Smaller of the terminal branches of the posterior tibial artery
It arises beneath the flexor retinaculum and passes forward deep to the abductor hallucis muscle
It ends by supplying the medial side of the big toe
During its course, it gives off numerous muscular, cutaneous, and articular branches.
Arteries of the Sole
Lateral Plantar Artery :
Larger of the terminal branches of the posterior tibial artery
It arises beneath the flexor retinaculum and passes forward deep to the abductor hallucis and the flexor digitorum brevis
On reaching the base of the 5th metatarsal bone, the artery curves medially to form the plantar arch and at the proximal end of the first intermetatarsal space joins the dorsalis pedis artery
During its course, it gives off numerous muscular, cutaneous, and articular branches. The plantar arch gives off plantar digital arteries to the toes.
Dorsalis Pedis Artery (The Dorsal Artery of the Foot)
On entering the sole between the two heads of the first dorsal interosseous muscle, the dorsalis pedis artery immediately joins the lateral plantar artery
Branches
The first plantar metatarsal artery, which supplies the cleft between the big and second toes.
Arteries of foot
Veins & Nerves of Sole
Medial and lateral plantar veins accompany the corresponding arteries, and they unite behind the medial malleolus to form the posterior tibial venae comitantes.
Nerves of the Sole of the Foot
Medial Plantar Nerve
It is a terminal branch of the tibial nerve
It arises beneath the flexor retinaculum and runs forward deep to the abductorhallucis, with the medial plantar artery
It comes to lie in the interval between the abductor hallucis and the flexor digitorum brevis.
Branches
Muscular branches to the abductor hallucis, the flexor digitorum brevis, the flexor hallucis brevis, and the first lumbrical muscle.
Cutaneous branches: Plantar digital nerves run to the sides of the medial three and a half toes
The nerves extend onto the dorsum and supply the nail beds and the tips of the toes.
Nerves of the Sole of foot
Lateral Plantar Nerve:
It is a terminal branch of the tibial nerve
It arises beneath the flexor retinaculum and runs forward deep to the abductor hallucis and the flexor digitorum brevis, in company with the lateral plantar artery
On reaching the base of the fifth metatarsal bone, it divides into superficial and deep branches
Branches
From the main trunk to the quadratus plantae and abductor digiti minimi
Cutaneous branches to the skin of the lateral part of the sole.
From the superficial terminal branch to the flexor digiti minimi and the interosseous muscles of the fourth intermetatarsal space.
Plantar digital branches pass to the sides of the lateral one and a half toes. The nerves extend onto the dorsum and supply the nail beds and tips of the toes.
From the deep terminal branch
This branch curves medially with the lateral plantar artery and supplies the adductor hallucis; the second, third, and fourth lumbricals; and all the interossei, except those in the fourth intermetatarsal space
Nerves of foot
Lymphatic drainage of Foot
Superficial lymphatics
medial and lateral
Medial superficial lymphatics
Drain the medial side of the dorsum and sole of foot
Converge on great saphenous vein
Then to vertical group of superficial inguinal lymph nodes
Terminate at deep inguinal lymph nodes
Lateral superficial lymphatics
Drain the lateral side of dorsum and sole of foot
These vessels pass post. To lateral mallolus and then with small saphenous vein enter the popliteal lymph nodes
Deep lymphatics
These follow the main vessels ( fibular, anterior and posterior tibial popliteal and femoral veins
From these lymph is carried to deep inguinal lymph nodes
Then in the end all the lymph from lower limb goes to iliac lymph nodes
The Foot as a Functional Unit
Arches of the Foot:
The foot is composed of numerous bones connected by ligaments, it has considerable flexibility that allows it to deform with each ground contact, thereby absorbing much of the shock.
The foot has three arches,
the medial longitudinal, lateral longitudinal, and transverse arches
The arches distribute
weight over the foot,
Act as shock absorbers and also helps during walking, running, and jumping.
Arches add to the foot’s ability to adapt to changes in surface contour.
Arches of Foot
Mechanisms of Arch Support
The Bones of the Arches
Medial longitudinal arch:
This consists of the calcaneum, the talus, the navicular bone, the three cuneiform bones, and the first three metatarsal bones
Lateral longitudinal arch:
This consists of the calcaneum, the cuboid, and the 4th and 5th metatarsal bones
Transverse arch:
This consists of the bases of the metatarsal bones and the cuboid and the three cuneiform bones
Maintenance of the Medial Longitudinal Arch
Shape of the bones:
The sustentaculum tali holds up the talus
The concave proximal surface of the navicular bone receives the rounded head of the talus; the slight concavity of the proximal surface of the medial cuneiform bone receives the navicular.
The rounded head of the talus is the keystone in the center of the arch
The inferior edges of the bones are tied together by
the plantar ligaments, which are larger and stronger than the dorsal ligaments.
The most important ligament is the plantar calcaneonavicular ligament
The tendinous extensions of the insertion of the tibialis posterior muscle play an important role in this respect.
Tying the ends of the arch together are the plantar aponeurosis, the medial part of the flexor digitorum brevis, the abductor hallucis, the flexor hallucis longus, the medial part of the flexor digitorum longus, and the flexor hallucis brevis
Suspending the arch from above are the tibialis anterior and posterior and the medial ligament of the ankle joint.
Maintenance of the Lateral Longitudinal Arch
Shape of the bones:
The distal end of the calcaneum and the proximal end of the cuboid. The cuboid is the keystone.
The inferior edges of the bones are tied together by the long and short plantar ligaments and the origins of the short muscles from the forepart of the foot
Tying the ends of the arch together are the plantar aponeurosis, the abductor digiti minimi, and the lateral part of the flexor digitorum longus and brevis.
Suspending the arch from above are the peroneus longus and the brevis
Maintenance of the Transverse Arch
Shape of the bones:
The marked wedge shaping of the cuneiform bones and the bases of the metatarsal bones
The inferior edges of the bones are tied together by the deep transverse ligaments, the strong plantar ligaments, and the origins of the plantar muscles from the forepart of the foot; the dorsal interossei and the transverse head of the adductor hallucis are particularly important in this respect.
Tying the ends of the arch together is the peroneus longus tendon.
Suspending the arch from above are the peroneus longus tendon and the peroneus brevis
The Foot as a Weight Bearer
The weight of the body is transmitted to the talus from the tibia. Then it is transmitted posteriorly to the calcaneus and anteriorly to the “ball of the foot” (the sesamoids of the 1st metatarsal and the head of the 2nd metatarsal), and that weight/pressure is shared laterally with the heads of the 3rd–5th metatarsals.
Between these weight-bearing points are the relatively elastic arches of the foot, which become slightly flattened by body weight during standing. They normally resume their curvature (recoil) when body weight is removed.
clinical
Pes cavus (clawfoot):
it is a condition in which the medial longitudinal arch is unduly high. Most cases are caused by muscle imbalance, in many instances resulting from poliomyelitis.
Pes planus (flat foot):
It is a condition in which the medial longitudinal arch is depressed or collapsed. As a result, the forefoot is displaced laterally and everted. The head of the talus is no longer supported, and the body weight forces it downward and medially between the calcaneum and the navicular bone. When the deformity has existed for some time, the plantar, calcaneonavicular, and medial ligaments of the ankle joint become permanently stretched, and the bones change shape. The muscles and tendons are also permanently stretched. The causes of flat foot are both congenital and acquired
Clubfoot (Talipes equinovarus):
Congenital condition
Involves the subtalar joint
Foot is inverted,ankle is plantar flexed,forefoot is adducted
Person bears the weight on lateral surface of forefoot
Walking is painful
There is shortness and tightness of muscles and tendons,ligaments and joint capsules on the medial side and posterior aspect of ankle
