Foot

Question 1

Give a brief overview of the foot

Answer 1

 The region of the lower limb distal to the ankle joint.
 It is subdivided into the ankle, the metatarsus, and the digits
 Hindfoot, midfoot and forefoot
 The foot has a dorsum (superior surface of foot) and a sole (inferior surface)

Question 2

Describe the plantar aponeurosis

Answer 2

• for grip and weight
  bearing
• thickens as 5 longitudinal bands that continue with the fibrous flexor sheaths
• sends septae to the metatarsals to create compartments and potential spaces

Question 3

Describe the skin on the sole of the foot

Answer 3

The sole has thick, highly sensitive skin, very firmly attached to the Plantar Aponeurosis

Question 4

Describe the plantar muscles

Answer 4

 Plantar muscles are arranged in layers
 Their actions are implied by the names, but they play important
roles in
− arch support
− adjustment of balance
− Gait, especially on uneven surfaces
 They are supplied by the lateral or medial plantar nerves
- The Medial Plantar is the equivalent of the Median Nerve
- The Lateral Plantar is the equivalent of the Ulnar Nerve

Question 5

What actions do the plantar muscles play a role in?

Answer 5

− arch support
− adjustment of balance
− Gait, especially on uneven surfaces

Question 6

What are the important plantar muscles to know?

Answer 6

Abductor digiti minimi
Flexor digitorum brevis
Abductor hallucis
Lumbricals 1 4
Quadratus plantae
Flexor digiti minimi brevis
Adductor hallucis
Flexor hallucis brevis
Plantar interossei
Dorsal interossei

Question 7

What are the plantar muscles that are innervated by the lateral plantar nerve?

Answer 7

Abductor digiti minimi
Lumbricals 4
Quadratus plantae
Flexor digiti minimi brevis
Adductor hallucis
Plantar interossei
Dorsal interossei

Question 8

What are the plantar muscles that are innervated by the medial plantar nerve?

Answer 8

Flexor digitorum brevis
Abductor hallucis
Lumbricals 1
Flexor hallucis brevis

Question 9

What does the posterior tibial artery become in the foot?

Answer 9

Posterior tibial artery becomes the medial and lateral plantar arteries after running posterior to the medial malleolus.

Question 10

What artery precedes the medial and lateral plantar arteries after running posterior to the medial malleolus?

Answer 10

Posterior tibial artery

Question 11

Where can the pulse of posterior tibial artery be felt?

Answer 11

Behind the medial malleolus

Question 12

What injuries may interrupt blood supply to the talus?

Answer 12

Fractures of the neck of the talus often interrupt the blood supply to the talus

Question 13

Where does the tibial nerve pass into the foot?

Answer 13

Tibial nerve passes into the sole behind medial malleolus, deep to the flexor retinaculum

Question 14

What does the tibial nerve become after passing into the sole behind the medial malleolus?

Answer 14

Divides into the Medial and Lateral plantar nerves

Question 15

give an overview of the plantar arches

Answer 15

 3 points of contact (?)
 Arches between points of contact as a result of shapes and arrangements of the bones of the foot
 Weight bearing/distribution; shock absorption; resilience; “spring in the stride”!

Question 16

What bones make up the plantar arches?

Answer 16

 Medial longitudinal arch: Calcaneus, talus, navicular, 3 cuneiform bones and medial 3 metatarsals
 Lateral longitudinal arch: Calcaneus, cuboid and 4th -5th metatarsals
 Transverse arch: Cuneiforms and cuboid; disappears near the heads of the metatarsals

Question 17

What bones make up the medial longitudinal plantar arch?

Answer 17

Calcaneus, talus, navicular, 3 cuneiform bones and medial 3 metatarsals

Question 18

What bones make up the lateral longitudinal plantar arch?

Answer 18

Calcaneus, cuboid and 4th -5th metatarsals

Question 19

What bones make up the transverse plantar arch?

Answer 19

Cuneiforms and cuboid; disappears near the heads of the metatarsals

Question 20

What are the passive supporters of all the plantar arches?

Answer 20

Shape of bones (forms bridge “keystone” at navicular bone)
Strong ligaments
Muscles (effective when contracting)

Question 21

What strong ligaments support the plantar arches

Answer 21

Calcaneonavicular plantar ligament: Supports the keystone. 
Long plantar ligament
Plantar aponeurosis
Deltoid ligament
Calcaneocuboid (short plantar) ligament

Question 22

What are the supporters of the medial plantar arch?

Answer 22

 Deltoid ligament
 Plantar aponeurosis
 Spring ligament

Question 23

What are the supporters of the lateral arch?

Answer 23

 Flexor digitorum longus 
 Lateral ligament
(Peroneus longus tendon,
short plantar ligament 
long plantar ligament 
plantar aponeurosis)*

Question 24

Where does the deep fibular nerve enter the dorsal of the foot?

Answer 24

Deep fibular nerve enters the dorsum of the foot passing under the extensor retinaculum

Question 25

What does the deep fibular nerve give rise to?

Answer 25

dorsal digital nerve to toes 1-2

Question 26

What gives rise to the dorsal digital nerve to toes 1-2?

Answer 26

The deep fibular nerve

Question 27

Where does the anterior tibial artery pass into the foot?

Answer 27

Anterior tibial artery passes under the inferior extensor retinaculum and becomes dorsalis pedis

Question 28

Where can one feel the pulse go dorsalis pedis?

Answer 28

Pulse of dorsalis pedis is felt in the first intermetatarsal space, between the tendons of extensor digitorum longus and extensor hallucis longus

Question 29

What are the retinacula around the ankle important for?

Answer 29

Keeping the tendons flush to the body, same as in the wrist

Question 30

Describe the location and borders of the tarsal tunnel

Answer 30

 Depression inferior to the medial malleolus  Talus  Calcaneus  Inferior surface of the sustentaculum tali  Flexor retinaculum

Question 31

What is contained within the tarsal tunnel?

Answer 31

``` From posterior to anterior: Tendon of flexor hallucis longus Tibial nerve Posterior tibial artery Tendon of flexor digitorum longus Tendon of tibialis posterior ```

Question 32

What tendons are found in the tarsal tunnel?

Answer 32

Tendon of flexor hallucis longus Tendon of flexor digitorum longus Tendon of tibialis posterior

Question 33

Where is the Lisfranc joint?

Answer 33

Between the metatarsals and the tarsals - not a straight line as joint between the intermediate cuneiform bone is slightly superior (remember axis - proximal)