
Calcaneal tendon (Achilles)
Gastrocnemius muscle function
Flexion of foot and leg (esp running)
- Medial head
- Lateral head (proximal) of Gastrocnemius m
- Distal part of Gastrocnemius m
- All 3 muscles form strongest tendon in the body (Calcaneal tendon)
Medial head tear of Gastrocnemius muscle
Fabella (lateral head calcification proximal to origin)
- a small sesamoid bone found in some mammals embedded in the tendon of lateral head of gastrocnemius.
- Neuromuscular bundle
- Soleus muscle (anterior to Gastrocnemius)
Soleus muscle origin
Soleal line of tibia (perforated by v-a-n), upper part of fibula
Soleus muscle insertion
Calcaneal tendon
Soleus muscle function
Flexion of foot (esp walking)
Achilles tendon injury and repair (weakens by age)
Plantaris muscle (between Soleus and Gastrocnemius)
Plantaris muscle origin
Lateral condyle of femur
Plantaris muscle insertion
Medial part of calcaneal tendon
Plantaris muscle function
Flexion of foot and leg
What is the clinical importance of Plantaris muscle?
Has a long tendon on medial side and is used if tendon needed in body
4 muscles in Posterior Deep Group
Popliteus muscle
Flexor digitorum longus muscle
Flexor hallucis longus muscle
Tibalis posterior muscle
Orange: Popliteus muscle
Red: Tibialis posterior muscle
Green: Flexor digitorum longus
Blue: Flexor hallucis longus
A?
Arcuate popliteal ligament
Popliteus muscle origin
Lateral condyle of femur and arcuate popliteal ligament
Popliteus muscle insertion
Posterior surface of tibia above soleal line
Popliteus muscle function
Flexion and medial rotation of leg (unlocking of knee)
Only muscle that doesnt attach to foot
Popliteus muscle only passes inside the knee joint cavity
Flexor digitorum longus muscle origin
Posterior surface of tibia below soleal line
Flexor digitorum longus muscle insertion
Passing from malleolar groove to bases of distal phalanges 2-5
Flexor digitorum longus muscle function
Flexes toes 2-5 and foot, inverses foot, makes origin for lumbricals
Main invertors
Tibilais anterior and Tibialis posterior
Flexor hallucis longus muscle origin
Lower part of posterior surface of fibula
Flexor hallucis longus muscle insertion
Base of distal phalax of hallux
Flexor hallucis longus muscle function
Flexion of hallux and foot. Supports medial longitudinal arch of foot.
Tibalis posterior muscle origin
Lateral part of posterior surface of tibia below soleal line, posterior surface of fibula, interosseous membrane
Tibalis posterior muscle insertion
Sustentaculum tali, tuberosity of navicular bone, talus, cuneiform bone, cuboid bone and metatarsal bone (2-4)
Tibalis posterior muscle function
Plantar flexion and powerful inversion of foot
Tibialis posterior dysfunction
- Flexor digitorum longus (crosses all other muscles)
- Tibialis posterior
- Calcanus
- Flexor hallucis longus
Under flexor retinaculum order of structures (front to back)
Tibialis posterior (most anterior)
Flexor digitorium
Flexor hallucis longus
Tarsal tunnel syndrome muscles
Tom- Tibalis anterior
Dick- Flexor digitorum longus
Harry- Flexor hallucis longus
Origin of flexor digitorum longus m
Origin of flexor hallucis longus
Superficial posterior leg muscles
Gastrocnemius
Soleus
Plantaris
Deep posterior leg muscles
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
- Fibular a
- Calcaneal branches
- Medial malleolar a
Where does the posterior tibial a come from
Popliteal artery
What does the fibular artery pass and course with
Passes the lateral compartment and courses with superficial fibular nerve
Nutrient artery of tibia courses into which artery?
Lateral and medial plantar artery (terminal artery)
Nutrient artery of tibia courses into which artery?
Lateral and medial plantar artery (terminal artery)
At the midpoint of flexor retinaculum you can take the pulse of the posterior tibial artery
What does th anterior tibial a course into
Dorsalis pedis
What are the branches of the fibular artery
Muscular branches (fibularis longus brevis)
Nutrient artery to fibula
Perforating branch
Communicating branch
Lateral malleolar branch
Calcaneal branch (termination point)
- Nutrient artery to fibula
- Communicating branch to posterior tibial artery
- Calcaneal branch
Up right: Dorsiflexion
Up left: Plantarflexion
Down right: Inversion
Down left: Eversion
Ankle Dorsiflexion muscles
Tibialis anterior
Extensor hallucis longus
Ankle Plantarflexion muscles
Gastrocnemius
Soleus
Ankle inversion muscles
Tibialis anterior and posterior
Ankle Eversion muscles
Fibularis longus and brevis
1st layer
Yellow- Abductor hallucis
Green- Plantar aponeurosis
Red- Flexor digitorum brevis
Blue- Abductor digiti minimi pedis
2nd layer
Up left: Long plantar ligament
Blue: Quadratus Plantae
Yellow: Tendons of the flexor digitorum longus
Red: Lumbricals
Tendons of the flexor digitorum longus insertion for and origin along with function
Origin for lumbricals, insertion for the quadratus plantae and flex the fingers
Quadratus plantae function
corrects the angulation for flexor digitorum longus
3rd layer
Yellow: Flexor hallucis brevis
Red up: Adductor hallucis oblique head
Red horizontal: Adductor hallucis transverse head
Blue: Flexor digiti minimi brevis
Whats the function of the 4th interosseous layer
Abduction
Plantar interosseous muscle function
Pad (Adduction)
Dorsal interosseous muscle function
Dab (Abduction) except the middle toe
Extrinsic muscles of the foot all leg muscles except
Popliteus
Intrinsic muscles of the foot dorsal side
Extensor digitorum brevis and Extensor hallucis brevis
Innervation of Extensor digitorum brevis and Extensor hallucis brevis
Deep fibular nerve
Intrinsic muscles of the foot plantar side
1st layer: Abductor hallucis, Flexor digitorum brevis and Abductor digiti minimi
2nd layer: Quadratus Plantae and Lumbricals
3rd layer: Flexor hallucis brevis, Adductor hallucis and Flexor digiti minimi brevis
4th layer: Interossei
If you cut tibial nerve which muscles are paralized?
All extrinsic muscles of the foot
- Lateral plantar a
- Lateral plantar n
- Medial plantar a and n
Between 1st and 2nd layer of sole muscles
Arteries- branches of posterior tibial a
Nerves- branches of posterior tibial n
- Medial proper plantar digital a
- Plantar digital a
- Superficial branch
- Deep branch
- Plantar arch
Deep branch contributes to
2nd and 3rd plantar metatarsal a
Superficial branch becomes
Medial proper plantar digital a
Digital branch contributes to
1st plantar metatarsal a
What forms the plantar arch
Lateral plantar a
Which layers is the plantar arch between?
3rd and 4th layers
Dorsal artery of the foot branches
Up to down
Lateral and medial tarsal a
Arcuate a
Deep plantar a (joins plantar arch)
1st dorsal metatarsal a
Up to down
Posterior perforating branches
Plantar arch
Deep plantar a
Anterior perforating branches
Lateral lymphatics of the foot
Popliteal lymph nodes which becomes deep inguinal lymph nodes
Medial lymphatics of the foot
Superficial inguinal lymph nodes
Clinical importance of Superficial inguinal lymph nodes
LAP or lymph adenopathy
enlargement of lymph nodes if palpated
Flatfoot- abnormal as the sole doesnt touch floor by all surface
both ball and heel touch floor
Babies are born with a flat foot and at about 10 years the arch appears
Blue: Anterior transverse arch
Red: Lateral longitudinal arch
Green: Medial longitudinal arch
What arranges to form the arches of the foot
Tarsal and metatarsal bones
The function of the arches of the foot
Shock absorber
Increases weight bearing capacity
Spreads the weight in all directions
What forms the lateral longitudinal arch
Calcaneus, cuboid and lateral 2 metatarsals
What forms the medial longitudinal arch
(highest arch)
All tarsal bones except cuboid and three medial metatarsals
What forms the Transverse plantar arch
Cuboid, cuneiforms, base of metatarsals
Arches are also supported by
Ligaments
What supports the Medial longitudinal arch
Tibialis anterior and posterior, Flexor hallucis longus, spring ligament (calcaneonaviculare plantare) and plantar aponeurosis
What supports the Lateral longitudinal arch
Short and long plantar ligament
Plantar aponeurosis
What supports the Transverse longitudinal arch
Fibularis longus muscle and Tibialis posterior
Palpations
What happens if you compress the common peroneal nerve
Fibularis longus and brevis will be paralyzed