Feet

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Feet
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• The foot is located distal to the talocrural
  joint.
• It forms a platform for supporting the body and
  locomotion
• Consists of
• 7 tarsal bones
• 5 metatarsal bones
• 14 phalanges

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• 3 functional parts
• Hindfoot talus calcaneus
• Midfoot Navicular, cuboid 3 cuneiform bones
• Forefoot metatarsals and phalanges

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• Skin Fascia of the Foot
• The skin is much thinner on the dorsum of the
  foot associated with thin loose connective
  tissue.
• Skin on the plantar weight bearing surface (heel,
  lateral margin ball of the foot ) is thick with
  fibrous connective tissue. Fat separated by
  fibrous septa create an efficient shock absorbing
  pad especially over the heel.

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• Deep fascia
• On the dorsum of the foot the deep fascia is
  continuous with the inferior extensor
  retinaculum.
• The plantar fascia has a thick central portion
  with thinner medial lateral parts
• The plantar fascia holds the parts of the foot
  together and protects the sole from injury it
  also helps maintain the transverse and
  longitudinal arches of the foot.

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Plantar aponeurosis

• Central thick fascia arises from the calcaneous
  and functions like a ligament, distally it forms
  5 independent bands becoming continuous with the
  fibrous digital sheaths.
• The aponeurosis crosses the heads of the
  metatarsal forming the superficial transverse
  metatarsal ligament.

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• In the mid fore foot vertical intermuscular
  septa extend superiorly from the plantar
  aponeurosis to the 1st 5th metatarsals forming
  the 5 compartments of the sole.
• Medial compartment Covered by the medial
  plantar fascia, contains the abductor hallicus,
  flexor hallicus brevis, tendon of the flexor
  hallicus longus and medial plantar nerves
  vessels.
• Central compartment deep to the plantar
  aponeurosis, contains flexor digitorum brevis,
  tendon of the flexor digitorum longus, muscles
  associated with the flexor digitorum longus and
  tendon (quadratus plantae), lumbricals, and
  adductor hallicus. Also contains the lateral
  plantar nerves vessels.

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• Lateral compartment- covered by thin skin
  subcutaneous tissue, lateral plantar fascia,
  abductor flexor digiti minimi brevis.
• Interosseous compartment encased in the plantar
  dorsal interossei fascia, contains the
  metatarsals, dorsal plantar interosseous
  muscles, deep plantar metatarsal vessels.
• Dorsal compartment between the dorsal fascia and
  tarsal metatarsal bones. It contains 2
  muscles the extensor hallicus brevis extensor
  digitorum brevis. Also contains dorsal
  neurovascular structures.

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• Foot Muscles
• Plantar muscles function as a group in supporting
  body weight while maintaining the arches of the
  foot.
• The muscles of the foot are of little importance
  individually. Rather than producing actual
  movement they are most active in fixing the foot
  and/or increasing the pressure applied to the
  ground by various aspects of the sole or the toes
  in order to maintain balance.
• They refine the efforts of the long muscles
  producing eversion/inversion flexion/extension
  to create a stable platform for the lower
  extremity.

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3 Arches of the Foot
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2nd Layer
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3rd Layer
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4th Layer
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Dorsum of Foot
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• 2 Neurovascular Planes between the layers of the
  plantar musculature
• 1) Superficial layer between the 1st 2nd layers
• 2) Deep between the 3rd 4th layers
• The tibial nerve divides posterior to the medial
  malleolus into the
• Medial plantar nerve
• Lateral plantar nerve
• These nerves supply the intrinsic muscles of the
  plantar aspect of the foot

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Plantar Fasciitis

• Inflammation strain of the plantar aponeurosis,
  occurs during high impact activities (especially
  running, high impact aerobics, jumping, etc.)
  surface may play a significant role in initiation
  or irritation of symptoms. Inappropriate
  footware plays a role.
• Pain is located on the plantar surface of heel
  and medial foot.
• Often worse after sitting, begins to dissipate
  5-10 minutes after onset of activity. Recurs with
  rest, most problematic at night.
• Tender to palpation at the medial tubercle of the
  calcaneus and medial surface of the calcaneous.
• Pain increases with passive extension of great
  toe and dorsiflexion of the ankle.

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Treatment

• Stretching, especially the calcaneal tendon
• Rest, avoid inciting activities
• Cold compression, ice bath, contrast bath
• Weight loss
• Arch support, heel lifts, taping, stable
  supportive shoes
• NSAIDs
• Local steroids, local anesthetic
• Night splints
• Ultrasound, Shockvave therapy
• Surgery
• Open
• Ultrasound guided needle fasciotomy

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Outcome

• Most (gt90) improve with non-surgical therapy,
  but this may require 1 year

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