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How many tarsal bone are there? Name the tarsal bones! 
- 7 Tarsal Bones:
- Starting distal, calcaneus, talus, navicular, cuboid, and 3 cuneiform bones (medial, intermediate, lateral)
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How many metatarsals do you have?
5 Duh
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How many phalanges does your hallux have?
only 2, a proximal and distal phalange
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Describe a calcaneal fracture
- -Typically caused by a fall to the heel
- -can be comminuted (in several pieces)
- -disabling because it disrupts the subtalar joint
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Dancer's Fracture
-caused by pointe technique, loss of blance and full body wt on metatarsal (causes different type of fractures associated with the 5th metatarsal)
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Fatigue Fractures
Caused by prolonged walking, repeated stress (fractures in the metatarsals)
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Describe avulsion fractures of the 5th metatarsal tuberosity
Caused by sudden and violent inversion, the fibularis brevis tendon can be avulsed also
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What fractures are possible in the metatarsals?
- -Hallux (1st phalange)- comminuted fracture
- -Displaced oblique fracture of 2nd phalange
- -Spiral fracture of 3rd phalange
- -Transverse displaced fracture of 4th phalange
- -Transverse non-displaced fracture of 5th metatarsal
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Abductor hallucis origin/insertion, action, innervation
- Origin: Calcaneus and plantar aponeurosis
- Insertion: Proximal phalanx of 1st digit (the hallux!)
- Action: Abducts and flexes the 1st digit--look at the name!
- Innervated by: Medial plantar n
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Flexor digitorum brevis origin/insertion, innervation, action?
- Origin: Calcaneus and plantar aponeurosis
- Insertion: Middle phalanx of lateral 4 digits
- Action: Flexes lateral 4 digits
- Innervated by: Medial plantar n (just like abductor hallucis)
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Abductor digiti minimi
- Origin: Calcaneus and plantar aponeurosis
- Insertion: Proximal phalanx of 5th digit
- Action: Abducts and flexes the 5th digit
- Innervated by: Lateral plantar n
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Quadratus plantae
- Origin: Calcaneus
- Insertion: Lateral margin of FDL tendon
- Action: Assists FDL in flexing the lateral 4 digits
- Innervated by: Lateral plantar n
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Plantar blood supply is provided by what artery?
- Posterior Tibial Artery!
- Gives rise to: Medial (the smaller muscles, muscles of big toe) & Lateral Plantar Arteries (larger)
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The deep plantar arch arises from what? and gives rise to what?
- Arises from: Medial, Lateral and Deep plantar arteries
- Gives off: 4 plantar metatarsal arteries , 3 perforating arteries, Digital arteries
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Dorsum Musculature of your foot consists of what 2 muscles? (muscles on top of your foot)
- Extensor digitorum brevis (extends the toes of II, III, IV) & Extensor hallucis brevis (extends the BIG toe)
- Both innerv. by Deep fibular N.
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What artery supplies blood to the dorsum of your foot?
- Terminal branches of the Anterior Tibial A. supplies
- -Dorsalis pedis (dorsal artery of the foot)
- -Lateral Tarsal artery
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The Lateral Tarsal Artery unites to form what?
- the Arcuate Artery (an arch) and it gives metatarsal arteries and dorsal digital arteries.
- also forms of the 1st Dorsal Metatarsal Artery (only properly named artery)
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Clinical: An absent Dorsalis Pedis exhibits what signs?
- The 5 "P SIGNS"-pain, pallor, paresthesia (pins and needles), paralysis, pulselessness.
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What is the function of the Plantar Fascia (plantar aponeurosis) think of your hand!
Plantar aponeurosis holds the parts of the foot together, protects the plantar surface from injury and supports longitudinal arches
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The plantar fascia arises from what and divides into?
Arises from the calcaneus, divides into 5 bands (comon 5 digits!) attaches to fibrous digital sheaths
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Vertical septa of the plantar aponeurosis that divides the foot into what?
3 vertical septa divide the foot into 3 compartments, medial, central and later plantar fascia
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Clinical: Pain on the plantar aspect of the heel and medial aspect of the foot is what? Pain is worse in the AM.
- Plantar fasciitis "flip flop disease"
- -Pt presents with the most pain in the AM
- -Indicates the Pt needs to change their tennis shoes due to a lack of support of the arches
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Clinical: Bursa or Bursitis on the medial side of the calcaneus idicates what condition?
- "Heel Spur" syndrome, a calcaneal spur on the medial side of the calcaneus
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What is the function of the plantar musculature?
- 4 layers of muscles that function to help maintain the arches of the foot and stand on even ground.
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The lumbricals of your foot:
- Part of your Second Layer of your foot!
- The BYE BYE muscles of your foot
- Origin
: tendons of FDL - Insert: Extensor expansions of lat. 4 digits
- Innerv: medial: Medial plantar N. lateral 3: Lateral plantar n.
- Action: Flex proximal phalanges, extend middle and distal phalanges of lateral 4 digits
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Flexor hallucis brevis
- Part of the second layer of your plantar muscles!
- Origin: Plantar surfaces of cuboid and lat. cuneiform
- Insert: Both sides of proximal phalanx of 1st digit
- Innerv: Medial plantar n.
- Action: flexes the proximal phalanx of 1st digit
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Adductor hallucis
- Part of the third layer of your plantar muscles!
- Origin: oblique: bases of 2-4 MT
- Transverse: plantar MTP ligaments
- Insert: proximal phalanx of 1st digit
- Innerv: Deep branch of Lateral plantar n.
- Action
: Adducts 1st digit
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Flexor digiti minimi brevis
- Part of the third layer of your plantar muscles!
- Origin: Base of 5th MT
- Insert: Proximal phalanx of 5th digit (pink toe!)
- Innerv: Superficial branch of lateral plantar nerve
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Interossei (dorsal shown below)
t
- Deepest layer (4th layer) of plantar musculature!
- Just like in the hands:
- "PAD & DAB"
- 3 plantar interossei (adduct towards 2nd toe)
- 4 dorsal interossei (abduct)
- Also weakly flex MTP jts.
- Innerv: ALL by Lateral plantar nerve
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Nerves of the foot?
- -->Tibial Nerve divides into:
- Medial Plantar N. (4 muscles)
- Lateral Plantar N. (6 muscles)
- Intrinsic muscles of the foot
- -->Deep Fibular Nerve
- Supplies the extensor digitorum brevis m
- Cutaneous innervation is supplied by 7 nerves
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Cutaneous innervation of plantar surface of foot?
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Dermatomes and Cutaneous Innervation of Lower Limb
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Cutaneous Innerv of Lower Limb
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Clinical: Sharp pain radiating into the arch of the foot, heal and sometimes toes, paresthesia, what is this condition and what is it caused by?
- Tarsal tunnel syndrom (TTS) or "Jogger's Foot"Presents with tendonitis and could compress tibial nerve
- Caused by repetitive eversion of the foot, like during running
- Due to entrapment of the Medial Plantar Nerve
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What does the Plantar Reflex test?
- tests for "Babinski sign", indicates brain injury or cerebral diseaseTests: L4, L5, S1, S2
- **cannot do in infants: due to not fully developed corticospinal tracts
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A 25 yr old female came to you after medially spraining her ankle while running last week. She complains of tingling in the sole of her foot and has diminished movements of her big toe and medial 3.5 digits. What nerve has been injured?
- Medial Plantar Nerve
- Look at cutaneous innervation of plantar surface of foot if you're confused!
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Venous Drainage of your foot:
Dorsum: Dorsal digital v. → Dorsal metatarsal v. → Dorsal venous arch → plantar venous arch
Sole: Plantar venous network → Med. & Lat. Marginal v.
- **Medial Drainage: Great Saphenous V.
- **Lateral Drainage: Small Saphenous V.
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Medial venous drainage of your foot feed into what vein?
Great Saphenous V
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Lateral venous drainage of your foot feed into what vein?
Small Saphenous V
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Medial lymphatic Drainage of you foot (test question on this know this!)
- Follows the Great Saphenous Vein
- –Medial side of foot → follows Gr. Saphenous v. → Superficial inguinal l.n.
- (vertical group) → (Deep inguinal l.n.
- →) External iliac l.n.
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Lateral lymphatic Drainage of you foot (test question on this know this!)
- –Follows
- Small Saphenous vein
- Lateral
- side of foot → follows Small saphenous v. → Popliteal l.n. →
- Deep inguinal l.n. →
- External iliac l.n.
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Lymphangiography
Medical imaging technique used to visualize the lymphatics (lymph nodes, capillaries, tissues)
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