Download NEUROVASCULAR SUPPLY OF FOOT

NEUROVASCULAR SUPPLY OF FOOT
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
•
•
•
Medial plantar arteries
Lateral plantar arteries
Both are terminal branches of the posterior tibial artery.
MEDIAL PLANTAR ARTERY
•
•
•
•
•
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
Anastomose: with the first dorsal metatarsal artery
Supplies: Abductor hallucis, Flexor digitorum brevis, medial side of big toe
LATERAL PLANTAR ARTERY
•
•
•
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
•
Perforating branches :
– Three in number
– Anastomose with the dorsal metatarsal arteries
•
Plantar metatarsal arteries:
– 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
•
Terminal branches of the tibial nerve:
– Medial planter nerves
– Lateral plantar nerves
MEDIAL PLANTAR NERVE
•
•
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:
Muscular:
– abductor hallucis muscle
– flexor digitorum brevis
– flexor hallucis brevis (in the third layer)
– 1st lumbrical
•
Cutaneous:
– Plantar digital nerve - Skin of medial three and half toes
– On dorsum, nail bed and tips of toes
LATERAL PLANTAR NERVE
•
•
Arises: beneath flexor retinaculum
Course:
– 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:
Main trunk:
– abductor digiti minimi
– accessory flexor (quadratus plantae)
– Cutaneous: Skin of lateral part of sole
•
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
•
Deep terminal:
– lumbricals 3, 4, 5
– adductor hallucis
– Interossei (except 4th intermetatarsal space)
VEINS OF SOLE OF FOOT
•
•
•
•
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
•
•
•
•
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 :
– Crosses navicular supply extensor digitorum brevis
•
Medial tarsal arteries :
– 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
– Gives off the second, third, and fourth dorsal metatarsal arteries
•
First dorsal metatarsal artery :
– Supply the adjoining sides of the great and second toes.
SUPERFICIAL PERONEAL NERVE
•
•
•
Emerges from between peroneus brevis and extensor digitorum longus
Branches:
– medial and lateral cutaneous
Supply:
– Skin on dorsum of foot
– Medial side of big toe
– Adjacent dies of 2nd, 3rd, 4th and 5th toes
DEEP PERONEAL NERVE
•
•
•
•
•
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
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
•
•
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
Supply:
– Skin along lateral margin of foot
– Lateral side of little toe
DORSAL VENOUS ARCH
•
•
•
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