Download The central compartment of the sole

The compartment of the little toe
It lies under the lateral planter fascia and is
bounded
by
the
lateral
intermuscular
septum medially and by the attachment of
the fascia to the dorsum of the fifth
metatarsal bone laterally. It includes the
abductor and flexor digiti minimi muscles
and the fifth metatarsal bone.
Little toe compartment
The central compartment of the sole
It lies deep to the planter aponeurosis. It is bounded
on either side by the medial and lateral intermuscular
fascia
It contains the flexor digitorum brevis muscle, the
tendons of the flexor digitorum longus and its
associated muscles ( quadratus plantae and four
lumbrical muscles), the tendon of the flexor hallucis
longus muscle and the lateral planter nerve and
vessels.
The central compartment
Lumbrical muscles
• They arise from the medial side of the lateral 4 flexor
digitorum longus tendons then incline superiorly and
inserted in the base of the proximal phalanx and
extensor expansion.
• Nerve supply: the 1st one supply by the medial planter
nerve. The other 3 muscles supplied by the lateral
planter nerve.
• Action: they are weak muscles play a part in the flexion
of the metatarsophalangeal joints of the lateral 4 toes.
•
Lumbrical muscles
Lateral planter nerve
The smaller of the two planters nerves arising from the
tibial nerve under the abductor hallucis muscle has a
distribution like the ulnar nerve in the hand. The nerve
pass between flexor digitorum brevis and quadratus
plantae muscles. it gives:
• muscular branches to the abductor digiti minimi and
quadratus plantae muscles.
• articular branches.
• At the lateral margin of the quadratus
plantae muscle the nerve divided into
superficial and deep branches. The deep
branch descends deeply into the adductor
–interosseous compartment.
• The superficial branch divided into proper
digital branch to the lateral side of the little toe
supply the flexor digiti minimi muscle, and a
common digital branch communicates with the
third common branch of the medial planter nerve
and divides into two proper digital branches to
the adjacent sides of the fourth and fifth toes.
Lateral planter artery
• It is the larger of the two terminal branches of the
posterior
tibial
artery.
Arise
deep
to
the
flexor
retinaculum then pass deep to the abductor hallucis and
flexor
digitorum
brevis
ms.
runs
lateral
to
the
corresponding nerve. At the medial side of the fifth
metatarsal bone the artery sinks deeply, on reaching the
base of the 5th metatarsal bone the artery curve medially
across the proximal ends of the second, third and fourth
metatarsal bones to form the planter arch.
The interosseous- adductor compartment
• It is the deepest plane of the sole of the foot, it
lies between the dorsal interosseous fascia and
the periosteum of the metatarsal bones inferiorly,
and the planter interosseous fascia covers the
superficial surface of the adductor hallucis
muscle superiorly.
• This compartment contain the dorsal and
planter
interosseous
muscles,
the
adductor hallucis muscle, the planter arch,
the deep branch of the lateral planter
nerve, and the dorsal metatarsal branches
of the dorsalis pedis artery.
The planter arch
It is formed from the lateral planter artery, the
arch completed medially by its union with the
deep planter branch of the dorsalis pedis artery
which reaches the sole through the proximal end
of the first intermetatarsal space. The arch lies
across the bases of the central metatarsal bones
and deep to the adductor hallucis muscle. The
arch gives:
•
four planter metatarsal arteries run between the
metatarsal bones, each artery divided into pairs of
proper digital arteries supply the adjacent sides of the
toes. The proper digital artery to the lateral side of the
little toe arise from the lateral planter artery opposite
the base of the fifth metatarsal bone. Each planter
metatarsal artery gives an anterior perforating branch
which
passes
through
the
interosseous
space
anastomosed with the corresponding branch of the
dorsal metatarsal artery.
•
The perforating branches arise from the
arch, passes through the proximal ends
of
the
lateral
three
intermetatarsal
spaces and between the heads of the
dorsal interosseous muscles to join the
dorsal metatarsal arteries.
Deep branch of the lateral planter nerve
• Sinks
into
the
interosseous
–adductor
compartment with the lateral planter artery and
passes medially across the bases of the
metatarsal bones posterior to the planter arch. It
gives:
• 1- muscular branches to the lateral 3
lumbrical muscles, the adductor hallucis m.
The interosseous muscles.
• 2- articular branches to the intertarsal and
tarsometatarsal joints.
The interosseous muscles
• They are 3 planter to the lateral 3 toes and
4 dorsal to the middle 3 toes.
• The dorsal interosseous muscles arise
from adjacent sides of metatarsal bones of
the space in which they lie.
• The planter
lnteroseous muscles arise from
the bases and the medial sides of the metatarsal
bones into which they insert. All the interosseous
muscles inserted in the base of the proximal
phalanges.
Only
the
dorsal
interosseous
muscles inserted in the extensor expansion of
the extensor digitorum longus.
•
• Nerve supply is the lateral planter nerve.
Action: the planter interosseous adduct the
lateral toes. The dorsal interosseous
abduct the middle 3 toes.
Dorsal interosseous
Lymphatic drainage of the lower limb
• Superficial inguinal lymph nodes: lie in the superficial
fascia below the inguinal ligament divided into horizontal
and vertical groups.
• The horizontal group lies just below and parallel to the
inguinal ligament, the medial one receive the superficial
lymphatic vessels from the anterior abdominal wall below
the level of the umbilicus and from the perineum.
• The lateral one receive
superficial lymphatic vessels
from the back below the iliac crest.
• The vertical group lies along the terminal part
of the great saphenous vein and receive the
majority of the superficial lymphatic vessels from
the lower limb.
• Efferent vessels from the superficial lymph
nodes pass through the saphenous opening to
the deep inguinal nodes.
Deep inguinal lymph nodes
• Are variable in number but they are commonly
three. They lie along the medial side of the
femoral vein, the most superior one located in
the femoral canal receive lymphatic vessels from
the superficial inguinal nodes and also from the
deep structures of the lower limb. The efferent
vessels from these nodes pass to the external
iliac nodes through the femoral canal.
Popliteal lymph nodes
• are embedded in the fatty tissue of the popliteal
fossa. They receive superficial lymph vessels
from the lateral side of the foot and leg
accompany the small saphenous vein, they also
receive lymphatic vessels from the knee joint
and the deep lymphatic vessels accompany the
anterior and posterior tibial arteries.