Q8-3. Fascia of the Foot

Question 1

What is the difference between the superficial fascia on the dorsum and that on the sole?

Answer 1

Dorsum: little fat

Sole: thick, fat-filled in key weight-bearing areas (toes, ball of foot, lateral side, and heel)

Question 2

where are the areas of thicker superficial fascia on the plantar foot?

what do these spaces correlate to?

Answer 2

1. thicker SF:
   
   • lateral margin of heel
   • proceeds to MT5, then medial MTs,
   • lateral toes and hallux
2. correlate w/ the pressure distribution during gait

Question 3

what separates superficial fascia (SF) on dorsum from SF on the sole?

Answer 3

fusion of the deep fascia (DF) to the dermis

Question 4

what is continuous with the deep fascia of the foot?

Answer 4

crural fascia

Question 5

the deep fascia of the foot and the crural fascia contributes to the formation of what?

Answer 5

retinacula

(a band around tendons that holds them in place)

Question 6

name of the deep fascia on the dorsum of the foot?

Answer 6

fascia dorsalis pedis

Question 7

*between which layers are the TA, EHL, EDL, and FT?

Answer 7

between superficial and deep layers of the deep fascia

Question 8

the deep layer of the deep fascia splits to enclose which muscles?

Answer 8

1. extensor digitorum brevis and
2. extensor hallucis brevis

Question 9

what contents run between the deep fascia and the bone?

Answer 9

• dorsalis pedis artery
• terminal branches of deep fibular nerve

Question 10

What is the deep fascia called on the sole of the foot?

Answer 10

plantar fascia/

plantar aponeurosis

Question 11

what are the divisons of the plantar aponeurosis?

Answer 11

medial,

central,

lateral

Question 12

medial plantar aponeurosis:

prox and distal attachments

Answer 12

• prox:
  
  • continuous w/ flexor retinaculum, & (?) medial process of calcaneal tuberosity
• distal:
  
  • medially: fascia dorsalis pedis
  • laterally: central plantar aponeurosis

Question 13

lateral PA:

prox and distal attachments

Answer 13

• proximal:
  
  • lateral process of calcaneal tuberosity
• distal:
  
  • medially: central plantar aponeurosis
  • laterally: fascia dorsalis pedis

Question 14

calcaneometatarsal ligament:

define

Answer 14

thick band of lateral plantar aponeurosis;

passes from lateral process of calcaneus to MT 5 tuberosity

Question 15

which division of the plantar aponeurosis is the strongest?

Answer 15

central PA

Question 16

central plantar aponeurosis:

attachments and divisions

Answer 16

1. prox: medial process of calcaneal tuberosity
2. divisions *@ midtarsal level
   
   • linked via transverse extensions of connective tissue to keep them properly aligned w/ each other and long axis of foot

Question 17

at level of the MT head, each digitation splits into a…

Answer 17

1. superficial slip/tract
2. deep slip/tract

Question 18

superficial slip/tract:

define

Answer 18

• contributes to the formation of the superficial transverse metatarsal ligament (STML)
• then attaches to the dermis

Question 19

deep slip/tract:

define

Answer 19

• Divides into 2 parts that lie on either side of the flexor tendons (forming flexor sheaths of lateral toes; attaching to sesamoids of hallux)
• Pass deep/dorsally to connect to the:
  • plantar metatarsophalangeal ligament/plantar pad or plate
  • deep transverse MT ligament
  • base of proximal phalanx

Question 20

what simple machine is the plantar aponeurosis compared to?

in what ways does it act like this machine?

Answer 20

• compared to windlass/pulley system
• actions
  
  • initated by heel rise
  • MTPJs passively dorsiflex
  • w/ passive dorsiflexion –> deep digital slips attached to the bases of the PPs are wound around their respective MT heads
  • winding tightens the PA, causing osseous compression in the midfoot –> raising the MLA and creating midfoot joint stability needed for propulsion on weight-bearing foot

Question 21

the medial plantar aponeurosis both covers and provides partial origin to which muscle?

Answer 21

abductor hallucis

Question 22

The central plantar aponeurosis both covers and provides partial origin to which muscle?

Answer 22

flexor digitorum brevis (FDB)

Question 23

The lateral plantar aponeurosis both covers and provides partial origin to which muscle?

Answer 23

abductor digiti minimi (ADM)

Question 24

what separates the 3 portions of the plantar aponeurosis?

Answer 24

grooves created by septa running between plantar aponeurosis and bone;

• medial intermuscular septum
• lateral intermuscular septum

Question 25

characteristics of the intermuscular septa running between plantar aponeurosis and bone?

Answer 25

* septa are relatively thin, irregular sheets perforated for the passage of tendons and neurovascular structures

Question 26

what are the components creating the 3 major osteofascial compartments?

Answer 26

* bones * plantar aponeurosis * septa

Question 27

intrinsic muscles of foot: **medial** compartment

Answer 27

1. abductor hallucis 2. flexor hallucis brevis (\*could be in central compartment)

Question 28

intrinsic muscles of foot: **central** compartment

Answer 28

* Flexor Digitorum Brevis * Quadratus plantae * Lumbricals * Adductor hallucis

Question 29

intrinsic muscles of foot: **lateral** compartment

Answer 29

* Abductor digiti minimi * Flexor digiti minimi brevis

Question 30

what separates the deeper/more superior interosseous compartment from the central compartment?

Answer 30

interosseous fascia

Question 31

contents of the interosseous compartment of the plantar foot

Answer 31

* 4 dorsal interossei (DABs) * 3 plantar interossei (PADs)

Question 32

although there are many variations of compartments of extrinsic muscles, what was the one example Dr. G provided?

Answer 32

5 compartments * medial compartment of sole * central compartment of sole * lateral compartment of sole * interosseous compartment of **foot** * dorsal compartment of **foot**

Question 33

extrinsic muscles of: **medial** compartment (example)

Answer 33

* abductor hallucis * flexor hallucis brevis * FHL tendon * medial planar nerve & vessels

Question 34

extrinsic muscles of: **central** compartment (example)

Answer 34

* Flexor Digitorum Brevis * FHL tendon * FDL tendon * Quadratus plantae * Lumbricals * Adductor hallucis * Lateral Plantar Nerve & Vessels

Question 35

extrinsic muscles of: **lateral** compartment

Answer 35

* Abductor digiti minimi brevis * Flexor digiti minimi brevis

Question 36

extrinsic muscles of: **interosseous** compartment

Answer 36

* MTs * Dorsal & Plantar Interossei * Deep plantar & MT vessels \*note, interosseous compartment is located in the forefoot only

Question 37

extrinsic muscles of: **dorsal** compartment

Answer 37

* Extensor hallucis brevis * Extensor digitorum brevis * Branches of the dorsalis pedis & deep fibular/peroneal nerve \*Draves (1986) subdivides this compartment into 3 layers based on splitting of the deep fascia as detailed on slide 4 of this conference

Question 38

a puncture wound or perforating ulcer can penetrate where and cause what?

Answer 38

can penetrate **deep central plantar spaces**, leading to **abscess/ deep infection of the foot**

Question 39

CC: deep infections of the foot symptoms and sequelae if left untreated

Answer 39

* sxs, esp along instep: * swelling * pain * erythema (redness, rash) * if untreated --\> * can spread proximally to the posterior compartment of the leg

Question 40

extrinsic muscles of: central compartment

Answer 40

* Flexor Digitorum Brevis * FHL tendon * FDL tendon * Quadratus plantae * Lumbricals * Adductor hallucis * Lateral Plantar Nerve & Vessels

Question 41

CC: compartment syndrome of foot; diagnosis

Answer 41

* sxs * increasing pain, exaggerted by toe stretching * swelling w/ loss of skin wrinkling * neurovascular deficits * May use needle stick measurements in unconscious patients

Question 42

CC: compartment syndrome of foot; treatment, and sequelae if left untreated

Answer 42

* treatment: emergeny fasciotomy to release interosseous compartments * sequelae if left untreated: * chronic pain * numbness * deformities like rigid claw and hammer toes * plantar muscle atrophy * callus formation * cavus foot

Question 43

CC: compartment syndrome of foot; cause

Answer 43

high energy injuries to the foot; can also lead to compartment syndrome of the leg (e.g. calcaneal fracture)