The Foot

Question 1

Plantar Fasciitis

Answer 1

-Caused by microscopic tears at calcaneal origin
-Very common in runners and overweight patients
Clinical features:
-Pain with first steps in morning and heel pain at night
-Exam shows pain in calcaneal origin and inflexible Achilles tendon

Question 2

Fascia of the foot

Answer 2

Plantar fascia
-Plantar aponeurosis: arises from calcaneus
-Medial plantar fascia
-Lateral plantar fascia
Dorsal fascia

Question 3

Arches of the foot

Answer 3

Longitudinal arch
-Medial (instep)
-Lateral
Transverse arch- combination of the medial and lateral arches, includes cuneiforms as well as cuboid

Question 4

Passive & Dynamic support of arches

Answer 4

Passive: all ligaments you have in the foot
Dynamic: tendons of muscles coming in to support the foot

Question 5

Pes Planus

Answer 5

Pes Planus- flat foot
Can have a flexible flat foot- loose arch when you step down only
- Something wrong with one of the ligaments, loose, allowing for head of talus to drop further than it should
Rigid- step down flat, lift up flat
- Improper bone development during childhood
- Little kids have super flat feet, as they walk more they create that arch. If not developing, something wrong with bone development
Fallen arch- one point had a nice arch but for whatever reason don’t anymore
- Something happened to tibialis posterior, no longer have arch support, flattened foot all the time
-Lose of muscle, stretching of ligaments
Head of talus has fallen down, forefoot has shifted out laterally

Question 6

Extensor Digitorum brevis muscle

Answer 6

Inn: deep fibular n.
Action(s): aids in extension of digits 2-4

Question 7

Extensor hallucis brevis muscle

Answer 7

Inn: deep fibular n.
Action(s): extends digit 1

Question 8

Arteries of the Dorsum of the Foot

Answer 8

Dorsalis pedis a.
-Arcuate a. : dorsal metatarsal aa, dorsal digital aa.
-First dorsal metatarsal a.
-Deep plantar a. (terminal branch)

Question 9

Nerves of the food

Answer 9

Deep fibular n.
-Motor inn. to mm.
-Sensory to skin b/w digits 1 & 2
Superficial fibular n.
-Sensory to most skin on dorsal aspect
Sural n.
- Skin on lateral side of foot & dorsolateral surface of digit 5
Saphenous n.
-Skin medial side of proximal foot

Question 10

Layer 1 muscles

Answer 10

abductor digiti minimi m.
flexor digitorum brevis m.
abductor hallucis m.

Question 11

Abductor hallucis muscle

Answer 11

Inn: medial plantar n.
Action(s): abducts & flexes hallux (at MTP joint)

Question 12

Flexor digitorum brevis muscle

Answer 12

Inn: medial plantar n.
Action(s): flexes digits 2-5 [at proximal interphalangeal (IP) joint]

Question 13

Abductor digiti minimi muscle

Answer 13

Inn: lateral plantar n.
Action(s): abducts & flexes digit 5 (at the MTP joint)

Question 14

Layer 2 muscles

Answer 14

Lumbricals
Quadratus plantae

Question 15

Quadratus plantae muscle

Answer 15

Inn: lateral plantar n.
Action(s): assists flexor digitorum longus m. in flexing digits 2-5

Question 16

Lumbrical muscles

Answer 16

Inn: medial plantar n. (lumbrical 1); lateral plantar n. (lumbricals 2-4)
Action(s): flexes MTP joint & extends IP joints of digits 2-5

Question 17

Layer 3 muscles

Answer 17

Flexor digiti minimi brevis m.
Adductor hallucis m.
flexor hallucis brevis m.

Question 18

Flexor Hallucis brevis muscle

Answer 18

Inn: medial plantar n.
Action(s): flexes MTP joint of hallux

Question 19

Adductor hallucis muscle

Answer 19

Inn: lateral plantar n.
Action(s): adducts & assists in transverse arch of foot by pulling metatarsals medially

Question 20

Flexor digiti minimi brevis m

Answer 20

Inn: lateral plantar n.
Action(s): flexes digit 5 at MTP joint

Question 21

Layer 4 muscles

Answer 21

Dorsal interossei mm.
Plantar interossei mm.

Question 22

Dorsal Interossei mm.

Answer 22

Inn: lateral plantar n.
Action(s): abducts digits 2-4 & flexes MTP joints

Question 23

Plantar interossei mm.

Answer 23

Inn: lateral plantar n.
Action(s): adducts digits 3-5 & flexes MTP joints

Question 24

Arteries of the sole of the foot

Answer 24

Posterior tibial a. –> lateral plantar a., form deep plantar arch–> branches: digital branches, plantar metatarsal aa., and perforating aa.
Medial plantar–> blood uspply to first digit

Question 25

Nerves in the Sole of the foot

Answer 25

Tibial n.
-medial calcaneal branches
-medial plantar n.
Branches: common plantar digital nn., proper plantar digital nn.

Lateral plantar n.
Branches: superficial branch (common plantar digital nn, proper plantar digital nn.), deep branch

Question 26

Bunion (halllux valgus)

Answer 26

-Most common deformity of the MTP joints
-Lateral deviation of the proximal phalanx
-More common in women than men (often cause by tight, pointed shoes)
-Clinical features: medial eminence pain, metatarsal head pain, deformity of toes, and inability to find shoes
-Possible limited ROM and pain with extreme ROM