Download NEUROVASCULAR SUPPLY OF FOOT

NEUROVASCULAR SUPPLY OF FOOT
LEARNING OBJECTIVES :
By the end of this lecture students should be able to:
• Describe vascular and nervous supply of sole and dorsum of foot
• Tell their course through foot
• Explain relationships
ARTERIES OF THE SOLE OF THE FOOT
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Medial plantar arteries
Lateral plantar arteries
Both are terminal branches of the posterior tibial artery.
MEDIAL PLANTAR ARTERY
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Smaller than the lateral
Arises: Beneath flexor retinaculum
Course:
– Runs along the medial side of the foot
– First: above the abductor hallucis
– Then: b/w abductor hallucis and flexor digitorum brevis
Anastamosis: with the first dorsal metatarsal artery
Supplies: Abductor hallucis, Flexor digitorum brevis, medial side of big
toe
LATERAL PLANTAR ARTERY
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Larger than the medial
Arises: Beneath flexor retinaculum
Course:
– Runs Laterally and forward
– First : between the calcaneus and abductor hallucis
– Then : between the flexor digitorum brevis and quadratus plantæ
– Turns Medially and extends from the base of the fifth metatarsal bone to
the proximal part of the first interosseous space, and forms the plantar
arch
– Unites with the deep plantar branch of the dorsalis pedis artery
PLANTAR ARCH
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PERFORATING BRANCHES :
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Three in number
Anastomose with the dorsal metatarsal arteries
PLANTAR METATARSAL ARTERIES:
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Divides into a pair of plantar digital arteries
To adjacent side of lateral four toes and lateral side of little toe
NERVE SUPPLY OF FOOT
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Terminal branches of the tibial nerve:
– Medial planter nerves
– Lateral plantar nerves
MEDIAL PLANTAR NERVE
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Arises: beneath flexor retinaculum
Course:
– Runs forward deep to abductor hallucis with medial planter artery
– Lies in interval between abductor hallucis and flexor digitorum brevis
BRANCHES:
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MUSCULAR:
– Abductor hallucis muscle
– Flexor digitorum brevis
– Flexor hallucis brevis (in the third layer)
– 1st lumbrical
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CUTANEOUS:
– Plantar digital nerve - Skin of medial three and half toes
– On dorsum, nail bed and tips of toes
LATERAL PLANTAR NERVE
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Arises: beneath flexor retinaculum
Course:
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Runs forward deep to abductor hallucis and flexor digitorum brevis with
lateral planter artery
On reaching base of 5th metatarsal bone, divides into superficial and deep
branch
BRANCHES:
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Main trunk:
– Abductor digiti minimi
– Accessory flexor (quadratus plantae)
– Cutaneous: Skin of lateral part of sole
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Superficial terminal:
– Flexor digiti minimi brevis
– Interossei (4th intermetatarsal space)
– Planter digital branch – lateral one and half toes
– On dorsum – nail beds and tips of toes
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Deep terminal:
– lumbricals 3, 4, 5
– Adductor hallucis
– Interossei (except 4th intermetatarsal space)
VEINS OF SOLE OF FOOT
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Medial plantar vein
Lateral plantar vein
Accompany corresponding arteries
Unite behind medial malleolus to form posterior tibial venae
comitantes
ARTERIES OF DORSUM OF FOOT
DORSALIS PEDIS ARTERY
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Continuation of the anterior tibial
From the ankle joint along the tibial side of the dorsum of the foot to the
proximal part of the first intermetatarsal space
Pass down b/w 2 heads of 1st dorsal interossei muscle
Joins lateral plantar artery
BRANCHES OF THE DORSALIS PEDIS ARTERY
LATERAL TARSAL ARTERY :
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– Crosses navicular supply extensor digitorum brevis
MEDIAL TARSAL ARTERIES :
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– Ramify on the medial border of the foot and join the medial malleolar network
ARCUATE ARTERY :
– Passes lateralward, over the bases of the metatarsal bones
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Gives off the second, third, and fourth dorsal metatarsal arteries
FIRST DORSAL METATARSAL ARTERY :
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Supply the adjoining sides of the great and second toes.
SUPERFICIAL PERONEAL NERVE
Emerges from between peroneus brevis and extensor digitorum longus
BRANCHES:
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Medial and lateral cutaneous
SUPPLY:
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Skin on dorsum of foot
Medial side of big toe
Adjacent dies of 2nd, 3rd, 4th and 5th toes
DEEP PERONEAL NERVE
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It enters the dorsum of the foot by passing deep to extensor
retinacula on lateral side of dorsalis pedis artery in front of the ankle
joint
Divides into a lateral and a medial terminal branch
Lateral terminal branch: supplies the extensor digitorum brevis
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Medial terminal branch: At the first interosseous space, divides into two dorsal
digital nerves, supply the adjacent sides of the great and second toes
Both give articular branches to joints of foot
SAPHENOUS NERVE
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Passes onto dorsum of foot in front of medial malleolus
Supply: Skin along medial side of foot as far forward as head of 1st metatarsal
bone
SURAL NERVE
• Enters foot behind lateral malleolus
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SUPPLY:
– Skin along lateral margin of foot
– Lateral side of little toe
DORSAL VENOUS ARCH
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Lies in subcutaneous tissue over heads of metatarsal bones
Drains:
– on medial side into great saphenous vein
– on lateral side into small saphenous vein
Greater part of blood from whole foot drains into arch via digital veins and
communicating veins from sole, which pass through interosseous spaces
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