Arches of the foot.
- Medial longitudinal arch
- Calcaneus, talus, navicular, 3 cuneiforms, 3 metatarsals
- Talar head is the keystone
- Tibialis anterior, fibularis longus
- Lateral longitudinal arch
- Calcaneus, cuboid, lateral 2 metatarsals.
- Transverse arch
- Cuboid, cuneiforms, bases of the metatarsals
- Medial and lateral longitudinal arches form pillars
- Fibularis longus and tibialis posterior
- Passive supports
- Bony congruence/shape
- KEY: 4 layers of fibrous tissue that bowstring – planta aponeurosis, long plantar ligament, short plantar ligament, spring ligament
- Active supports
- Active contraction of intrinsic foot muscles
- Active contraction of muscles with long tendons coming to foot
Layers of the sole
- 1st : abductor hallucis, flexor digitorum brevis(both medial plantar nerve), abductor digiti minimi(lateral plantar nerve),
- 2nd Quadratus plantae(lateral plantar- flex toes), lumbricals(lateral 3 lateral plantar), flexor digitorum longus, flexor hallucis longus.
- 3rd flexor hallucis brevis(medial plantar nerve), adductor hallucis(deep lateral plantar), flexor digitiminimi brevis(superficial lateral plantar)
- 4th plantar ossei(lateral plantar nerve- adduct and flex at MTP), dorsal interossei(lateral plantar – abduct and flex MTP), fibularis longus tendon, tibialis posterior tendon.
Plantar aponeurosis – deep fascia from calcaneus to metatarsals- divided into 3 compartments by intermuscular septa from the skin.
- Medial compartment – abductor hallucis, flexor hallucis brevis, flexor hallucis longus tendon, medial plantar nerves and vessels
- Central compartment – plantar aponeurosis, flexor digitorum brevis, flexor hallucis longus and flexor digitorum longus tendons, quadratus plantae, lumbricals, adductor hallucis, lateral plantar nerve and vessels
- Lateral compartment – abductor and flexor digiti minimi brevis.
Blood supply – foot
- Posterior tibial gives medial and lateral plantar arteries which then reanastamose under metatarsals as deep plantar arch and give digital arteries.
- Anterior tibial changes to dorsalis pedis which enters the deep plantar arch at 1st webspace.
- Neurovascular planes
- Superficial – between 1st and 2nd muscle layers – medial plantar nerve, lateral plantar nerve and artery
- Deep – between 3rd and 4th
- On calcaneous
- Gives attachment to the plantar calcaneo-navicular (spring) ligament, tibiocalcaneal ligament, and medial talocalcaneal ligament. This eminence is concave above, and articulates with the middle calcaneal articular surface of the talus; below, it is grooved for the tendon of the Flexor hallucis longus;