Sole Of The Foot

Dr. Rakesh Kumar Verma

Assistant ProfessorDepartment of AnatomyKGMU UP Lucknow

SKIN

ThickNerve Supply

SkinSkin Thick and

hairless.Firmly bound down to the underlying deep fascia by numerous fibrous bands.

Shows a few flexure creases at the sites of skin movement.

Sweat glands are present in large numbers.

The sensory nerve supply to the skin of the sole of the foot

SUPERFICIAL FASCIA

Cutaneous Nerves

Cutaneus Arteries

CUTANEOUS NERVES

Medial calcaneal branch of the tibial nerve

Medial plantar nerve

Lateral plantar nerve

Sural & saphenous nerve

DEEP FASCIA

Planter AponeurosisDeep transverse metatarsal

LigamentFibrous flexor sheathSeptae

Plantar aponeurosis • Definition:

Thickened band of deep fascia in the sole of the foot.

• Attachment: Posteriorly: Medial

tubercle of calcaneus.Anteriorly: Divides

into 5 slips which pass to the 5 toes.

On each side: Attached to the metatarsal bones by medial and lateral intermuscular septa.

Plantar aponeurosis

• Functions: Protects the

underlying nerves and vessels.

Maintains the longitudinal arches of the foot.

MUSCLES FOUR LAYERS

FIRST(SUPERFICIAL)

SECOND

THIRD

FOURTH

1st Layer

• Three Muscles: 1)Abductor hallucis2)Flexor digitorum

brevis3)Abductor digiti

minimi

1st Layer

SECOND LAYER

• 1.QUADRATUS PLANTAE/FLEXOR DIGITORUM ACCESSORIOUS

• 2.LUMBRICALS• 3.TENDON OF FLEXOR

DIGITORUM LONGUS• 4.TENDON OF FLEXOR

HALLUCIS LONGUS

2nd Layer• Two Tendons:

1) Flexor halusis longus2) Flexor digitorum

longus• Two Muscles:

1) Quadratus Plantae (Flexor

digitorum accessorius)

2) 4 Lumbricals muscles

1st & 2nd Layers

3rd Layer• Three

Muscles: 1)Flexor hallucis

brevis.2)Adductor

hallucis3)Flexor digiti

minimi brevis

FOURTH LAYER

• 1.DORSAL INTEROSSEI (4) 2.PLANTER INTEROSSEI(3)

• 3.TENDON OF PERONEUS LONGUS

• 4.TENDON OF TIBIALIS POSTERIOR

4th Layer• Two Tendons:

1)Tibialis posterior2)Peroneus Longus

• Two Muscles: 1)3 Planter

Interossei2)4 Dorsal Interossei

3rd & 4th Layers

NERVESMEDIAL PLANTER

LATERAL PLANTER

Medial Plantar NerveIt is larger of the two terminal

branch of the posterior tibial nerve.

Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle.

Terminate at the bases of the metatarsal bones by dividing into 3 planter digital nerves.

Medial Plantar Nerve• Branches: Muscular (to four muscles)

to: Abductor hallucis.1) Flexor digitorum brevis.2) Flexor hallucis brevis 3) First lumbrical muscle Cutaneous:

Planter cutaneous branches:

1) To the skin of the medial 2/3 of the sole of the foot.

2) Planter digital nerves Articular branches: To

intertarsal and tarso-metatarsal joints.

Lateral Plantar NerveIt is smaller of the two terminal

branches of the posterior tibial nerve.

Enters the foot midway between the medial malleolus and the medial tubercle of the calcaneus under cover the flexor retinaculum. Passes forwards and laterally deep to abductor hallusis.

Terminate at the base of the 5th metatarsal bone, by dividing into a superficial and a deep branches.

Lateral Plantar NerveBranches: Muscular :

1) Flexor digitoum accessorius muscle

2) Abductor digiti minimi3) Flexor digiti minimi brevis4) Adductor halucis muscle.5) Interossei6) 2nd, 3rd & 4th lumbricals.

Cutaneous: 1) Skin of the lat. 1/3 of the sole2) Skin on the lat.side of the planter

surface of the little toe and the adjoining sides of the 4th & 5th toes.

3) The planter digital branches, also, supply the skin on the dorsum of the terminal phalanges of the lateral one and half toes.

Tibial nerve

Med. Plantar Nerve

Deep Branch Superficial Branch

NERVES OF SOLE

To Flex. Dig. Accessorius

To Abd. Digiti Minimi

To Flex. Dig. Min. Brevis & Muscles of4th interos. space

Lat. Plantar Nerve

Br. to Abd. Hallucis

Br. to Flex. Dig. Brevis

Br. to Flex. Hal. Brevis

1st Lumbrical

2nd Lumbrical

Medial Plantar ArteryOne of the two terminal

branches of the posterior tibial artery.

Enter the foot midway between the medial malleolus and the medial tubercle of the calcaneus, under cover the flexor retinaculum. Passes forwards deep to the abductor hallucis muscle. Passes b/w the abd.hallucis and flexor digitorum brevis.

Medial Plantar ArteryTermination: By

anastmosing with the 1st planter metatarsal artery.

Branches:

Muscular

Digital: 3 superficial digital branches these branches end by anastmosing with the first, second and third planter metatarsal arteries.

Lateral Plantar Artery• One of the two terminal

branches of the posterior tibial artery.

• At first between the 1st and 2nd layers, then curves medially between the 3rd and 4th layers of the sole.

• Turns medially with the deep branch of the lateral planter nerve with slight forward convexity to from the plantar arch between the 3rd & 4th layers of muscles.

Lateral Plantar Artery• Branches: Muscular Anastomotic branches: b/w arcuate &

lateral tarsal arteries of the dorsalis pedis artery.

Posterior perforating arteries: 3 branches which anastomose with the dorsal

metatarsal arteries.

Planter digital artery: to the lateral side of the little toe.

Three planter metatarsal arteries

Transverse section through sole of right foot

Dorsalis Pedis A.

2nd layer

1st layer

3nd layer

Trunk of LateralPlantar art.

Deep Br. Of Lat. Plantar art.

4th layer

Metatarsal - 1Metatarsal - 5

3 Prox. Perforating A

APPLIED ANATOMY• ARCHES OF FOOT• PAIN• MTEATARSALGIA• PLANTAR FASCITIS• INFECTION• INJURY• DIABETIC FOOT• CALCANEAL SPUR

QUESTION-1• Which dermatome is mainly stimulated in

plantar reflex:• A) L 4• B) L 5

C) S 1• D) S 2

QUESTION-2• All of the following belong to 3rd layer of

muscles in sole except:• A) Flexor hallucis brevis• B) Abductor hallucis • C) Adductor hallucis • D) Flexor digiti minimi brevis

QUESTION-3

• During walking though the flexor digitorum longus contracting strongly, the toes do not buckle because of action of all the following muscles except:

• A) flexor digitorum accessorious • B) Extensor digitorum longus• C) Lumbricles• D) Interossei

QUESTION-4

• Plantar arch mainly formed by medial plantar artery – True/ false

QUESTION-5

• In tarsal tunnel syndrome the sensory supply to which area of the sole is Mainly affected:

• A) Heel• B) Medial margin of sole• C) Middle part of sole• D) Lateral part of sole