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Extensor Digitorum Brevis
- Proximal Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
- Distal Attachment: Long extensor tendons of medial four digits (2-4)
- Innervation: Deep peroneal n. (L5, S1)
- Main Actions: Extends four medial toes at MTP and IP joints
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Flexor Digitorum Brevis
- Proximal Attachment: Medial tubercle of tuberosity of calcaneus; plantar aponeurosis; intermuscular septa
- Distal Attachment: Both sides of middle phalanges of lateral four digits
- Innervation: Medial plantar n. (S2, S3)
- Main Actions: Flexes lateral four digits
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Abductor Hallucis
- Prxomial Attachment: Medial tubercle of of tuberosity of calcaneus; flexor retinaculum; plantar aponeurosis
- Distal Attachment: Medial side of base of proximal phalanx of first digit
- Innervation: Medial plantar nerve (S2, S3)
- Main Actions: ABducts and flexes first digit (great toe/hallux)
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Abductor Digiti Minimi
- Proximal Attachment: Medial and lateral tubercles of the calcaneus; plantar aponeurosis; intermuscular septa
- Distal Attachment: Lateral side of base of proximal phalanx of 5th digit
- Innervation: Lateral plantar nerve (S2, S3)
- Main Actions: ABducts and flexes little toe (5th digit)
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Quadratus Plantae
- Proximal Attachment: Medial surface and lateral margin of plantar surface of calcaneus
- Distal Attachment: Posterolateral margin of tendons of flexor digitorum longus
- Innervation: Lateral plantar nerve (S2, S3)
- Main Actions: Assists flexor digitorum longus in flexing lateral four digits by redirecting the force
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Lumbricals
- Proximal Attachment: Tendons of flexor digitorum longus
- Distal Attachment: Medial aspect of expansion over lateral four digits
- Innervation: Medial one: medial plantar nerve (S2, S3); Lateral three: lateral plantar nerve (S2, S3)
- Main Actions: Flex proximal phalanges, extend middle and distal phalanges of lateral four digits (flexion of MTP, extension of IPs)
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Flexor Hallucis Brevis
- Proximal Attachment: Plantar surface of cuboid and lateral cuneiforms
- Distal Attachment: Both sides of base of proximal phalanx of 1st digit; tendons contain sesamoid bones
- Innervation: Medial plantar nerve (S2, S3)
- Main Actions: Flexes proximal phalanx of 1st digit
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Adductor Hallucis
- Proximal Attachment: Obliqe head: bases of metatarsals 2-4; Transverse head: Plantar ligaments of metatarsalphalangeal (MTP) joints
- Distal Attachment: Tendons of both heads attach to lateral side of base of proximal phalanx of 1st digit
- Innervation: Deep branch of lateral plantar nerve (S2, S3)
- Main Actions: ADducts 1st digit; assists in transverse arch of foot by metatarsals medially
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Flexor Digiti Minimi
- Proximal Attachment: Base of 5th metatarsal
- Distal Attchment: Base of proximal phalanx of 5th digit
- Innervation: Superfcial branch of lateral plantar nerve (S2, S3)
- Main Actions: Flexes proximal phalanx of 5th digit, thereby assisting with its flexion
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Plantar interossei muscles (three muscles)
- Proximal Attachment: Bases and medial sides of metatarsals 3-5
- Distal Attachment: Medial sides of bases of phalanges of 3rd-5th digits
- Innervation: Lateral plantar nerve (S2, S3)
- Main Actions: ADducts digits 2-4 and flex metatarsophalangeal joints; PAD (Plantar ADduct)
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Dorsal interossei muscles (four muscles)
- Proximal Attachment: Adjacent sides of metatarsals 1-5
- Distal Attachment: 1st: medial side of proximal phalanx of 2nd digit; 2nd-4th: lateral sides of 2nd-4th digits
- Innervation: Lateral plantar nerve (S2, S3)
- Main Actions: ABduct digits 2-4 and flex metatarsophalangeal joints; DAB (Dorsal ABduct)
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Muscles of 1st layer of foot
- Abductor hallucis
- Abductor digiti minimi
- Flexor digitorum brevis
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Muscles of 2nd layer of foot
- Quadratus plantae
- Lumbricals
- Long flexor tendons
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Muscles of 3rd layer of foot
- Adductor hallucis
- Flexor Hallucis brevis
- Flexor digiti minimi brevis
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Muscles of the 4th layer of foot
- Plantar interosseous
- Dosral interosseous
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Medial Plantar Nerve
- Origin: Tibial n.
- Roots:
- Supplies: Skin of medial plantar surface of foot and medial 3.5 digits; 3.25 muscles of plantar surface (Flexor hallucis brevis; ABductor hallucis, Flexor digitorum brevis; medial lumbrical)
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Medial Calcaneal Branch (n.)
- Origin: Tibial n.
- Roots:
- Supplies: Skin of medial 3/4 of plantar and posterior surfaces of calcaneus
- Lies superficial to plantar aponeurosis; senses inflammation associated with plantar fasciatis
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Lateral Plantar Nerve
- Origin: Tibial n.
- Roots:
- Supplies: Skin of lateral plantar surface of foot and lateral 1.5 toes; 6.75 muscles of plantar surface
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Talocrural Joint
- a.k.a. Mortise joint
- between tibia and talus
- hinge joint
- plantarflexion and dorsiflexion
- most closed-pack and congruent in dorsiflexion
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Lateral Collateral Ligaments
- Anterior Talofibular (ATFL)
- Posterior Talofibular (PTFL)
- Calcaneofibular (CFL)
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Anterior Talofibular Ligament
- ATFL
- Lateral malleolus to neck of talus near tarsal sinus
- Prevents: Inversion in plantarflexion
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Posterior Talofibular Ligament
- PTFL
- Malleolar fossa to lateral tubercle of talus
- Prevents: Inversion in dorsiflexion
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Calcaneofibular Ligament
- CFL
- Lateral malleolus to lateral surface of calcaneus
- Prevents: Inversion in neutral
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Medial Collateral Ligaments (Deltoid Ligament)
- Superficial: Posterior tibiotalar (PTT); Tibiocalcaneal (TC); Tibionavicular (TN)
- Deep: Anterior tibiotalar (ATT)
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Posterior Tibiotalar Ligament
- PTT
- Posterior medial malleolus to posterior talus
- Prevents: Eversion in dorsiflexion
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Tibiocalcaneal Ligament
- TC
- Medial malleolus to sustentaculum tali
- Prevents: Eversion in neutral
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Tibionavicular Ligament
- TN
- Medial malleolus to navicular superior to tuberosity
- Prevents: Eversion in plantarflexion
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Anterior Tibiotalar Ligament
- ATT
- Medial malleolus to anterior talus
- Prevents: Eversion in plantarflexion
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Subtalar Joint
- 3 articulations: convex anterior and medial; concave posterior
- Allows leg to rotate independently of foot
- Suppported by: 4 talocalcaneal ligaments (lateral, medial [btwn sustentaculum tali and tubercles of talus], posterior, interosseus [in tarsal sinus]; cervical ligament (in tarsal sinus); CFL; tibiocalcaneal
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Long Plantar Ligament
- Planter surface of calcaneus to cuboid and bases of MTs 2-4
- Supports lateral longitudinal arch
- Acts as retinaculum for peroneus longus tendon
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Short Plantar Ligament
- "Plantar calcaneocuboid ligament"
- Anterior inferior surface of calcaneus to inferior cuboid
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Plantar Calcaneonavicular Ligament
- "Spring ligament"
- Calcaneus and sustantaculum tali to navicular tuberosity and underside of navicular
- Supports medial longitudinal arch
- Absorbs and redistributes force during walking to give "spring" in step
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Plantar Aponeurosis
- Thickening of plantar fascia in center of plantar surface
- Calcaneus to base of proximal phalynx
- Functions: supports/reinforces arches, protects deeper foot muscles, Windlass mechanism
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Medial Longitudinal Arch
- Calcaneus to heads of MTs 1 and 2 (sesamoid bones)
- Keystone: Navicular-talar joint; talus
- Measure height by measuring how high navicular is
- Supports and distributes weight of tibia on talus
- Supported by the spring ligament, tibialis anterior, and peroneus longus
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Lateral Longitudinal Arch
- Calcaneus to heads of MTs 4 and 5
- Keystone: Cuboid
- Supported by long and short plantar ligaments; peroneus longus, brevis, and tertius
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Transverse Arch
- Across foot between cuneiforms and cuboid
- Pillars are longitubdinal arches
- Keystone: Intermediate cuneiform
- Held together by dynamic forces of peroneus longus tibialis posterior
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Medial calcanel branch of posterior tibial a.
Lies superficial to the plantar aponeurosis
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Dorsalis Pedis a.
- Origin: Anterior tibial a.
- Runs: down medial aspect of dorsum of foot
- Branchs: Lateral tarsal artery which bends around into the arcuate artery
- Arcuate artery is connected to plantar arch by perforating branches
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Medial and Lateral Plantar aa.
- Orgin: Posterior tibial a.
- Join to create plantar arch
- Connected to ascuate artery via perforating branches
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Open-chain Pronation
Calcaneus: everts, ABducts, dorsiflexes
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Open-chain Supination
Calcaneus: inverts, ADducts, plantarflexes
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Closed-chain Pronation
- Calcaneus: everts
- Talus: ADducts, plantarflexes
- Tibia: IR
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Closed-chain Supination
- Calcaneus: inverts
- Talus: ABducts and dorsiflexes
- Tibia: ER
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