The lower limb courses
Lec15. . . Sole of foot
Cutaneous innervation
1) medial plantar nerve
• Gives one proper and three common digital nerve .
• supplies the skin over the medial two thirds of the sole and 3 + 1/2 medial
toe .
2) lateral plantar nerve
• Gives one common and one proper digital nerves .
• supply the skin over the lateral one third of the sole of foot
and 1+1/2 lateral toe .
3) sural nerve supply the skin laterally while the saphenous nerve supply
the skin medially .
4) medial calcaneal branch of tibial nerve
• supply the skin of the heel .
Deep fascia of sole of foot
• Consists of three part central , medial and lateral part .
• the central part very thick ( plantar aponeurosis )
• The medio and lateral part are thin is called ( medial and lateral
plantar fascia )
The Plantar aponeurosis
• Is a 3angle thichening of the deep fascia of the sole of foot loceted centrally.
• Apex of plantar aponeurosis attached to the medial process of calcaneal
tuberosity .
• Slips are connected to each other by superficial transverse
metatarsal ligament at the level of metatarsal head .
Note / In the midfoot and forefoot , vertical intermuscualr septa extend
superiorly from the margin of the PAsis. Toward 1st and 5st metatarsal to
formation three compartment ( medial , central , lateral ) of sole of the foot .
• foruth compartment located only in the forefoot ( interosseous
compartment )
• Fifth compartment located above to 4st compartment is called ( dorsal
compartment ) lies between dorsal fascia and dorsal interosseous muscle . It
contains muscle ( EHB and EDB )
Interosseous compartment
Dorsal compartment
Medial compartmet
Lateral compartment Central compartment
Calcaneal spur
Muscles of the sole of the foot
• Five layer ( Ten muscle )
• 4 muscle innervate by medial plantar nerve .
• 6 muscle innervate by lateral plantar nerve .
Muscle of first layer
1) abductor hallucis
• Origin : medial process of calcaneal tuberosity and plantar
aponeurosis
• Insertion : medial side of base of proximal phalanx of 1st big toe .
• Nerve supply by medial plantar nerve S2 S3.
• abducts and flexes 1st digit at MP joint ( metatarsophalangeal joint )
2) Flexor digitorum brevis
• origin : medial process of calcaneal tuberosity and plantar aponeurosis .
• insertion : both side of middle phalanges and of lateral 4 toe .
• nerve supply by medial plantar nerve ( S2 S3 )
• Flexes lateral 4toe at proximal IPJ .
3) abductor digiti minimi
• origin : medial and lateral process of calcaneal tuberosity and plantar
aponeurosis.
• insertion : lateral side of base of proximal phalanx of 5st toe .
• Nerve supply by lateral plantar nerve S2 S3
• Abducts the little toe at MPJ
Muscle of second layer
1) Quadratus plantae
• Origin : medial surface of calcaneus and lateral process of calcaneal
tuberosity .
• Insertion : posterolateral margin of tendon of FDL .
• nerve supply by lateral plantar nerve S2 S3 .
• Assists FDL ( to flexes lateral four digits )
2) lumbricals
• Origin : First lumbrical ( medial side of tendon FDL ) while second ,
Third and fourth lumbricals ( adjacent surface of tendon FDL )
• insertion : medial aspect of expansion over lateral 4 digits .
• Nerve supply : medial one ( Medial plantar nerve ) while the lateral
three ( lateral plantar nerve )
• Flexion of MTPJ .
• Extenstion of IPJ.
Note / The first lumbricale is unipennate .
Muscle of third layer
1) Flexor hallucis brevis
• Origin : lateral head taking origin from plantar surface of cuboid and lateral
cuneiform while the medial head taking origin from tibialis posterior
tendon .
• insertion : both side of base of proximal phalanx of firat digits .
• Nerve supply by medial plantar nerve S2 S3
• Flexes MTPJ .
2) Adductor hallucis
• Origin : oblique head ( base of metatarsal 2 , 3 and 4 ) while the transverse
head ( plantar ligament of MTP joint 3 , 4 and 5 )
• insertion : lateral side of the base of proximal phalanx of 1st toe
• nerve supply by deep branch of lateral plantar nerve S2 S3
• Adducts MTPJ .
3) Flexor digit minimi brevis
• Origin : base of 5th metatarsal .
• insertion : base of proximal phalanx of 5th digiti
• nerve supply by superficial branch of lateral plantar nerve S2 S3
• Flexes little toe at MTPJ .
Muscle of fourth layer
Plantar interossei ( three muscle )
• Origin : medial side of metatarsal 3, 4 and 5
• Insertion : dorsal expansion base of proximal phalanges of toe 3, 4 and 5
• nerve supply by lateral plantar nerve S2 S3
• Adduction of toe III to V at MPJ and flexion on the MPJ .
Dorsal interossei
• Origin : adjacent side of metatarsal 1-5
• insertion : dorsal expantion 2-4
• nerve supply by lateral plantar nerve .
• abduction of toe II , III and IV at MPJ and flextion at MPJ .
5 layer ( Tendon of peroneus longus and tibialis posterior )
Artery of sole of foot
• Is derived from the posterior tibial artery which divides deep to the FR
midway between the medial malleolus and heel into medial and lateral
plantar artery ( this artery accompany the similarly named nerves )
• The medial and lateral plantar artery passes deep to the
abdustor hallucis .
Medial plantar artery
• Smaller terminal branch of the posterior tibial artery .
• it passes forward in groove between Abductor hallucis and FDB
• it ends by joining with digital branch of the deep plantar arch
( which supply the medial side of the great toe )
Lateral plantar artery
• anterolateral direction into sole of the foot .
• deep to the proximal end of the abductor hallucis muscle and then
between quadratus plantae and FDB muscle .
• it reaches the base of metatarsal V where it lies in the groove between FDB
and Abductor digiti minimi muscle from here the lateral plantar artery curves
medially to form the deep plantar arch which is completed by joining the
deep plantar artery ( branch of dorsalis pedis artery )
Deep plantar arch
• circulatory anastomosis formed by lateral plantar artery and
deep plantar branch ( dorsalis pedis artery )
• supply the sole of foot .
Branches
1) four plantar metatarsal artery
• to the 4 clefts divides into plantar digital artery .
2) three perforating artery
• acsends superior to anastomosis with arcuate artery of
dorsalis pedis artery .
3) digital branch
• to the lateral side of little toe
4) digital branch
• that join with medial plantar artery to supply the medial side of big toe .
Nerve supply
• the tibial nerve enters the foot through the tarsal tunnel posterior to
medial malleolus .
• in the tunnel , the nerve is lateral to the posterior tibial artery and gives
medial calcaneal branch , which penetrate the FR to supply skin over the
heel.
• midway between medial malleolus and heel the tibial nerve gives
- Large ( medial plantar nerve )
- Smaller ( lateral plantar nerve )
• The medial and lateral plantar nerve lie together between
corresponding artery .
ھﻮ اﻟﻜﺒﯿﺮLateral ھﻮ اﻟﺼﻐﯿﺮ ﺑﯿﻨﻤﺎ اﻟـmedialاﻻرﺗﺮي ﺑﺎﻟﻌﻜﺲ اﻟـ
Medial plantar nerve
• Larger terminal branch of the tibial nerve .
• runs with medial plantar artery between abductor hallucis and FDB .
Muscular branch
- abductor hallucis
- Flexor digitorum brevis
- flexor hallucis brevis
- 1st lumbrical
Cutaneous innervation
• 3 common and 1 propor .
• supply the skin over the medial two thirds of sole and medial 3+1/2 toe .
• 3+1/2 medial nail beds of their phalanges .
Artivular branch
Lateral plantar nerve
• it is the smaller terminal branch of the tibial nerve .
• begins deep to the FR , appears in the sole deep to the abductor
hallucis .
• it tuns forward and lateraly to the base of the 5st metatarsal accompanying
to the lateral plantar artery .
• On reaching between flexor digitorum brevis and abductor
digiti minimi it divides two branch . Superficial and deep .
Superfcial branch
• Flexor digiti minimi brevis
• 3st plantar inerosseous .
• 4st dorsal inerosseus .
Deep branch
• abductor digiti minimi
• lumbricals excepts first
• quadratus plantae
• adductor hallucis
• plantar interossei excepts 3st
• dorsal inerossi excepts 4th
