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OSU Anatomy of the Foot CD Text OSU Anatomy of the Foot CD Text.....................................................................10 Introductory Information ......................................................................................10 Course Syllabus ..............................................................................................10 Course Description: .....................................................................................10 Course Objectives and Outcomes: ..............................................................10 General Instructions:....................................................................................10 Basic Anatomy Of The Foot ............................................................................10 Module One: Bones of the Foot ..........................................................................11 Lesson One Basic Terminology.......................................................................11 Objectives ....................................................................................................11 Basic Terminology .......................................................................................11 Dorsal.......................................................................................................11 Plantar......................................................................................................11 Medial ......................................................................................................11 Lateral ......................................................................................................11 Proximal/Distal .........................................................................................11 Midline......................................................................................................12 Other basic terms ........................................................................................12 Anterior.....................................................................................................12 Posterior...................................................................................................12 External ....................................................................................................12 Internal .....................................................................................................12 Superior....................................................................................................12 Inferior ......................................................................................................12 Central .....................................................................................................12 Peripheral.................................................................................................12 Prone .......................................................................................................12 Supine ......................................................................................................12 Lesson Two: Bones of the Foot.......................................................................13 Bones of the Forefoot ..................................................................................13 Objectives ................................................................................................13 The 19 Bones of the Forefoot: 5 Metatarsals and 14 Phalanges .............13 Metatarsals ...........................................................................................13 Phalanges.............................................................................................13 Bones of the Midfoot....................................................................................14 Objectives ................................................................................................14 The 7 Bones of the Midfoot: Navicular, Cuboid, & 3 Cuneiforms .............14 Navicular...............................................................................................14 Cuneiforms ...........................................................................................14 Cuboid ..................................................................................................14 Dorsal View ..........................................................................................14 Plantar View .........................................................................................14 Lateral View..........................................................................................14 Bones of the Hindfoot ..................................................................................15 The 2 Bones of the Hindfoot: Talus and Calcaneus .................................15 Talus.....................................................................................................15 Calcaneus.............................................................................................15 Review ............................................................................................................15 Question 1 ...................................................................................................15 Question 2 ...................................................................................................15 Question 3 ...................................................................................................15 Question 4 ...................................................................................................15 Question 5 ...................................................................................................15 Question 6 ...................................................................................................15 Question 7 ...................................................................................................15 Question 8 ...................................................................................................15 Question 9 ...................................................................................................15 Question 10 .................................................................................................15 Question 11 .................................................................................................16 Question 12 .................................................................................................16 Question 13 .................................................................................................16 Question 14 .................................................................................................16 Module Two: Joints & Arches ............................................................................17 Lesson One: Basic Terminology......................................................................17 Synovial Joint...............................................................................................17 How it works.............................................................................................17 Bursae (singular = bursa).........................................................................17 Bursae......................................................................................................18 Tendon sheaths .......................................................................................18 Articular Capsule......................................................................................18 Lesson Two: Joints Of The Foot......................................................................19 Joints of the Forefoot ...................................................................................19 Phalanges Joints......................................................................................19 5th Metatarsophalangeal Joint..............................................................19 Joints Of The Hindfoot & Midfoot .................................................................20 Objectives ................................................................................................20 Joints Of The Hindfoot & Midfoot ; Ankle Joint, Subtalar Joint, and Transverse Tarsal Joint............................................................................20 Ankle Joint ............................................................................................20 Subtalar Joint........................................................................................20 Transverse Tarsal Joint ........................................................................20 Joints That Divide The Midfoot From The Forefoot......................................20 Objectives ................................................................................................20 Tarsometatarsal Joint...............................................................................20 Lesson Three: Arches Of The Foot .................................................................21 Objectives ....................................................................................................21 The Arches ..................................................................................................21 Medial Longitudinal Arch ..........................................................................21 Lateral Longitudinal Arch .........................................................................21 Transverse Arch.......................................................................................21 Review ............................................................................................................22 Question 1 ...................................................................................................22 Question 2 ...................................................................................................22 Question 3 ...................................................................................................22 Question 4 ...................................................................................................22 Question 5 ...................................................................................................22 Question 6 ...................................................................................................22 Question 7 ...................................................................................................22 Question 6 ...................................................................................................22 Question 9 ...................................................................................................22 Module Three: Ligaments Of The Foot ...............................................................23 Lesson One: Basic Terminology......................................................................23 Ligaments and Tendons, What's the difference? .....................................23 Ligaments .............................................................................................23 Tendons................................................................................................23 Lesson Two: Ligaments of the Foot ................................................................23 Ligaments On The Lateral Side Of The Ankle .............................................23 Lesson Objectives....................................................................................23 Lateral Ligaments.....................................................................................23 Lateral Collateral Ligament...................................................................24 Anterior Talofibular Ligament................................................................24 Posterior Talofibular Ligament..............................................................24 Calcaneofibular Ligament .....................................................................24 Other Ligaments On The Lateral Side Of The Ankle................................24 Anterior Tibiofibular Ligament...............................................................24 Posterior Tibiofibular Ligament .............................................................24 Ligaments On The Medial Side Of The Ankle..............................................25 Lesson objectives.....................................................................................25 Deltoid Ligaments ....................................................................................25 Anterior Tibiotalar ligament...................................................................25 Tibionavicular ligament .........................................................................25 Tibiocalcaneal ligament ........................................................................25 Post Tibiotalar ligament ........................................................................25 Plantar Ligaments........................................................................................26 Lesson objectives.....................................................................................26 Plantar Ligaments ....................................................................................26 Long Plantar Ligament .........................................................................26 Plantar Calcaneonavicular Ligament (Spring Ligament).......................26 Short plantar ligament or Calcaneocuboid Ligament ............................26 REVIEW ..........................................................................................................27 Question 1 ...................................................................................................27 Question 2 ...................................................................................................27 Question 3 ...................................................................................................27 Question 4 ...................................................................................................27 Module Four: Muscles of the Foot.......................................................................28 Lesson One: Basic Terminology......................................................................28 Tendon ........................................................................................................28 Retinaculum.................................................................................................28 Peroneal Retinaculum ..............................................................................28 Extensor Retinaculum ..............................................................................28 Flexor Retinaculum ..................................................................................28 Origin and Insertion .....................................................................................29 Origin .......................................................................................................29 Insertion ...................................................................................................29 Intrinsic and Extrinsic...................................................................................29 Intrinsic muscles.......................................................................................29 Extrinsic Muscles of the Foot ..........................................................................29 Muscles in the Anterior Compartment..........................................................29 Tibialis Anterior ........................................................................................29 Extensor Digitorum Longus ......................................................................29 Peroneus Tertius......................................................................................29 Extensor Hallucis Longus.........................................................................29 Muscles in the Lateral Compartment ...........................................................30 Peroneus Longus .....................................................................................30 Peroneus Brevis.......................................................................................30 Muscles in the Deep Posterior Compartment ..............................................30 Tibialis Posterior.......................................................................................30 Flexor Digitorum Longus ..........................................................................30 Flexor Hallucis Longus .............................................................................30 Popliteus ..................................................................................................30 Muscles in the Superficial Posterior Compartment ......................................31 Gastrocnemius .........................................................................................31 Soleus ......................................................................................................31 Plantaris ...................................................................................................31 Intrinsic Muscles of the Foot............................................................................31 Dorsal Muscles ............................................................................................31 Extension Digitorum Brevis ......................................................................31 Extensor Hallucis Brevis...........................................................................31 Dorsal Interossei (4).................................................................................31 Intrinsic Plantar Muscles of the foot.................................................................32 Muscles in the Fourth (deepest) Layer ........................................................32 Plantar Interossei (3)................................................................................32 Muscles in the Third Layer...........................................................................32 Flexor Hallucis Brevis...............................................................................32 Adductor Hallucis .....................................................................................32 Flexor Digiti Minimi Brevis ........................................................................32 Muscles in the Second Layer.......................................................................33 Quadratus Plantae ...................................................................................33 Lumbricals (4) ..........................................................................................33 Muscles in the First (Superficial) Layer........................................................33 Abductor Hallucis .....................................................................................33 Abductor Digiti Minimi ..............................................................................33 Flexor Digitorum Brevis ............................................................................33 Review ............................................................................................................33 Question 1 ...................................................................................................33 Question 2 ...................................................................................................33 Question 3 ...................................................................................................33 Question 4 ...................................................................................................34 Question 5 ...................................................................................................34 Question 6 ...................................................................................................34 Question 7 ...................................................................................................34 Question 8 ...................................................................................................34 Question 9 ...................................................................................................34 Question 10 .................................................................................................34 Module Five: Nerves, Arteries, & Veins of the Leg and Foot ..............................35 Lesson One: Basic Terminology......................................................................35 Anastomsis ..................................................................................................35 Innervate......................................................................................................35 Fibular / Peroneal ........................................................................................35 Artery ...........................................................................................................35 Nerves .........................................................................................................35 Veins............................................................................................................35 Lesson Two: Nerves of the Leg and Foot........................................................36 Femoral Nerve .............................................................................................36 Sciatic Nerve................................................................................................36 Common Fibular Nerve................................................................................36 Tibial Nerve..................................................................................................36 Lateral Sural Cutaneous Nerve....................................................................36 Medial and Lateral Plantar Nerve ................................................................36 Saphenous Nerve ........................................................................................37 Deep Fibular Nerve......................................................................................37 Superficial Fibular Nerve .............................................................................37 Lesson Three: Arteries of the Leg and Foot ....................................................38 Femoral Artery .............................................................................................38 Popliteal Artery ............................................................................................38 Anterior Tibial...............................................................................................38 Fibular Artery ...............................................................................................38 Lateral Plantar .............................................................................................38 Arcuate Artery..............................................................................................38 Plantar Arterial Arch with Plantar Metatarsal arteries ..................................38 Posterior Tibial Artery ..................................................................................38 Dorsalis Pedis Artery ...................................................................................39 Medial Plantar Artery ...................................................................................39 Lesson Four: Veins of the Leg and Foot .........................................................39 Femoral Vein ...............................................................................................39 Small Saphenous Vein ................................................................................39 Great Saphenous Vein ................................................................................39 Dorsal Venous Arch.....................................................................................39 Review ............................................................................................................39 Question 1 ...................................................................................................39 Question 2 ...................................................................................................39 Question 3 ...................................................................................................40 Question 4 ...................................................................................................40 Question 5 ...................................................................................................40 Question 6 ...................................................................................................40 Question 7 ...................................................................................................40 Question 8 ...................................................................................................40 Question 9 ...................................................................................................40 Question 10 .................................................................................................40 Question 11 .................................................................................................41 Question 12 .................................................................................................41 Question 13 .................................................................................................41 Question 14 .................................................................................................41 Question 15 .................................................................................................41 Question 16 .................................................................................................41 Question 17 .................................................................................................41 Module Six: Skin of the Foot ...............................................................................42 Lesson One: Basic Terminology......................................................................42 Dermis .........................................................................................................42 Epidermis.....................................................................................................42 Sebum .........................................................................................................42 Subcutaneous..............................................................................................42 Lesson Two: Skin ............................................................................................43 Epidermis.....................................................................................................43 Fat Cells ......................................................................................................43 Hair Folicle...................................................................................................43 Horny Layer .................................................................................................43 Nerve Ending ...............................................................................................43 Sebaceous Gland ........................................................................................43 Sweat Gland ................................................................................................43 Review ............................................................................................................44 Question 1 ...................................................................................................44 Question 2 ...................................................................................................44 Question 3 ...................................................................................................44 Question 4 ...................................................................................................44 Question 5 ...................................................................................................44 Question 6 ...................................................................................................44 Question 7 ...................................................................................................44 Question 8 ...................................................................................................44 Question 9 ...................................................................................................44 Question 10 .................................................................................................44 OSU Anatomy of the Foot CD Text Introductory Information Course Syllabus Course Description: This course consists of interactive self-paced learning modules designed to five students a basic understanding of foot anatomy. Students studying Pedorthics will acquire professional knowledge and skills that can be applied to Pedorthic assessment and treatment techniques. Additionally the illustrations presented in this course may be helpful in performing g patient management techniques by serving as a tool for patient education. Course Objectives and Outcomes: Upon completion of this course, the student will: Identify, name, recognize, pronounce and spell the body parts of the human foot, including the bones, joints & arches, ligaments, muscles & tendons, nerves, veins, arteries and skin. Conduct a self-assessment of learning gain by completing a series of review questions. General Instructions: To navigate throughout modules use the interactive buttons located at the top and bottom of each frame, i.e., next, back and index buttons, etc. Sound and additional information can accessed by clicking interactive buttons located on most frames. Press the escape button on your keyboard to change view or exit the program. Basic Anatomy Of The Foot Module One: Bones Module Two: Joints and Arches Module Three: Ligaments Module Four: Muscles & Tendons Module Five: Nerves, Arteries, & Veins Module Six: Skin Module One: Bones of the Foot Lesson One: Basic Terminology Lesson Two: Bones of the Foot Bones of the Forefoot Bones of the Midfoot Bones of the Hindfoot Review: Lessons 1& 2 Lesson One Basic Terminology Objectives Define and understand the basic terms as they relate to anatomy. Some basic terms should be familiar before reviewing the bones. Basic Terminology Divisions of the foot Bones of the Forefoot Bones of the Midfoot Bones of the Hindfoot Basic Terminology Dorsal The upper area of foot is referred to as the dorsal surface of the foot. Plantar The weight-bearing surface (bottom) of the foot is called the plantar surface. Medial The inside edge of the foot (Tibial side) toward the middle is called the medial side. Lateral The outer edge of the foot (fibular side) is called the lateral side. Proximal/Distal The terms proximal and distal are used to clarify a location point or the point of attachment. The terms describe the relationship of "being nearer (proximal) or farther (distal) from" a reference point. The knee is distal to the hip but proximal to the foot. The metatarsal is proximal to the phalange and distal to the midfoot Which is Lateral and which is Medial Lateral- refers to the outside part of the foot Medial - refers to the inside or midline part of the body. Midline The Midline refers to the "middle" line drawn from the posterior "back of the foot" to the anterior "front of the foot." The term is also used when referencing the middle of the body, "Midline of the body." Midline of the body Midline of the right foot. Other basic terms Anterior Anterior is toward the front aspect of the body. Posterior Posterior is toward back aspect of body. External External is close to surface of body. Internal Internal is close to center of body. Superior Superior is positioned above. Inferior Inferior is positioned below. Central Central is toward center of the mass of the body. Peripheral Peripheral is away from the center of the body mass. Prone Prone is anterior surface down. Supine Supine is anterior surface up. Lesson Two: Bones of the Foot The foot is composed of 26 bones. For descriptive purposes, the foot is divided into three anatomical divisions: the hindfoot, midfoot, and forefoot. Bones of the Forefoot Objectives Identify and name the bones of the forefoot. Describe the location of the bones of the forefoot. State the number of bones in the forefoot. Recognize, spell, and pronounce the names of the bones of the forefoot. The 19 Bones of the Forefoot: 5 Metatarsals and 14 Phalanges There are nineteen bones in the forefoot, five metatarsal bones and fourteen phalanges. They are numbered one to five beginning on the medial side Metatarsals Each metatarsal bone has a base at the proximal end, a shaft in the middle, and a head at the distal end. They are shaped like fingers. The metatarsal heads make up the ball of the foot; therefore, they are the weight-bearing portion of the metatarsal bones The metatarsals are numbered one through five beginning from the medial side. Phalanges The fourteen phalanges are long, pencil-like bones that make up the toes. There are fourteen phalanges. Each phalanx has a unique name The phalanges in yellow are proximal phalanges. Those indicated in RED are Intermediate or middle phalanges. Those in BLUE are distal phalanges. Bones of the Midfoot Objectives 1. 2. 3. 4. Identify and name the bones of the Midfoot. Describe the location of the bones of the Midfoot. State the number of bones in the Midfoot. Recognize, spell, and pronounce the names of the bones of the Midfoot. The 7 Bones of the Midfoot: Navicular, Cuboid, & 3 Cuneiforms The midfoot has five short, stocky bones, the navicular, the cuboid, and the three cuneiforms. These five bones and the two-hindfoot bones, the talus and calcaneus, make up the seven tarsal bones of the foot Navicular The navicular is the only bone in the midfoot to come in contact with all the other bones of the midfoot. Cuneiforms To help describe the location of the three cuneiforms, they are usually identified as the (1) medial cuneiform (inside), the (2) intermediate or middle cuneiform, and the (3) lateral cuneiform (outside). Cuboid The cuboid is the largest of the five bones in the midfoot and is located on the lateral side. Dorsal View The midfoot has five short, stocky bones, the navicular, the cuboid, and the three cuneiforms. These five bones and the two hindfoot bones, the talus and calcaneus, make up the seven tarsal bones of the foot Plantar View The midfoot has five short, stocky bones, the navicular, the cuboid, and the three cuneiforms. These five bones and the two hindfoot bones, the talus and calcaneus, make up the seven tarsal bones of the foot Lateral View The midfoot has five short, stocky bones, the navicular, the cuboid, and the three cuneiforms. These five bones and the two hindfoot bones, the talus and calcaneus, make up the seven tarsal bones of the foot Bones of the Hindfoot The 2 Bones of the Hindfoot: Talus and Calcaneus Talus The Talus is the highest bone in the foot. The dome-like top of the talus fits in the ankle joint. Calcaneus The calcaneus is the largest bone of the foot; it is the large heel bone. The talus bone rests on the front part of the Calcaneus bone. Review Question 1 The highest bone in the foot is the Calcaneus. True False Question 2 How many bones are there in the foot? 9 26 21 16 Question 3 The navicular is located in the midfoot True False Question 4 The midfoot consists of how many bones? 5 26 9 76 Question 5 How many tarsal bones are in the foot? 2 7 5 Question 6 There are two tarsal bones in the forefoot. True False Question 7 There are ten metatarsal bones in the foot. True False Question 8 The big toe is also referred to as the: Hallux Forefoot Tendon Sesamoid Question 9 Each ____ bone has a base, a shaft in the middle, and a head at the front or distal end. Navicular Metatarsal Cuneiforms Cuboid Question 10 The Forefoot consists of: 19 bones 26 Bones 5 bones 10 bones Question 11 Which of the following is the correct spelling of a group of bones located in the forefoot? Phelanges Philanges Palanges Phalanges Question 12 Click on the cuboid bone. Question 13 Click on the navicular bone. Question 14 Click on the Talus bone. Module Two: Joints & Arches Module Two: Joints and Arches of the foot Lesson One: Basic Terminology Lesson Two: Joints of the foot Purpose Of Joints Joints Of The Forefoot Joints Of The Midfoot Joints Of The Hindfoot Joints That Divide The Midfoot From Forefoot Lesson Three: Arches Of The Foot Review: Lessons 1, 2, & 3 Lesson One: Basic Terminology A joint is formed where two or more bones meet. Joints allow motion and flexibility within a confined range of motion. There are 33 joints in the foot. In this module we will not cover all these joints. There are three types of joints in the human body; fibrous "immovable", cartilaginous "slightly moveable" and synovial "freely moveable." Synovial Joint Synovial joints are the most common of the three types and the only type found in the foot. The synovial joint is a very simple but highly engineered biological arrangement that allows for a range of movement, has a high weight bearing capacity and reduces wear caused by friction through a lubrication process How it works A double layered membrane called the articular capsule encloses the joint cavity. The outer layer is a tough membrane of collagen fibers (dense irregular connective tissue proper), which is firmly attached to the surface of the bones on either side of the joint. It is continuous with the periosteum. The internal layer is the synovial membrane (loose connective tissue proper), which covers all internal joint surfaces. The articulating surfaces of the bones are covered by a thin layer of articular cartilage and lubricated by a special fluid called synovial fluid, which is secreted by the synovial membrane that lines the cavity. This fluid is highly viscous and slippery, reducing friction Synovial Membrane Articular Capsule Periosteum Synovial Fluid Bursae (singular = bursa) Bursae (singular = bursa) are closed, partially collapsed balloons containing synovial fluid and lined with synovial membrane on the inside and a fibrous membrane on the outside. They are found in the vicinity of joints where movement between two adjacent tissues might otherwise result in excessive friction. They are located between any two of bone, tendon, muscle or skin and they prevent these organs from rubbing against each other: like the joint cavity, with which they frequently connect, they serve to reduce friction. Some synovial joints need more lubrication that the synovial membrane can provide. These joints may have bursae and/or tendon sheaths, which provide this additional lubrication Bursae Some synovial joints need more lubrication then the synovial membrane can provide. These joints may have bursae and/or tendon sheaths, which provide this additional lubrication Tendon sheaths Tendon sheaths are similar to bursae, but differ in shape. They look like sausage-shaped balloons that wrap around long tendons subjected to friction. Articular Capsule An articular capsule surrounds the joint cavity. This capsule is a tough membrane composed of collagen fibers and is firmly attached to the surface of the bones on either sides of the joint. The articular capsule is continuous with the periosteum. The capsule has a synovial membranes lining. The synovial membranes can also form bursae and tendon sheaths. Articular cartilage located at the end of the bone is the weight bearing surface of the joint. Bursae are filled with synovial fluid and are found in the vicinity of joints where movement between bone, muscle, tendon or skin might result in excessive friction. The synovial fluid secreted by the membrane lubricates the joint and reduces the friction Lesson Two: Joints Of The Foot A joint is formed where two or more bones meet. Joints hold the bones in place and permit the necessary flexibility so the required range of motion (ROM) may occur. There are 33 joints in the foot. Joints allow for motion and flexibility between the bones of the foot. Forefoot joints Hindfoot & Midfoot Joints Joints that divide Midfoot from Forefoot Joints of the Forefoot There are 14 phalangeal joints in the forefoot. Select phalanges below for more details (or just click next.) Phalanges Joints There are 14 Phalangeal Joints in the fore foot, each having its own unique name. Following is an easy 3 step process in helping to identify them. Step One Where is the joint located. Step Two: Identify the bones on each side of the joint. Step Three: Know the meanings of the words distal, proximal and inter (middle). 5th Metatarsophalangeal Joint In This image of the forefoot there are 14 phalangeal joints. A joint is found between each of theses bones. The joint name is often made up of the bones on each side of the joint. In this example the name of the joint is the 5th Metatarsophalangeal joint (5th MTP Joint). The metatarsal 5th MTP Joint 5th Proximal phalanx Phalangeal Joints 5th proximal phalanx 5th proximal interphalangeal joint (5th PIP) 5th distal interphalangeal joint (5th DIP). Joints Of The Hindfoot & Midfoot Objectives A. B. C. D. Identify and name the joints of the hindfoot & midfoot Describe the location of the joints of the hindfoot & midfoot State the number of joints of the hindfoot & midfoot. Recognize, spell, and pronounce the names of the joints of the hindfoot & midfoot. Joints Of The Hindfoot & Midfoot ; Ankle Joint, Subtalar Joint, and Transverse Tarsal Joint Ankle Joint The ankle joint also known as the talocrual joint, is the distal joint of the lower leg and serves as the connections between the lower leg and the foot Ankle Joint Subtalar Joint The major joint in the hindfoot as well as the largest joint in the entire foot is the Subtalar Joint, also referred to as the Talocalcaneal Joint. This joint has three facets, and is located between the talus and calcaneus bone. The highlighted areas indicated are the three facets of this joint on which the talus rests. Because it has triplane motion, it is one of the main joints of the foot pertaining to biomechanics. Because of the way the Subtalar and ankle joints are located anatomically to each other and each having a different primary plane of motion - Subtalar joint is transverse and ankle joint is sagittal their combined rotational relationship allows for smooth ambulation of the body over all types of terrain. Transverse Tarsal Joint The transverse tarsal joint also referred to as the midtarsal and chopart's joint is comprised of two joints, the talonavicular and calcaneocuboid joints. Talus / Navicular = Talonavicular Calcaneus / Cuboid = Calcaneocuboid Joints That Divide The Midfoot From The Forefoot Objectives A. B. C. D. Identify and name the joints that divide the Midfoot from the Forefoot. Describe the location of the joints that divide the Midfoot from the Forefoot. State the number of joints that divide the Midfoot from the forefoot. Recognize, spell, and pronounce the names of the joints that divide the midfoot from the forefoot. Tarsometatarsal Joint The Tarsometatarsal joint also referred to as the Lisfranc Joint is located between the midfoot and the forefoot. The joint name is made up of the tarsals and the metatarsals. Lesson Three: Arches Of The Foot Objectives A. Identify and name the three arches of the foot. B. Describe the location of the three arches of the foot C. State the number of arches of the D. Recognize, spell, and pronounce the names of the three arches of the foot. The Arches The foot has three arches. The arches art maintained by: Shape of the bone Ligaments binding the bone together Muscular support The Three Arches are: Medial Longitudinal Arch Lateral Longitudinal Arch Transverse Arch Medial Longitudinal Arch The Medial Longitudinal Arch is the most important of the three arches. The Medial Longitudinal Arch is composed of the Talus calcaneus, navicular, three cuneiforms and the first three metatarsal bones. The talus is the point and "keystone" in the arch. The spring ligament, connecting the calcaneus and navicular bones, and the long and short plantar ligaments are instrumental in maintaining the medial longitudinal arch. Lateral Longitudinal Arch The lateral longitudinal arch is lower and flatter than the medial longitudinal arch. The lateral longitudinal arch is composed of the calcaneus, cuboid, and fourth and fifth metatarsal bones. The cuboid is the highest point and "keystone" in the arch. Transverse Arch The transverse Arch is at a right angle to both longitudinal arches. The Transverse arch is composed of the cuboid, and the metatarsal bases. The wedge-shaped bones of the cuneiforms help shape the transverse arch and hold it together. Review Question 1 Click on the 2nd Metatarsophalangeal Joint. Question 2 Locate and click on the 4th MTPJ. Question 3 Which is the correct name for the joint indicated in the image to the right? 3rd Metatarsophalangeal 2nd Proximal Interphalangeal 6th Distal Interphalangeal 3rd Proximal Interphalangeal Question 4 Which is the correct name of this Phalangeal Joint? 5th PIP 5th DIP 5th MTP 1st PIP Question 5 Select and click on the 3rd Distal Interphalangeal joint. Question 6 Locate and click on the 2nd DIP joint. Question 7 Locate the Transverse Tarsal Joint? Click on the location of the joint in the image to the right. Question 6 The joint area indicated in the image to the right is referred to by three names. One is the Transverse Tarsal Joint. What are the other two names? Chopart's Joint Subtalar Joint Metatarsal Joint Tarsometatarsal Joint Question 9 Locate and click on the Tarsometatarsal joint. Module Three: Ligaments Of The Foot Lesson One: Basic Terminology Lesson Two: Ligaments Of The Foot Ligaments On The Lateral Side Of The Ankle Ligaments On The Medial Side Of The Ankle Ligaments On The Plantar Side Of The Ankle Review: Lessons 1 & 2 Lesson One: Basic Terminology Ligaments and Tendons, What's the difference? Ligaments and tendons each have a specific role and function Ligaments Ligaments attach bone to bone helping keep the bones in their proper place, much like a rubber band is used to hold together a sheaf of papers. Ligaments are grouped together in cords, bands or sheets, and are as strong as rope. Tendons Tendons attach muscle to bone. Tendons are a tough cord or band of connective tissue that are at one end attached to bone and at the other end attached muscle. Muscles move bone by pulling on tendons. As a Puppeteer pulls a string to move a puppet the muscle pulls the tendon, which in turn moves the bone. Lesson Two: Ligaments of the Foot Ligaments On The Lateral Side Of The Ankle Lesson Objectives A. Identify and name the ligaments on the lateral side of the ankle B. Describe the location of the ligaments on the lateral side of the ankle C. State the number of ligaments on the lateral side of the ankle D. Recognize, spell, and pronounce the names of the ligaments on the lateral side of the ankle. Lateral Ligaments Anterior Talofibular Ligament Posterior Talofibular Ligament Calcaneofibular Ligament Other Ligaments On The Lateral Side Of The Ankle Ligaments are named according to the parts they connect. For example, the three important ligaments on the outer or lateral side of the ankle are referred to as the lateral-collateral ligament Lateral Collateral Ligament The names of the three individual parts of the ankle's lateral-collateral ligament reflect the parts they connect. The first part is the (1) anterior talofibular ligament, and second part is the (2) posterior talofibular ligament. Both of these connect the talus and the fibula. The third part (3) calcaneofibular ligament, connects the calcaneus and the fibula. Most ankle sprains involve the anterior Talofibular. Anterior Talofibular Ligament The anterior Talofibular Ligament connects the talus to the fibula on the front or anterior side of the ankle It's also one of the three lateral-collateral ligaments. Most sprains involve these ligaments, especially the Anterior Talofibular Ligament. Posterior Talofibular Ligament The posterior talofibular ligament connects two bones, the Talus and the Fibula on the back or posterior since of the ankle. It's also one of the three lateral-collateral ligaments. Calcaneofibular Ligament The calcaneofibular ligament connects the Calcaneus to the Fibula bone It's one of the three lateral=collateral ligaments. Other Ligaments On The Lateral Side Of The Ankle Other main ligaments on the lateral side of the ankle include the following: Anterior Tibiofibular Ligament Posterior Tibiofibular Ligament Anterior Tibiofibular Ligament The Anterior Tibiofibular Ligament (1) attaches the Tibia and Fibula bones on the front side of the ankle. The ligament can be identified because its name is comprised of the two bones it attaches to. Posterior Tibiofibular Ligament The Posterior Tibiofibular Ligament (2) Connects the Tibia to the Fibula bone on the back or rear side of the ankle The ligament can be identified because its name is comprised of the two bones it attaches to. Ligaments On The Medial Side Of The Ankle Lesson objectives A. B. C. D. Identify and name the ligaments on the medial side of the ankle. Describe the location of the ligaments on the medial side of the ankle. State the number of ligaments on the medial side of the ankle. Recognize, spell, and pronounce the names of the ligaments on the medial side of the ankle. Deltoid Ligaments The ligaments that appear on the medial side of the ankle are referred to as the Deltoid Ligaments. Deltoid ligament injuries occur much less commonly than lateral ligament injuries. This ligament which is very strong, fans out from the inside of the ankle bone or Tibia. The Deltoid Ligament can be injured when the ankle turns out severely (ankle eversion injury), but it is so strong that instead of tearing itself, it pulls off a piece of bone before the ligament Anterior Tibiotalar Ligament Tibionavicular Ligament Tibiocalcaneal Ligament Post Tibiotalar Ligament Anterior Tibiotalar ligament The anterior Tibiotalar ligament connects the Tibia bone to the anterior (front side) of the Talus bone. Tibionavicular ligament The Tibionavicular ligament is the thin, flat ligament joining the Tibia to the Navicular. Tibiocalcaneal ligament The Tibiocalcaneal ligament connects the Tibia to the Calcaneus. Post Tibiotalar ligament The Post Tibiotalar ligament connects the posterior (back side) of the Tibia to the Talus. Plantar Ligaments Lesson objectives A. B. C. D. Identify and name the plantar ligaments of the foot. Describe the location of each plantar ligament of the foot. State the number of plantar ligaments of the foot. Recognize, spell, and pronounce the names of the plantar ligaments of the foot. Plantar Ligaments Three plantar ligaments support the longitudinal arch of the foot. They are the Long Plantar Ligament Plantar Calcaneonavicular Ligament, and Short plantar ligament or Calcaneocuboid Ligament. Long Plantar Ligament The Long Plantar Ligament connects the plantar surface of the Calcaneus to the Navicular, Cuboid, and bases of the three metatarsal bones which support the lateral longitudinal arch of the foot. Plantar Calcaneonavicular Ligament (Spring Ligament) The Plantar Calcaneonavicular Ligament connects the Calcaneus with the whole surface of the Navicular bone. Because it is fibroelastic, it is commonly known as the spring ligament. This important ligament supports the medial longitudinal arch by limiting the ability of the arch to flatten. Short plantar ligament or Calcaneocuboid Ligament The Short plantar ligament also known as the Calcaneocuboid Ligament connects the calcaneus with the Cuboid on their plantar surfaces, supporting the lateral longitudinal arch of the foot. REVIEW Question 1 The Anterior Talofibular Ligaments connect which two of the following bones 1. Talus and Calcaneus 2. Talus and Fibula 3. Talus and Tibia 4. Cuboid and Calcaneus Question 2 Calcaneofibular Ligament Using the image to the right, click on the Calcaneofibular Ligament. Question 3 Posterior Talofibular Ligament Click on the posterior Talofibular ligament in the image to the right. Question 4 Deltoid Ligaments The highlighted area is what Deltoid Ligament? A. Anterior Tibiotalar B. Tibiocalcaneal C. Tibionavicular D. Posterior Tibiotalar Module Four: Muscles of the Foot Lesson One: Basic Terminology Muscle is a tissue whose contractions move the limbs, trunk, and internal organs. Three types of muscle occur in the body Skeletal Cardiac Smooth It is the skeletal muscles of the lower leg and foot that we are concerned with. Certain terms need to be understood in the study of the muscles of the lower leg and foot. Tendon Retinaculum Origin and Insertion Intrinsic and Extrinsic Tendon Tendon attaches muscle to bone. Tendon is composed of parallel bundles of collagenous fibers. The Achilles tendon is the large tendon at the lower end of the gastrocnemius muscle, inserted into the calcaneus. It is the strongest and thickest tendon in the body. Retinaculum Peroneal Retinaculum Peroneal Retinaculum is on the lateral side of the foot. It divides into a superior and an inferior peroneal retinacula. Contains peroneus longus and peroneus brevis tendons Is continous with the inferior part of the extensor retinaculum. Extensor Retinaculum On the dorsum of the foot Contains extensor tibialis anterior, extensor digitorum longus, extensor hallucis longus and peroneus tertius tendons Extensor Retinaculum is Y-shaped; dividing into a superior and inferior side and is continous with the peroneal retinaculum. Flexor Retinaculum On the dorsum of the foot Medial side of foot, from the medial malleolus to the calcaneus. All of the flexor tendons pass through the flexor retinaculum as they wrap around to the plantar aspect of the foot. Contains tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons. (Referred to as Tom, Dick, and Harry.) Origin and Insertion Origin and Insertion are terms used to describe the placement and attachment of muscles. Origin Origin is the fore fixed attachment of a muscle. Insertion Insertion is the movable attachment of the distal end of a muscle, which produces skeletal movement when the muscle contracts. Intrinsic and Extrinsic Intrinsic muscles Intrinsic muscles of the foot are those muscles that have both their origin and insertion in the foot. Extrinsic muscles of the foot are those muscles that have their origin in the lower leg and their insertion in the foot. Extrinsic Muscles of the Foot The extrinsic muscles are divided by function and physiology into for groups or compartments. These groups of muscles each have a primary function of movement of the foot and work together to facilitate the complex range of motion (ROM) required on the foot. These compartments are: Anterior Compartment Lateral compartment Deep posterior compartment Superficial posterior Compartment Muscles in the Anterior Compartment The anterior compartment contains four muscles Tibialis Anterior Extensor Digitorum Longus Peroneus Tertius Extensor Hallucis Longus Tibialis Anterior Origin at the lateral condyle and lateral surface of the tibia. Insertion at the plantar surface of the medial cuneiform and plantar surface on the base of the first metatarsal. Extensor Digitorum Longus Origin at the lateral condyle of the fibula and the anterior surface of the fibula. Insertion at the middle and distal phalanges of toes 2-5. Peroneus Tertius Origin at the anterior surface of the fibula. Insertion at the base of the 5th metatarsal. Extensor Hallucis Longus Origin at the anterior surface of the fibula Insertion at the distal phalanx of the great toe. Muscles in the Lateral Compartment The lateral compartment contains only two muscles. Peroneus Longus Peroneus Brevis Peroneus Longus Origin at the head and lateral surface of the fibula. Insertion at the medial cuneiform and the base of the 1st metatarsal. Peroneus Brevis Origin at the lateral surface of the fibula Insertion on the lateral aspect of the 5th metatarsal. Muscles in the Deep Posterior Compartment The deep posterior compartment contains four muscles. Tibialis Posterior Flexor Digitorum Longus Flexor Hallucis Longus Popliteus Tibialis Posterior Origin at the posterior, proximal tibia, the medial surface of the fibula and the Interossei membrane Insertion primarily at the navicular tuberosity, inserts also at the plantar surface of the three cuneiforms, the bases of the lateral 2nd - 4th metatarsals, the cuboid, and the sustenaculum tall of the calcaneus. Flexor Digitorum Longus Origin at the posterior surface of the tibia. Insertion at the plantar surface at bases of 2nd-5th distal phalanges. Flexor Hallucis Longus Origin at the distal 2/3 of the posterior fibula. Insertion at the plantar surface of the distal phalanx of Hallux. Popliteus Insertion at the anterior or the popliteal groove on the lateral surface of the lateral femoral condyle. Origin at the posterior surface of the tibia in a fan-like fashion, just superior to the popliteal line. Muscles in the Superficial Posterior Compartment The Superficial Posterior Compartment contains three muscles. Gastrocnemius Soleus Plantaris Gastrocnemius Origin at the medial and lateral condyle of the femur. Insertion at the posterior surface of the calcaneus by means of the calcaneal tendon. (Achilles tendon). Soleus Origin at the upper fibula and the middle 1/3 of the medial border of the tibia. Insertion into the calcaneus with gastrocnemius by the calcaneal (Achilles) tendon. Gastrocnemius and soleus are together referred to as triceps surae. Plantaris Origin above the lateral head of gastrocnemius on femur. Insertion at the medial posterior part of the calcaneus, blending with the calcaneal tendon. Intrinsic Muscles of the Foot Intrinsic muscles of the foot are wholly contained, origin and insertion, within the foot. The intrinsic muscles are primarily responsible for the movement of the toes. The intrinsic muscles of the foot are both dorsal and plantar muscles. Dorsal Muscles There are 3 dorsal muscles of the foot. Extensor Digitorum Brevis Extensor Hallucis Brevis Dorsal Interossei (4) Extension Digitorum Brevis Origin at the superior surface of anterior calcaneus. Insertion to the long extensor tendons of extensor digitorum longus in toes 2, 3, and 4. The most medial slip is referred to as Extensor Hallucis Brevis. Extensor Hallucis Brevis Origin at the superior surface of the anterior calcaneus. Insertion at the proximal phalanx of the big toe. Dorsal Interossei (4) Origin at the inner shafts of all metatarsals Inserts at the bases of the proximal phalanges in toes 2 (both sides), 3 and 4 (lateral side). Intrinsic Plantar Muscles of the foot The intrinsic plantar muscles are described as having four layers, in order to be more easily viewed and studied. The fourth layer is the deepest layer, closest to the bone. The fourth layer consists only of: Plantar Interossei (3) The third layer consists of: Flexor Hallucis Brevis Adductor Hallucis Flexor Digiti Minimi Brevis The second layer consists of: Quadratus Plantae Lumbricals The first layer (Superficial) consists of: Abductor Hallucis Abductor Digiti Minimi Flexor Digitorum Brevis Muscles in the Fourth (deepest) Layer The fourth layer consists only of: Plantar Interossei (3) Plantar Interossei (3) Origin at the medial aspects of metatarsals 3-5. Insertion at the bases of the corresponding proximal phalanges. Muscles in the Third Layer The third layer consists of: Flexor Hallucis Brevis Adductor Hallucis Flexor Digiti Minimi Brevis Flexor Hallucis Brevis Origin at the medial aspect of the cuboid and the lateral cuneiform Insertion at the medial and lateral aspects of the base of proxiomal phalanx of the great toe. Adductor Hallucis Origin at oblique head from bases 2-4 metatarsals; transverse head from the plantar metatarsal ligaments and the deep transverse ligaments. Insertion at proximal phalanx of great toe. Flexor Digiti Minimi Brevis Origin at the base of the 5th metatarsal and the sheath of peroneus longus Insertion at the lateral side of base of proximal phalanx of little toe. Muscles in the Second Layer Quadratus Plantae Lumbricals Quadratus Plantae Origin at the lateral and medial sides of the calcaneus Insertion at the tendons of flexor digitorum longus. Lumbricals (4) Origin at tendons of flexor digitorum longus Insertion at the tendons of extensor digitorum longus on dorsal foot. Muscles in the First (Superficial) Layer The first layer (Superficial) consists of: Abductor Hallucis Abductor Digiti Minimi Flexor Digitorum Brevis Abductor Hallucis Origin at medial process of posterior calcaneal tuberosity and flexor retinaculum. Insertion at medial aspect of base of proximal phalanx of big toe. Abductor Digiti Minimi Origin at medial and lateral aspects of posterior calcaneal tuberosity Insertion at lateral side of base of proximal phalanx of 5th toe and 5th metatarsal. Flexor Digitorum Brevis Origin at medial process of posterior calcaneal tuberosity Insertion at middle phalanges of lateral four toes. Review Question 1 Tendons attach muscles to: Hyaline cartilage Bone Ligaments Joints Question 2 The strongest and thickest tendon in the human body is: Peroneus Longus tendon Interossei Membrane Extensor Retinaculum Achilles Tendon Question 3 The intrinsic muscles of the foot are those muscles that have both origin and insertion in the foot. True False Question 4 Extensor Digitorum Longus and Extensor Hallucis Longus are extrinsic muscles with insertions on the plantar aspect of the foot. True False Question 5 The superior extensor retinaculum contains the peroneus longus and the peroneus brevis tendons and prevents them from bowstringing. True False Question 6 Is it the origin or insertion of a muscle that which typically produces movement when the muscle contracts: Origin Insertion Question 7 Which extrinsic muscle does not insert in the foot? Soleus Tibialis Anterior Extensor Hallucis Brevis Popliteus Question 8 There are four layers of muscle on the dorsum of the foot. True False Question 9 Is Peroneus Tertius included in the lateral or the anterior compartment of the extrinsic muscles? Lateral Anterior Question 10 Tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons are: Tendons that are on the medial side of the foot Bound by the flexor retinaculum Referred to as “Tom, Dick, and Harry” Insert on the plantar aspect of the foot Module Five: Nerves, Arteries, & Veins of the Leg and Foot Lesson One: Basic Terminology Certain terms need to be understood in the study of the nerves, arteries and veins of the lower leg and foot. Anastomsis Innervate Fibular / Peroneal Artery Nerves Veins Anastomsis Arteries branch as they travel through the body. The connections or unions of these branches are referred to as anatomosis. Innervate The stimulation of communications of parts of the body through its nerves. Fibular / Peroneal Peroneal is the old terminology which has since been replaced by the term fibular. You may still see both terns used interchangeable. Artery Arteries are the blood vessels which supply the body with oxygen enriched blood. Nerves The nerves provide both sensory and motor function. Veins The blood vessels that drain the oxygen depleted blood back to the heart are referred to as veins. Lesson Two: Nerves of the Leg and Foot There are nine specific nerves which provide motor and sensory innervation for the lower leg and foot Femoral Sciatic Common Fibular Tibial Lateral Sural Cutaneous Medial and Lateral Plantar Saphenous Deep Fibular Superficial Fibular Femoral Nerve Passing under the inguinal ligament lateral to the femoral artery, the femoral nerve provides motor innervation to sartorius, rectus femoris, vastus lateralis, vastus intermedius vastus medialis, and pectineus muscles. Its sensory innervation is the skin of the anterior thigh. Sciatic Nerve The largest nerve in the body, the sciatic nerve is the major nerve of the leg, its branches provides motor innervation to all leg and foot muscles. It also supplies sensory innervation to the skin of the leg and foot, except on the medial side. It is composed of terminal branches, the tibial and common fibular divisions. The sciatic nerve is not considered to have any direct muscular branches. Common Fibular Nerve Also referred to as the common peroneal nerve, the common peroneal nerve is a superficial nerve providing motor innervation to muscles of the lateral and anterior compartments of the leg and the dorsal foot muscles. Its sensory innervation includes the distal one third of the anterior surface of the leg, the dorsum of the foot. Not including the web between the great and second toes; the distal interphalangeal segments of all the toes; the deep fibular nerve. Tibial Nerve The tibial nerve is the larger of sciatic nerve divisions. It provides motor innervation to the superficial and deep posterior compartment muscles of the leg and the plantar muscles of the foot. It supplies sensory innervation for skin of the plantar surface of the foot and toes; and the dorsal surface of the distal toes in the nail bed region. Lateral Sural Cutaneous Nerve Strictly a sensory nerve, the lateral sural cutaneous nerve supplies the skin of the lateral side of the leg. Medial and Lateral Plantar Nerve The medial plantar nerve is the larger of the two terminal branches of the tibial nerve. It provides motor innervation to the great toe. The lateral plantar nerve supplies sensory innervation to the skin of the fifth and the lateral half of the fourth toes and motor innervation to the deep muscles of the foot. Saphenous Nerve The saphenous nerve provides no motor stimuli. Its supplies sensory innervation to the skin of the medial side of the leg and foot. Although the saphenous nerve travels alongside the great saphenous vein, it does not pass through the adductor hiatus at the knee; instead, it passes anterior to the medial malleoulus at the ankle. Deep Fibular Nerve Provides motor innervation to the muscles of the anterior compartment of the leg and dorsum of the foot. Sensory innervation is supplied to the skin of the web between the great and second toes. Trauma to the anterior side of the leg can result in pressure buildup from swelling or bleeding that can damage the deep fibular nerve causing “foot drop”. This is referred to as anterior compartment syndrome. Superficial Fibular Nerve This nerve provides motor innervation to the lateral compartment muscles of the leg. Sensory innervation is supplied to the distal one third of the anterior surface of the leg and the dorsum of the foot, except for the skin of the web between the great and second toes and the nail beds of all toes. Lesson Three: Arteries of the Leg and Foot There are ten main arteries which supply the lower leg and foot. Femoral Popliteal Anterior Tibial Fibular Lateral Plantar Arcuate Plantar Arterial Arch with Plantar Metatarsal Posterior Tibial Dorsalis Pedis Medial Plantar Femoral Artery The femoral artery is continous with the popliteal artery, changing names at the adductor hiatus. It supplies the thigh, leg and foot. Popliteal Artery A continuation of the femoral artery, the popliteal artery supplies the knee, leg and foot. Anterior Tibial One of the two primary blood vessels in the lower leg, the anterior tibial artery supplies the anterior leg; dorsum and deep foot. Anterior Tibial Artery changes its name at the level of the ankle joint to the Dorsalis Pedis Artery. Fibular Artery Also referred to as the peroneal artery, the fibular artery supplies the muscles and fascia of the lateral leg and ankle. At the ankle, the fibular artery anastomoses with the anterior and posterior tibial arteries. Lateral Plantar Supplies the toes, including the nail beds as well as the plantar arterial arch and its branches in the deep foot. Arcuate Artery The Arcuate artery supplies the dorsum of the foot, except for the Hallux and distal phalangeal segments of the toes. Plantar Arterial Arch with Plantar Metatarsal arteries Supplies the deep foot and the plantar metatarsal branches. The plantar metatarsal branches then supply the toes, as well as the dorsum of the distal phalangeal segment. The plantar arch anastomosis with the deep plantar branch of the Dorsalis Pedis artery. Posterior Tibial Artery Along with the anterior tibial artery, the posterior tibial artery is one of the primary blood vessels in the lower leg. It supplies the posterior and lateral leg and the plantar aspect of the foot. This artery is a direct continuation of the popliteal artery, changing names at the inferior border of the Popliteus muscle. Dorsalis Pedis Artery The Dorsalis Pedis artery anastomosis with the plantar arterial arch; the anterior tibial artery continues as the Dorsalis Pedis artery, changing names at the level of the ankle. This artery supplies the dorsal aspect of the foot. Medial Plantar Artery Supplies the medial side of the sole of the foot. Although it does not usually participate in formation of the plantar arterial arch, the medial plantar artery anastomosis with the plantar metatarsal arteries. Lesson Four: Veins of the Leg and Foot Four major veins drain the lower leg and foot Femoral Small Saphenous Great Saphenous Dorsal Venous Arch Femoral Vein The femoral vein travels parallel to the femoral artery. Small Saphenous Vein Draining into the popliteal vein, the small saphenous vein drains the skin and superficial fascia of the lateral side of the foot and leg. Great Saphenous Vein Drains the skin and superficial fascia of the lower medial side of the foot and leg into the femoral vein. Dorsal Venous Arch Drains the dorsum of the toes and the superficial structures of the dorsum of the foot into the great saphenous vein medially and the small saphenous vein laterally. The dorsal venous arch is visible under the thin skin on the dorsum of the foot. Review Question 1 The largest nerve in the body is: Spinal Cord Sciatic Nerve Femoral Nerve Question 2 The common Peroneal Nerve innervates the: Thigh Medial side of the foot Lateral side of the leg Question 3 The Lateral Sural Cutaneous Nerve is strictly a: Sensory nerve Motor Nerve Both sensory and motor Question 4 The Sciatic Nerve is composed of two terminal branches, one is the Common Fibular and the other is the: Common Femoral Tibial Medial Sciatic Branch Question 5 Innervation is the act of imparting or directing: Nerve stimulation Oxygenated blood supply Deoxygenated blood supply Question 6 Peroneal is interchangeable with: Fibular Tibial Femoral Question 7 Arteries are blood vessels that: Transport oxygen enriched blood to tissues Transport oxygen depleted blood back to the lungs and heart Transport all body fluids Question 8 Veins are the blood vessels that: Transport oxygen enriched blood to tissues Transport oxygen depleted blood back to the lungs and heart Transport all body fluids Question 9 The artery that supplies the knee, leg, and foot with blood is the: Medial Plantar Dorsalis Pedis Popliteal Question 10 The Anterior Tibial Artery changes names at the ankle to the: Dorsalis Pedis Fibular Posterior Tibial Question 11 The Fibular Artery supplies blood to the: Medial Side of the leg Lateral side of the leg Deep posterior compartment Question 12 The Lateral Plantar Artery supplies blood to the toes, nail beds as well as the: Plantar Arterial Arch Dorsal Arterial Arch Dorsalis Pedis Question 13 The Arcuate Artery supplies blood to the: Popliteal Artery Anterior Tibia Dorsum of the foot Question 14 One of the primary arteries in the lower leg that supplies blood to the posterior and lateral leg and the plantar aspect of the foot is the: Posterior Tibial Artery Anterior Tibial Artery Dorsalis Pedis Question 15 The vein that drains the skin and superficial fascia of the lateral side of the foot and leg is the: Small Saphenous Great Saphenous Dorsal Venous Arch Question 16 The vein that drains the skin and superficial fascia of the lower medial side of the foot and leg is the: Small Saphenous Great Saphenous Dorsal Venous Arch Question 17 The vein that drains the dorsum of the toes and the superficial structures of the dorsum of the foot is the: Small Saphenous Great Saphenous Dorsal Venous Arch Module Six: Skin of the Foot Lesson One: Basic Terminology Certain terms need to be understood in the study of the skin. Dermis Epidermis Sebum Subcutaneous Dermis The inner layer of the skin, the dermis contains nerve endings, blood vessels, sebaceous glands, sweat glands, and the bases of the hair and nails. Epidermis The outside layer of the skin, the epidermis is also called the cuticle. It contains pigments and pore ducts. Sebum The skin’s natural oil, it rises to the surface of the epidermis to keep the skin lubricated and protected. Sebum helps retain body heat and prevent excess evaporation of perspiration. Subcutaneous The bottom layer of the skin, it helps hold the skin to all the tissues underneath. Lesson Two: Skin There are seven specific areas of the skin layer which will be covered in this lesson. Epidermis Fat Cells Hair Folicle Horny Layer Nerve Ending Sebaceous Gland Sweat Gland Epidermis The top layer of the skin, it is the only part of the skin that can be seen. The epidermis is several cells thick and has an external, horny layer. Ninety-five percent of the cells in the epidermis are working on making new skin. Fat Cells Located in subcutaneous layer, the fat cells help keep the body warm, absorbs shocks, and insulates the body. Hair Folicle Hair grows out of the tiny tubes called follicles, which has their roots in the subcutaneous layer and continues up through the dermis. Each hair has its own follicle. Horny Layer The uppermost layer of the epidermis, the horny layer is made up of dead cells that are constantly shed from the surface. New skin cells form at the bottom of the epidermis, then move toward the top of the dermis. As they move up, the older cells die and become part of the horny layer, This process takes about three weeks to one month. Nerve Ending The nerve ending works with the brain and nervous system to provide the sense of touch and convey pressure, temperature, and pain. Sebaceous Gland The sebaceous gland creates sebum which keeps the skin lubricated and protected. Ducts normally connect beneath the skin’s surface with the follicles, providing sebum to coat the hair with a light covering of oil. The sebum gives the hair some shine and a little waterproofing. Sweat Gland Sweat glands create sweat, which rises up onto the epidermis through sweat pores. The sweat then joins with the sebum to form a protective film on the skin that’s a bit sticky. Sweat also helps to cool the body surface and help maintain normal body temperature. Each square inch of skin contains hundreds of sweat glands. Review Question 1 The nerve ending works with the heart and skeletal system to provide the sense of touch and convey pressure, temperature, and pain. True False Question 2 Epidermis – is the top layer of the skin, it is the only part of the skin that can be seen. True False Question 3 The bottom layer of the skin is the subcutaneous, it helps hold the skin to all the tissues underneath. True False Question 4 The skin’s natural oil is called the epidermis, it rises to the surface of the outside layer of the skin to keep the skin lubricated and protected. True False Question 5 Fat cells are located in the subcutaneous layer, the fat cells help keep the body warm, absorbs shocks, and insulate the body. True False Question 6 The inner layer of the skin is called the epidermis. True False Question 7 Hair grows out of the tiny tubes called follicles. True False Question 8 The horny layer of the epidermis is made up of dead cells that are constantly shed from the surface. True False Question 9 Sweat glands create sweat, which rises up onto the epidermis through sweat pores. True False Question 10 Sweat warms the body surface and does not help to maintain normal body temperature. True False
