anatomy of feet
DESCRIPTION
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MOB TCD
Feet
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Foot
• Tarsal bones• Calcaneus• Talus• Navicular• Cuboid• Cuneiforms• Five metatarsals• Phalanges
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Tarsal Canal and Tarsal Sinus MOB TCD
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Inversion and Eversion
• Inversion is raising the medial border of the foot
• Sole of the foot looks medially • Close pack• Eversion is raising the lateral
border of the foot • Sole of the foot looks laterally• Least pack
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• Initiated at the transverse tarsal joint
• Calcaneocuboid• Anterior portion of the
talocalcaneonavicularLast, 1963
Inversion and Eversion MOB TCD
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• Main movement takes place at the clinical sub-talar joint i.e.• Talocalcaneal • Inferior portion of the
talocalcaneonavicular
• The pivot is the ligament of the neck of the talus
Inversion and Eversion MOB TCD
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Axis
• Upwards forwards and medially
• Middle of most convex posterior facet on superior surface of calcaneus
• Middle of most convex of the anterior head of talus
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Talocalcaneal Anatomical SubTalar Joint
• Synovial plane joint• Concave inferior aspect of
body of talus• Convex posterior facet on
superior surface of the calcaneus
• Articular surface is covered with hyaline cartilage
• Part of the clinical subtalar joint
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• Capsule attached just beyond the articular margins
• Synovial membrane lines capsule and non articular structures
• Interosseous ligament
Talocalcaneal Anatomical SubTalar Joint
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Subtalar Interosseosus
• Capsule of both talocalcaneal• Posterior portion of the
talocalcaneonavicular joint
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Talocalcaneonavicular Joint
• Synovial ball and socket joint
• Ball is anterior and inferior aspect of the head of the talus
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• Socket• Two anterior facets on the
superior surface of the calcaneus
• Posterior aspect of the navicular
• Spring ligament • Medial limb of birfurcate
i.e. lateral calcaneonavicular (LCN)
Talocalcaneonavicular Joint MOB TCD
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• Capsule attached just beyond the articular margin
• Interosseous ligament post• Medial are the• Spring ligament and
superficial portion deltoid ligament
• Lateral are the lateral calcaneo navicular ligament of bifurcate
• Ligament neck of talus
Talocalcaneonavicular Joint MOB TCD
Plantar Calcaneonavicular Ligament
• Plantar calcaneonavicular or spring ligament is attached to
• Sustentaculum tali• Tuberosity of navicular
• Covered by articular cartilage
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Ligaments of Sub-Talar Joint
• Inferior extensor retinaculum• Ligament of the neck of talus• Interosseous ligament• Bifurcate ligament
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Ligament of Neck of Talus
• Sinus tarsi to• Lateral aspect of neck of
talus• Pivot of inversion and
eversionLast,1963
*
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Inferior Extensor Retinaculum
• Medial root inside the tarsal sinus
• Intermediate to talus with the interosseous ligament, inside sinus
• Lateral root to calcaneus outside sinus
Klein & Spreitzer, 1993
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Tarsal Canal and Tarsal Sinus
• Fat• Nerve endings• Branches of posterior
tibial and peroneal arteries
• Capsules and ligaments of talocalcaneal and talocalcaneonavicular joints
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Ligament Attachments MOB TCD
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Bifurcate Ligament
• Lateral calcaneonavicular ligament (CNL) is medial limb
• Medial calcaneocuboid ligament (CCL) is lateral limb
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• Two individual ligaments• Separate attachments• Different fiber orientation• Different histologySmith, 2001
Bifurcate Ligament MOB TCD
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Lateral Calcaneonavicular Ligament
• Folded and twisted appearance• Prominent medial and lateral
edges/folds• Three groups of fibres
• Medial• Lateral (deep)• Intra-articular
Smith 2001
N
A
C
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• Intra-capsular CC joint• Smaller than CNL, always
present• Hourglass shaped fibres,
twisted mediallySmith 2001
Medial Calcaneo Cuboid Ligament MOB TCD
Talocalcaneonavicular Joint
• Synovial membrane lines the capsule and non-articular structures nerve supply
• Tibial nerve• Deep and superficial
peroneal nerves
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• Invertors• In dorsi-flexion• Tibialis anterior• In plantar-flexion• Tibialis posterior
Talocalcaneonavicular Joint MOB TCD
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• Evertors• In dorsi-flexion• Peroneus tertius • In plantar-flexion• Peroneus longus• Peroneus brevis
Talocalcaneonavicular Joint MOB TCD
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Calcaneo Cuboid Joint
• Plane synovial• Ligaments• Capsular• Ligament of neck of
talus• Long and short plantar
ligament• Bifurcate ligament
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• The long plantar ligament• Short plantar ligament• Support the calcaneo cuboid
portion of the transverse tarsal joint
Calcaneo Cuboid Joint MOB TCD
Long Plantar Ligament
• Long plantar is attached to• Medial, lateral and anterior
tubercles of calcaneus• Either side of the groove on the
cuboid• Base of middle three • Metatarsals
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Short Plantar Ligament
• Short plantar • Broader and wider and deep to
long plantar• Anterior to anterior tubercle of
calcaneus• Posterior to posterior ridge on
cuboid
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Inferior Surface MOB TCD
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Cutaneous Supply of Sole MOB TCD
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Sole of Foot
• Skin• Plantar aponeurosis• Attached to• Medial and lateral tubercles of
calcaneus• Five slips • Divide into two• Fuse deep transverse ligament of sole • Abduction and adduction from a line
drawn through the middle of second toe
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First Layer of Sole
• Abductor hallucis• Medial plantar nerve• Flexor digitorum brevis• Medial plantar nerve• Abductor digiti minimi• Lateral plantar nerve
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• Long flexor tendons• Tibial nerve• Flexor hallucis longus• Tibial nerve• Flexor digitorum longus• Tibial nerve• Four lumbricals• Unipennate medial plantar nerve• Bipennate lateral plantar nerve• Flexor accessorius• Lateral plantar nerve
Second Layer of Sole MOB TCD
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• Flexor hallucis brevis• Medial plantar nerve• Adductor hallucis• Flexor digiti minimi • Lateral plantar nerve• Vessels run between
1st and 2nd layer3rd and 4th layers
Third Layer of Sole MOB TCD
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• Tendons • Tibialis posterior• Tibial nerve• Peroneus longus• Superficial peroneal nerve• Dorsal interossei• Lateral plantar nerve
Fourth Layer of Sole MOB TCD
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Seasmoid Bones
• Larger medial in• Abductor hallucis and
medial half of flexor hallucis brevis
• Smaller lateral in• Adductor hallucis and • Lateral half of flexor
hallucis brevis
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Foot
• If sesamoid bones are bipartite
• It is always bilateral• If fracture single• Take off point of walking
is hallux • Flexor hallucis longus• Tibial nerve
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Joints of Foot
• Mid-tarsal compound synovial• Metatarso-phalangeal joint• Synovial condylar joint• Deep transverse ligament of sole• Interphangeal joints• Synovial hinge
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Second Metatarsal
• Second metatarsal is the most fixed
• Thinnest • Longest • Stress fractures
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Longitudinal Arches MOB TCD
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Longitudinal• Medial• Lateral
Transverse • Tarsal• Metatarsal heads
Arches MOB TCD
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Posterior pillar• Calcaneus
Keystone• Talus• Navicular, medial,
intermediate and lateral cuneiforms
Anterior pillars• Heads of medial three
metatarsals
Medial Longitudinal Arches MOB TCD
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• Tie beam• Plantar aponeurosis
Medial Longitudinal Arches MOB TCD
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• Spring ligament• Deltoid ligament• Tibialis anterior• Deep peroneal nerve• Tibialis posterior• Flexor hallucis longus• Tibial nerve
Medial Longitudinal Arches MOB TCD
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• Tibialis anterior• Tibialis posterior• Flexor hallucis longus• Flexor medial longus
(medial 3)• Short flexor muscles
Medial Longitudinal Arches MOB TCD
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Supports of Arches MOB TCD
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Posterior pillar• Calcaneus
Anterior pillars• Heads of lateral two metatarsals
Keystone• Cuboid
Lateral Longitudinal Arches MOB TCD
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Tie beam• Plantar aponeurosis
Lateral Longitudinal Arches MOB TCD
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• Peroneus longus• Peroneus brevis• Short flexor muscles on lateral aspect• Long and short plantar ligaments
Supports of Lateral Arches MOB TCD
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Supports of Lateral Arches MOB TCD
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Transverse Arch MOB TCD
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• Medial pillar• Head of first metatarsal • Lateral pillar• Deep transverse
ligament of sole• Transverse head of
adductor hallucis
Transverse Arch MOB TCD
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• Depressed arch• Head of the third
metatarsal compresses the lateral branch of medial digital nerve
• Morton’s metatarsalgia • Pain increased by tight
shoes, relieved by taking shoes off
Transverse Arch MOB TCD
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Morton’s Metatarsalgia MOB TCD
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Second Metatarsal
• Second metatarsal is the most fixed
• Thinnest • Longest • Stress fractures• Can effect any other bone
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Foot Problems MOB TCD
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Nerve Supply of the Foot
• Medial calcaneal nerve• Medial plantar nerve• Three and half toes• Lateral plantar nerves• One and half toes
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Nerve Supply of Dorsum
• Superficial peroneal nerve• Deep peroneal nerve, first
cleft• Saphenous nerve, medial
border to base of big toe• Sural nerve, lateral border
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Nerve Supply MOB TCD
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Feet
• Pronated or flat foot• Increase knee and back pain• Medial tibial syndrome• Cuboid syndrome• Pes cavus rigid foot• Achilles tendonosis
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Pronated Foot MOB TCD
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Foot Prints MOB TCD
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Pes Cavus MOB TCD
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Foot Problems MOB TCD
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Foot Problems MOB TCD
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Foot Problems MOB TCD
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Foot Problems
Server’s
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Netter
Heel Pain MOB TCD
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Heel Pain
Netter
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