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FOOT Ankle: the narrowest and malleolar parts of the distal leg, proximal to the dorsum and heel of the foot, including the ankle joint.

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Foot

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FOOT

• Ankle: the narrowest and malleolar parts of the distal leg, proximal to the dorsum and heel of the foot, including the ankle joint.

• Foot provides a platform for supporting the body when standing and has an important role in

when standing and has an important role in locomotion.

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• Three anatomical and functional zones: - Hindfoot: talus and calcaneus.

- Midfoot: navicular, cuboid, and cuneiforms. - Forefoot: metatarsals and phalanges. The

part/region of the foot contacting the floor or ground is the sole.

• Part superiorly is the dorsum of the foot or dorsal

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• Part superiorly is the dorsum of the foot or dorsal region of the foot.

• Sole of the foot underlying the calcaneus is the heel, and the sole underlying the heads of the medial two metatarsals is the ball of the foot.

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SKIN AND SUBCUTANEOUS TISSUE

• Skin of the dorsum of the foot is thinner and less sensitive than skin on most of the sole.

• Skin over the major weight-bearing areas of the sole—the heel is thick.

• Fibrous septa—divide this tissue into fat-filled

areas, making it a shock-absorbing pad, especially areas, making it a shock-absorbing pad, especially over the heel.

• Skin ligaments anchor the skin to the plantar aponeurosis.

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DEEP FASCIA OF FOOT

• Thin where it is continuous with the inferior extensor retinaculum.

• Continuous with the plantar fascia which has a thick central part and weaker medial and lateral parts.

• Thick, central part of the plantar fascia forms the strong plantar aponeurosis, which invests the

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strong plantar aponeurosis, which invests the central plantar muscles.

Plantar fascia

• Holds the foot together

• Protects the sole from injury

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Plantar Aponeurosis

• Composed of dense collagen fibres arranged longitudinally

• Arises from the medial process of calcaneus and fans out over the sole

• Longitudinal bundles of the aponeurosis divide into five bands continuous with the fibrous digital

five bands continuous with the fibrous digital sheaths.

• Distal to the metatarsal heads they are connected by transverse fibres (superficial transverse

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Plantar Aponeurosis

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• In the midfoot and forefoot, vertical intermuscular septa forms the three compartments of the sole: • Medial compartment of the sole: contains the

abductor hallucis, flexor hallucis brevis, the tendon of the flexor hallucis longus, and the medial plantar nerve and vessels.

Central compartment of the sole: contains the

Central compartment of the sole: contains the

flexor digitorum brevis, the tendons of the flexor hallucis longus and flexor digitorum longus,

quadratus plantae and lumbricals,and the adductor hallucis, lateral plantar nerve.

Lateral compartment of the sole: contains the

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• Forefoot contains a fourth compartment

-Interosseous compartment of the foot.

- Contains the metatarsals, dorsal and plantar

interosseous muscles, deep plantar and metatarsal vessels.

A fifth compartment, the dorsal compartment of

the foot: contains extensors hallucis brevis and

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the foot: contains extensors hallucis brevis and

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Muscles of Foot

• 20 individual muscles of the foot: - 14: plantar aspect

- 2: dorsal aspect • 4 - intermediate.

• Muscles of the sole are arranged in four layers • Muscles of the sole are arranged in four layers

within four compartments.

• Plantar muscles function as a group during the

support phase of stance, maintaining the arches of the foot.

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• Muscles of the foot are of little importance individually.

Note that the:

Plantar interossei ADduct (PAD) and arise from a single metatarsal as unipennate muscles.

Dorsal interossei ABduct (DAB) and arise from two

Dorsal interossei ABduct (DAB) and arise from two

metatarsals as bipennate muscles.

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• Two neurovascular planes between the muscle layers of the sole of the foot:

- a superficial one between the 1st and the 2nd muscular layers

- a deep one between the 3rd and the 4th muscular layers.

• Tibial nerve divides posterior to the medial

malleolus into the medial and lateral plantar nerves. malleolus into the medial and lateral plantar nerves. • These nerves supply the intrinsic muscles of the

plantar aspect of the foot.

• Two closely connected muscles on the dorsum of the foot are the extensor digitorum brevis (EDB)

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ARCHES OF FOOT

• Foot is composed of bones connected by ligaments and absorb shock.

• Tarsal and metatarsal bones are arranged in longitudinal and transverse arches which supports and add to the

weightbearing capabilities and resiliency of the foot.

• Distribute weight over the foot as shock absorbers and springboards during walking, running, and jumping.

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springboards during walking, running, and jumping.

• Weight of the body is transmitted to the talus from the

tibia, posteriorly to the calcaneus and anteriorly to the “ball of the foot”

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Longitudinal arch of the foot

• Medial and lateral parts which act as a unit

• Transverse arch of the foot spreads weight in all directions.

Medial longitudinal

• Higher and more important than the lateral longitudinal arch.

longitudinal arch.

• Composed of the calcaneus, talus, navicular, three cuneiforms, and three metatarsals.

• The talar head is the keystone

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Lateral longitudinal arch

Flatter than the medial part of the arch

• Rests on the ground during standing .

• Made up of the calcaneus, cuboid, and lateral two metatarsals.

Transverse arch of the foot Runs from side to side.

Runs from side to side.

• Formed by the cuboid, cuneiforms, and bases of the metatarsals.

• Medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch.

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Integrity of the bony arches of the foot is maintained by:

Passive factors:

• Shape of the bones

• Four layers of fibrous tissue that bowstring the longitudinal arch:

Plantar aponeurosis. Long plantar ligament.

Plantar calcaneocuboid (short plantar) ligament. Plantar calcaneonavicular (spring) ligament.

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Plantar calcaneonavicular (spring) ligament.

Dynamic supports:

Active bracing action of intrinsic muscles of foot for the longitudinal arch

Contraction of muscles with long tendons extending into foot: - Flexors hallucis and digitorum longus for the longitudinal

arch.

References

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