Sole Of The Foot

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Sole Of The Foot

• Dr. Rakesh Kumar Verma
• Assistant Professor
• Department of Anatomy
• KGMU UP Lucknow

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SKIN

• Thick
• Nerve Supply

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Skin

• Skin
• 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

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SUPERFICIAL FASCIA

• Cutaneous Nerves
• Cutaneus Arteries

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CUTANEOUS NERVES

• Medial calcaneal branch of the tibial nerve
• Medial plantar nerve
• Lateral plantar nerve
• Sural saphenous nerve

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• DEEP FASCIA
• Planter Aponeurosis
• Deep transverse metatarsal Ligament
• Fibrous flexor sheath
• Septae

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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.

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Plantar aponeurosis

• Functions
• Protects the underlying nerves and vessels.
• Maintains the longitudinal arches of the foot.

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• MUSCLES FOUR LAYERS
• FIRST(SUPERFICIAL)
• SECOND
• THIRD
• FOURTH

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1st Layer

• Three Muscles
• Abductor hallucis
• Flexor digitorum brevis
• Abductor digiti minimi

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1st Layer
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SECOND LAYER

• 1.QUADRATUS PLANTAE/FLEXOR DIGITORUM
  ACCESSORIOUS
• 2.LUMBRICALS
• 3.TENDON OF FLEXOR DIGITORUM LONGUS
• 4.TENDON OF FLEXOR HALLUCIS LONGUS

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2nd Layer

• Two Tendons
• Flexor halusis longus
• Flexor digitorum longus
• Two Muscles
• Quadratus Plantae (Flexor digitorum
  accessorius)
• 4 Lumbricals muscles

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1st 2nd Layers
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3rd Layer

• Three Muscles
• Flexor hallucis brevis.
• Adductor hallucis
• Flexor digiti minimi brevis

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FOURTH LAYER

• 1.DORSAL INTEROSSEI (4) 2.PLANTER INTEROSSEI(3)
• 3.TENDON OF PERONEUS LONGUS
• 4.TENDON OF TIBIALIS POSTERIOR

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4th Layer

• Two Tendons
• Tibialis posterior
• Peroneus Longus
• Two Muscles
• 3 Planter Interossei
• 4 Dorsal Interossei

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3rd 4th Layers
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• NERVES
• MEDIAL PLANTER
• LATERAL PLANTER

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Medial Plantar Nerve

• It 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.

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Medial Plantar Nerve

• Branches
• Muscular (to four muscles) to Abductor hallucis.
• Flexor digitorum brevis.
• Flexor hallucis brevis
• First lumbrical muscle
• Cutaneous Planter
  cutaneous branches
• To the skin of the medial 2/3 of the sole of the
  foot.
• Planter digital nerves
• Articular branches To intertarsal and
  tarso-metatarsal joints.

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Lateral Plantar Nerve

• It 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.

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Lateral Plantar Nerve

• Branches Muscular
• Flexor digitoum accessorius muscle
• Abductor digiti minimi
• Flexor digiti minimi brevis
• Adductor halucis muscle.
• Interossei
• 2nd, 3rd 4th lumbricals.
• Cutaneous
• Skin of the lat. 1/3 of the sole
• Skin on the lat.side of the planter surface of
  the little toe and the adjoining sides of the 4th
  5th toes.
• The planter digital branches, also, supply the
  skin on the dorsum of the terminal phalanges of
  the lateral one and half toes.

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Tibial nerve
NERVES OF SOLE
Lat. Plantar Nerve
Med. Plantar Nerve
To Flex. Dig. Accessorius
To Abd. Digiti Minimi
Br. to Abd. Hallucis
Br. to Flex. Dig. Brevis
Deep Branch
Superficial Branch
Br. to Flex. Hal. Brevis
1st Lumbrical
To Flex. Dig. Min. Brevis Muscles of 4th
interos. space
2nd Lumbrical
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Medial Plantar Artery

• One 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.

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Medial Plantar Artery

• Termination 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.

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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.

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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

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Transverse section through sole of right foot
3 Prox. Perforating A
Dorsalis Pedis A.
4th layer
Metatarsal - 1
Metatarsal - 5
3nd layer
2nd layer
Deep Br. Of Lat. Plantar art.
1st layer
Trunk of Lateral Plantar art.
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• APPLIED ANATOMY
• ARCHES OF FOOT
• PAIN
• MTEATARSALGIA
• PLANTAR FASCITIS
• INFECTION
• INJURY
• DIABETIC FOOT
• CALCANEAL SPUR

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QUESTION-1

• Which dermatome is mainly stimulated in plantar
  reflex
• A) L 4
• B) L 5C) S 1
• D) S 2

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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

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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

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QUESTION-4

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

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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