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The
FOOT
First & second layers of muscles of
the sole
introduction
The muscles acting on the foot can be divided
into two distinct groups; extrinsic and intrinsic
muscles.
 The
extrinsic muscles arise
from the anterior,
posterior and lateral
compartments of the leg.
They are mainly
responsible for actions
such as eversion,
inversion,
plantarflexion and
dorsiflexion of the foot.
 The
intrinsic muscles are
located within the foot
and are responsible for
the more fine motor
actions of the foot, for
example movement of
individual digits.
First layer:
Abductor Hallucis :
-Origin: Originates from
the medial tubercle of
the calcaneus,
-Insertion: It attaches to
the medial base of the
proximal phalanx of the
great toe.
-Actions: Abducts the
great toe.
-Innervation: Medial
plantar nerve.
First layer:
Abductor Digiti Minimi :
-Origin: Originates from the
medial and lateral tubercles of the
calcaneus.
-Insertion: It attaches to the
lateral base of the proximal
phalanx of the 5th digit (little toe).
-Actions: Abducts the 5th digit.
-Innervation: Lateral plantar
nerve.
First layer:
Flexor Digitorum Brevis :
-Origin: Originates from the
medial tubercle of the
calcaneus.
-Insertion: It attaches to the
middle phalanges of the lateral
four digits. It is perforated by the
tendons of flexor digitorum
longus.
-Actions: Flexes the lateral four.
-Innervation: Medial plantar
nerve.
Second layer :
Flexor digitorum accessories :
-Origin: Originates from the medial
and lateral plantar surface of the
calcaneus.
-Insertion: It attaches to the tendons of
flexor digitorum longus.
-Actions: Assists flexor digitorum longus
by bringing the tendon more in line
with toes, thus helps in flexing of the
interphalangeal and
metatarsophalangeal joints of the
lateral four digits.
-Innervation: Lateral plantar nerve.
Second layer :
Lumbricals :
-Origin: Originates from the tendons
of flexor digitorum longus.
-Insertion: Attaches partly to the
extensor expansion and partly into
the base of proximal phalanx of the
lateral four digits.
-Actions: Flexes at the
metatarsophalangeal joints, while
extending the interphalangeal joints
of the lateral four toes.
-Innervation: The most medial
lumbrical is innervated by the medial
plantar nerve. The remaining three
are innervated by the deep division
of lateral plantar nerve.
Second layer :
Tendon of flexor
digitorum longus :
The tendon splits into four
tendons for the lateral four toes.
The tendon receives the
insertion of the flexor digitorum
accessorius and its slips give
origin to the lumbrical muscles.
Each slip perforate the the
tendons of the flexor digitorum
brevis to reach its insertion into
the terminal phalanx.
Second layer :
Tendon of Flexor hallucis
longus :
This tendon passes forward
and medially and crosses
deep to the tendon of the
flexor digitorum longus to be
inserted into the base of the
terminal phalanx of the big
toe.
THIRD AND FOURTH
LAYERS OF THE FOOT
THE THIRD LAYER
1- FLEXOR HALLUCES BREVIS.
2-ADDUCTOR HALLUCIS.
3-FLEXOR DIGITI MINIMI BREVIS.
FLEXOR HALLUCIS BREVIS
*origin: Cuboid and lateral
cuniform.
*Insertion: Base of proximal
phalanx of the big toe.
*Nerve supply: medial planter
nerve.
*Action: Flexion.
FLEXOR DIGITI MINIMI BREVIS
*Origin: Base of 5 metatarsal
and cuboid bone.
*Insertion: Base of proximal
phalanx of the little toe.
*Nerve supply: Superficial
division of lateral planter
nerve.
*Action: Flexion.
ADDUCTOR HALLUCIS
*Origin:
a- Transverse Head: Planter ligaments of
metatarso phalangeal joint of lateral four
toes.
b- Oblique head: Base of 2 3 4
metatarsal bone.
*Insertion: Lateral side of the base of
proximal phalanx of the big toe.
Action:
a- Transverse Head: Maintain the
transverse arch of the foot.
b- Oblique Head: Adduction and Flexion
FOURTH LAYER
1- TENDON OF PERONEUS LONGUS.
2-TENDON OF TIBIALIS POSTERIOR.
3- PLANTER INTEROSSEI MUSCLE.
4- DORSAL INTEROSSI MUSCLE.
TENDON OF PERONEUS LONGUS
•it runs in a groove on the planter
surface of the cuboid bone.
•it is inserted into the base of
1
metatarsal bone and the adjoining part
of the medial cuneiform bone.
TENDON OF TIBIALIS POSTERIOR
•It divides into medial and lateral part.
•The medial part is inserted into the tuberosity of
navicular bone and medial cuneiform bone.
•The lateral part is inserted into the other
metatarsal bone except the talus and to the
bases of 2 3 4 metatarsal bones.
PLANTER INTEROSSEI (PAD)
• ORIGIN: Lateral 3 metatarsal bones.
• INSERTION: The base of proximal phalanx and extensor expansion.
• ACTION: They adduct the lateral toes.
• they extend the interphalangeal joint and flex the metatarsophalangeal joint.
• NERVE SUPPLY: the first and second muscles are supplied by deep
division of lateral planter nerve.
• the third muscle is supplied by the superficial division of lateral planter
nerve.
DORSAL INTEROSSEI (DAB)
• ORIGIN: Adjoining sides of two metatarsal bones.
• INSERTION: Base of proximal phalanx and extensor expansion.
• ACTION: They abduct the 2 3 4 toes.
• They extend the interphalangeal joint and flex the metatarsophalangeal joint.
• NERVE SUPPLY:The first three muscle are supplied by deep
division of lateral planter nerve.
• The fourth muscle is supplied by superficial division of lateral
planter nerve.
PLANTER APONEUROSIS
PLANTER APONEUROSIS
•It is a dense sheet of fibrous tissue.
•Posteriorly, it is attached to medial and lateral
tubercles of the calcaneus.
•Anteriorly, it divides into five slips.
•Tow intermuscular septa pass from the edges of the
aponeurosis.
•The lumbrical muscles, planter digital arteries and
nerve can be seen between the slips of the
planter aponeurosis.
•It protects the underlying vessels and nerves.
•It maintains the longitudinal arch.
the bones
of the foot
tarsus
metatarsals
phalanges
The muscles of the dorsum of the foot:
*Extensor digitorum brevis:
_has 4 tendons inserted into
the medial 4 toes.
*The medial slip passes to
the proximal phalanx of the
big toe and known as
(Extensor hallucis brevis)
*The lateral 3 slips join the
extensor expansions of the
corresponding toes.
Dorsal interossei:
_inerted
*partly into the base of the proximal phalanx.
*partly into the extensor expansion.
_ The action:
*Abduction of the 2nd, 3rd and 4th toes.
*Extension of the interphalangeal joints
*Flexion of the metatarso-phalangeal joints.
Synovial sheaths
obejectives
Definition
Function
Injury
Types
Definition
A synovial sheath is one of the two membranes of
a tendon sheath which covers a tendon. The other
membrane is the outer fibrous tendon sheath
Function
it surround the tendons of muscles to facilitate
their movements during action of these muscles
and prevent their friction with surrounding
structures.
Sheaths of extensor tendons:1-(tibialis anterior) --->
the sheath extends from the
upper border of superior
extensor retinaculum to the
insertion
2- (extensor hallicus longus):the sheath extends from the lower
border of superior extensor
retinaculum to the base of big toe
3- extensor digitorum longus &
peroneus tertius) --->
the sheath extends from the lower
border of (superior extensor
retinaculum) to the middle of the
dorsum of the foot
Synovial sheaths of peroneal
tendons:
- A single sheath surrounds the tendons
of (peroneus longus and brevis.)
-It begins alittle above the lateral
malleolus
-It passes with the tendons under cover of
the (superior peroneal retinaculum).
-then it divides into two sheaths, one for
each tendon which passes separately
under the( inferior peroneal retinaculum)
and runs to the insertion
Synovial sheaths of flexor
tendons:1- (tibialis posterior)---> the sheath
begins one inch above the flexor
retinaculum and ends at the navicular
bone
2- (flexor digitorum longus) --->
the sheath begins one inch above the
flexor retinaculum and ends about
the middle of the foot
3- (flexor hallicus longus)--->
the sheath begins one inch above
the flexor retinaculum and ends at
the insertion of the tendon
Arches of the Foot

The bones of the foot are arranged in such a way
to form two longitudinal arches and one transverse
arch.

The arches of the foot are the bony part that
don’t come in contact with the ground during
standing.

Falling of these arches lead to Flat foot
Functions :
•
a spring.
•
distribution.
•
protection.
•
Shock absorbtion.
The medial longitudinal arch:

Posterior pillar: calcaneous

Top: talus

Anterior pillar: navicular, 3cunifoerm bone, med 3
metatarsals.

Factors keeping the medial longitudinal arch:

Ligament: Medial part of planer aponeurosis,Spring
lig,deltoid lig,long and short planter ligament.

Muscles: Tibialis pos,tibialis ant,flexor halllucis longus
,flexor digitorm longus ,short muscles of the sole

Bony factor: the shape and conistitution of the bone
keep the foot in the arching position
The lateral longitudinal arch:

Posterior pillar: calcaneous

Top: cuboid at the high point

Anterior pillar: Lateral two metatarsal

Factors keeping the lateral longitudinal arch:

Ligament: lateral part of planter aponeurosis, long and
short planter ligament.

Muscles: peroneous longus, flexor digitorm longus and
short muscles of the little toe.

Bony factors: the shape and conistitution of the bone
keep the foot in the arching position.
The transverse arch:

It is formed by: Bases of the metatarsal
bones, cuboid and the three cuniforms
(incomplete arch).

Factors keeping the transverse arch:

Bony Factor: Intermediate and lateral
cuniforms are wedge-shaped.

Ligament: Deep transverse lig. and
interosseous ligs.

Muscles: peroneus longus, tranverse
head of adductor halluces ,slips of
tibialis posterior.
Anomalies of the foot
Flat foot (pes planus): Rotation of the calcaneous
,eversion of the plantar surface, slipping down of the talus
and navicular, lengthening of the medial longitudinal arch
and abduction of the forefoot.
Talipes equinovarus: plantar flexion,inversion and
adduction o the forefoot.
Talipes calcaneovulgus: Dorsiflexion, eversion and
abduction.