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FOOT/TOES ANATOMYFOOT/TOES ANATOMY

KIN 191AKIN 191AAdvanced Assessment of Advanced Assessment of Lower Extremity InjuriesLower Extremity Injuries

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INTRODUCTIONINTRODUCTION

ANATOMYANATOMY BONY STRUCTURESBONY STRUCTURES ARTICULATIONSARTICULATIONS MUSCULATURE MUSCULATURE ARCHES OF THE FOOTARCHES OF THE FOOT NEUROANATOMYNEUROANATOMY ARTERIES AND BURSAARTERIES AND BURSA

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BONY STRUCTURESBONY STRUCTURES 26 bones + 2 sesamoids26 bones + 2 sesamoids Three sectionsThree sections

Rearfoot (hindfoot)Rearfoot (hindfoot)• CalcaneusCalcaneus• TalusTalus

MidfootMidfoot• NavicularNavicular• CuboidCuboid• 3 Cuneiforms3 Cuneiforms

ForefootForefoot• 5 Metatarsals5 Metatarsals• 14 Phalanges14 Phalanges

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7 Tarsals (Rear+Mid Foot)7 Tarsals (Rear+Mid Foot) CalcanuesCalcanues TalusTalus NavicularNavicular CuboidCuboid 3 cuneiforms3 cuneiforms

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ForefootForefoot 5 5 metatarsalmetatarsalss Each toeEach toe

• 3 phalanges (w/ exception 3 phalanges (w/ exception of the great toe)of the great toe)

DistalDistal MiddleMiddle ProximalProximal

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CalcaneusCalcaneus The largest of the tarsal bonesThe largest of the tarsal bones Calcaneal tubercleCalcaneal tubercle

Posterior projectionPosterior projection Sustentaculum taliSustentaculum tali

The anterior superior medial surface of the The anterior superior medial surface of the calcaneus bodycalcaneus body

Inferior groove Inferior groove • Flexor hallucis longus Flexor hallucis longus

tendontendon

Medial view

Posterior view

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Lateral potion of the anterior calcaneusLateral potion of the anterior calcaneus• Articulates with the cuboidArticulates with the cuboid

Peroneal tuberclePeroneal tubercle• Lateral side projection of the calcaneusLateral side projection of the calcaneus

Peroneus longus: inferior to the tubercle Peroneus longus: inferior to the tubercle Peroneus brevis: superior to the tuberclePeroneus brevis: superior to the tubercle

Lateral view

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HeadHead Articulates with Articulates with

navicularnavicular

Medial tubercleMedial tubercle Attachment site for Attachment site for

deltoid ligamentdeltoid ligament

NeckNeck Projects head Projects head

anteriorlyanteriorly

DomeDome Articulates with distal Articulates with distal

tibia and tibia and fibularfibular in in ankle mortiseankle mortise

TalusTalus

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Ankle Ankle mortisemortise The distal tibia and fibular The distal tibia and fibular

formform The talus sitsThe talus sits

• MortiseMortise: a: a rectangular cavity rectangular cavity in a piece of wood, stone, or in a piece of wood, stone, or other material, prepared to other material, prepared to receive a tenonreceive a tenon

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Inferior surface of the talusInferior surface of the talus Anterior facetAnterior facet Middle facetMiddle facet Posterior facetPosterior facet 5 functional articulations5 functional articulations

• Superiorly: the distal end of the tibiaSuperiorly: the distal end of the tibia• Medially: the medial malleousMedially: the medial malleous• Laterally: the lateral malleolusLaterally: the lateral malleolus• Inferiorly: the calcaneusInferiorly: the calcaneus• Anteriorly: the navicularAnteriorly: the navicular

No muscle attachments No muscle attachments

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MidfootMidfoot

Formed by navicular, 3 cuneiforms, and Formed by navicular, 3 cuneiforms, and cuboidcuboid

NavicularNavicular Anteriorly articulates with the 3 cuneiformsAnteriorly articulates with the 3 cuneiforms Laterally articulates with the cuboidLaterally articulates with the cuboid Posteriorly articulates with the talusPosteriorly articulates with the talus Navicular tuberosityNavicular tuberosity

• Medial aspectMedial aspect• Primarily insertion for the tibialis posterior musclePrimarily insertion for the tibialis posterior muscle

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CuboidCuboid Medially articulates with the Medially articulates with the

third (lateral) cuneiform and third (lateral) cuneiform and navicularnavicular

Anteriorly articulates the 4Anteriorly articulates the 4 thth and and 55th th MetatarsalsMetatarsals

Posteriorly articulates with the Posteriorly articulates with the calcaneuscalcaneus

SulcusSulcus• Formed anterior to the cuboid Formed anterior to the cuboid

tuberosity and posterior to the tuberosity and posterior to the base of the 5base of the 5thth metatarsal metatarsal

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CuneiformsCuneiforms Medial (1Medial (1stst)) Intermediate (2Intermediate (2ndnd)) Lateral (3Lateral (3rdrd))

Posteriorly articulates with the navicularPosteriorly articulates with the navicular Each cuneiform articulates with the Each cuneiform articulates with the

corresponding metatarsal anteriorlycorresponding metatarsal anteriorly Lateral border of the 3Lateral border of the 3rdrd cuneiform cuneiform

• Articulates with the medial aspect of the cuboidArticulates with the medial aspect of the cuboid

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Forefoot and ToesForefoot and Toes 5 Metatarsals5 Metatarsals

• HeadHead (distal) (distal)• Body Body (shaft)(shaft)• BaseBase (proximal) (proximal)

14 phalanges14 phalanges• Head Head (distal)(distal)• Body Body (shaft)(shaft)• Base Base (proximal)(proximal)

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ARTICULATIONSARTICULATIONS

Subtalar JointSubtalar Joint Midfoot JointsMidfoot Joints

Talocalcaneonavicular jointTalocalcaneonavicular joint Calcaneocuboid jointCalcaneocuboid joint Midtarsal jointsMidtarsal joints

Forefoot JointsForefoot Joints Tarsometatarsal joints (Lisfranc joint)Tarsometatarsal joints (Lisfranc joint) Intermetarsals jointsIntermetarsals joints Metatarsophalangeal (MTP) jointsMetatarsophalangeal (MTP) joints Interphalangeal (IP) jointsInterphalangeal (IP) joints

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Subtalar JointSubtalar Joint Articulation between calcaneus and talusArticulation between calcaneus and talus No muscle attach to the talus, the stability of No muscle attach to the talus, the stability of

the subtalar joint is derived from ligamentous the subtalar joint is derived from ligamentous and bony restraintsand bony restraints

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Triplanar MotionsTriplanar Motions

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Midfoot JointsMidfoot Joints

Talocalcaneonavicular joint and the Talocalcaneonavicular joint and the calcaneocuboid joint calcaneocuboid joint the junction the junction between the rearfoot and midfootbetween the rearfoot and midfoot TCN jointTCN joint

• Plantar calcaneonavicular (Spring) ligamentPlantar calcaneonavicular (Spring) ligament

Midtarsal jointsMidtarsal joints

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Forefoot JointsForefoot Joints Tarsometatarsal joints Tarsometatarsal joints

(Lisfranc joint)(Lisfranc joint) Intermetatarsal jointsIntermetatarsal joints Metatarsophalangeal (MTP) Metatarsophalangeal (MTP)

jointsjoints Interphalangeal (IP) jointsInterphalangeal (IP) joints

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Forefoot JointsForefoot Joints Tarsometatarsal joints Tarsometatarsal joints

(Lisfranc joint)(Lisfranc joint) Intermetatarsal jointsIntermetatarsal joints Metatarsophalangeal (MTP) Metatarsophalangeal (MTP)

jointsjoints Interphalangeal (IP) jointsInterphalangeal (IP) joints

1 IP joint1 IP joint 4 PIP joints4 PIP joints 4 DIP joints4 DIP joints

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MUSCULATUREMUSCULATURE• IntrinsicIntrinsic

• Originate on one of the bones of the foot Originate on one of the bones of the foot and directly influence the motion of the and directly influence the motion of the foot or toesfoot or toes

• ExtrinsicExtrinsic• Originate on the leg or distal femur and Originate on the leg or distal femur and

influence motion at the knee and ankle influence motion at the knee and ankle in addition to the foot and toesin addition to the foot and toes

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Intrinsic MusculatureIntrinsic Musculature

• 2(1) dorsal surface superficial muscle(s)2(1) dorsal surface superficial muscle(s)

• 4 (3+) layers of plantar surface muscles4 (3+) layers of plantar surface muscles• Layer I (Superficial)Layer I (Superficial)• Layer II (Middle)Layer II (Middle)• Layer III (Deep)Layer III (Deep) Layer IV (Deep to deep)Layer IV (Deep to deep)

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DORSAL SURFACEDORSAL SURFACE• Extensor digitorum brevis (MTP, PIP, DIP)Extensor digitorum brevis (MTP, PIP, DIP)• Extensor hallucis brevis (MTP)Extensor hallucis brevis (MTP)

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Extensor Digitorum BrevisExtensor Digitorum Brevis

Sinus tarsi – site of muscle Sinus tarsi – site of muscle belly/origin of EDBbelly/origin of EDB

O: O: Superolateral calcaneusSuperolateral calcaneus I: I: Dorsal base of proximal Dorsal base of proximal

phalanx of 2phalanx of 2ndnd (1 (1stst) - 4) - 4thth toes toes N: N: Deep peroneal n.Deep peroneal n. A: A: Secondary extensor of the Secondary extensor of the

toes (MTP, PIP, DIP)toes (MTP, PIP, DIP)

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Extensor Hallucis BrevisExtensor Hallucis Brevis

O: O: Superolateral calcaneusSuperolateral calcaneus I: I: Dorsal base of proximal Dorsal base of proximal

phalanx of big toephalanx of big toe N: N: Deep peroneal n.Deep peroneal n. A: A: Secondary extensor of the Secondary extensor of the

big big toe (MTP)toe (MTP)

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PLANTAR SURFACE – Layer IPLANTAR SURFACE – Layer I• Abductor hallucis (MTP)Abductor hallucis (MTP)• Abductor digiti minimi pedis (MTP)Abductor digiti minimi pedis (MTP)• Flexor digitorum brevis (MTP, Flexor digitorum brevis (MTP,

PIP)PIP)

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Abductor HallucisAbductor Hallucis

O: O: Medial calcaneal Medial calcaneal tuberosity/Flexor tuberosity/Flexor

retinaculum and retinaculum and plantar plantar fasciafascia

I: I: Plantar base of Plantar base of proximal phalanx proximal phalanx of the big toeof the big toe

N: N: Medial plantar n. Medial plantar n. A: A: Primary abductor Primary abductor

of the big toe of the big toe (MTP)(MTP)

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Abductor Digiti Minimi PedisAbductor Digiti Minimi Pedis

O: O: Proximal lateral Proximal lateral calcaneus/Plantar calcaneus/Plantar fasciafascia

I: I: Lateral portion of Lateral portion of the base of proximal the base of proximal phalanx of the 5phalanx of the 5thth

toetoe N: N: Lateral plantar n. Lateral plantar n. A: A: Primary abductor of Primary abductor of

the 5the 5thth toe (MTP) toe (MTP)

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Flexor Digitorum BrevisFlexor Digitorum Brevis

O: O: Medial calcaneal Medial calcaneal tuberositytuberosity

I: I: Proximal (medial and Proximal (medial and lateral lateral sides) phalanges of sides) phalanges of 22ndnd-5-5thth toestoes

N: N: Medial plantar n.Medial plantar n. A: A: Secondary flexor of the 2Secondary flexor of the 2ndnd

through 5through 5thth toes toes (MTP/PIP)(MTP/PIP)

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PLANTRAR SURFACE – Layer IIPLANTRAR SURFACE – Layer II• Quadratus plantae: Flexes 2-5Quadratus plantae: Flexes 2-5thth toes (MTP, toes (MTP,

PIP, DIP)PIP, DIP)• Lumbricals pedis: Lumbricals pedis: Flexes 2-5Flexes 2-5thth toes (MTP) toes (MTP)

Extends 2-5Extends 2-5thth toes toes (PIP, (PIP, DIP)DIP)

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Quadratus PlantaeQuadratus Plantae

Changes the angle of pull Changes the angle of pull for the FDL when contractedfor the FDL when contracted

O:O: Medial/lateral heads Medial/lateral heads from med/lat from med/lat

calcaneuscalcaneus I: I: Dorsal/plantar FDLDorsal/plantar FDL N: N: Lateral plantar n.Lateral plantar n. A:A: Flexes 2-5Flexes 2-5thth toes toes

(MTP, PIP, DIP)(MTP, PIP, DIP)

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Lumbricals PedisLumbricals Pedis

O:O: Tendons of FDLTendons of FDL I: I: Posterior surface of the Posterior surface of the

22ndnd-5-5thth toes via FDL toes via FDL tendonstendons

N: N: 11stst – Medial plantar n. – Medial plantar n. 22ndnd-4-4thth – Lateral plantar n. – Lateral plantar n.

A:A: Flexes 2-5Flexes 2-5thth toes (MTP) toes (MTP) Extends 2-5Extends 2-5thth toes toes (PIP, (PIP,

DIP) DIP)

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PLANTAR SURFACE – Layer PLANTAR SURFACE – Layer IIIIII

• Flexor hallucis brevis (MTP)Flexor hallucis brevis (MTP)• Flexor digiti minimi pedis (MTP)Flexor digiti minimi pedis (MTP)• Adductor hallucis (MTP)Adductor hallucis (MTP)

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Flexor Hallucis BrevisFlexor Hallucis Brevis

O: O: Medial plantar surface of Medial plantar surface of cuboidcuboid

I: I: Medial/lateral sides of Medial/lateral sides of proximal phalanx of the proximal phalanx of the big toebig toe

N: N: Medial plantar n.Medial plantar n. A:A: Secondary flexor of the Secondary flexor of the

big big toe (MTP)toe (MTP)

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Flexor Digiti Minimi PedisFlexor Digiti Minimi Pedis

O: O: Plantar surface of Plantar surface of cuboid and base of 5cuboid and base of 5thth metatarsalmetatarsal

I: I: Plantar surface of Plantar surface of proximal phalanx of the proximal phalanx of the 55thth toetoe

N: N: Lateral plantar n.Lateral plantar n. A: A: Secondary flexor of the Secondary flexor of the

55thth toe (MTP)toe (MTP)

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Adductor HallucisAdductor Hallucis O: O: OOblique head – blique head – bases of bases of

22ndnd-4-4thth metatarsals metatarsals TTransverse head – ransverse head – plantar plantar surface of 3surface of 3rdrd-5-5thth metatarsal metatarsal headsheads

I: I: Lateral base of proximal Lateral base of proximal phalanx of great toephalanx of great toe

N: N: Lateral plantar n.Lateral plantar n. A: A: Adducts the big toe Adducts the big toe

(MTP)(MTP)

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PLANTAR SURFACE – Layer IVPLANTAR SURFACE – Layer IV• PPlantarlantar interosseiinterossei: : adadducts toes 3-5ducts toes 3-5thth (MTP) (MTP)• DDorsalorsal interosseiinterossei pedis: pedis: ababducts 2-4ducts 2-4thth (MTP) (MTP)

PAD DAB

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PPlantar Interosseilantar Interossei

O:O: Medial side of the Medial side of the metatarsalsmetatarsals

I:I: Sides of phalanges Sides of phalanges and distal tendon of EDLand distal tendon of EDL

N:N: Lateral plantar n.Lateral plantar n. A:A: AdAdducts 3ducts 3rdrd-5-5thth toes toes (PAD)(PAD)

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DDorsal Interossei Pedisorsal Interossei Pedis

O:O: Adjacent sides of the Adjacent sides of the two two metatarsalsmetatarsals

I:I: Sides of phalanges Sides of phalanges and and distal tendon of distal tendon of EDLEDL

N:N: Lateral plantar n.Lateral plantar n. A:A: AbAbducts 2ducts 2ndnd-4-4thth toes toes

(DAB)(DAB)

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Extrinsic MusculatureExtrinsic Musculature

Tibialis anteriorTibialis anterior Extensor digitorum longusExtensor digitorum longus Extensor hallucis longusExtensor hallucis longus Peroneus tertiusPeroneus tertius

Peroneus longusPeroneus longus Peroneus brevisPeroneus brevis

GastrocnemiusGastrocnemius SoleusSoleus PlantarisPlantaris

Tibialis posteriorTibialis posterior Flexor digitorum longusFlexor digitorum longus Flexor hallucis longusFlexor hallucis longus

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ARCHES OF THE FOOTARCHES OF THE FOOT

Anterior MetatarsalAnterior Metatarsal

Medial LongitudinalMedial Longitudinal

Lateral LongitudinalLateral LongitudinalTransverseTransverse

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Soft Tissue Support of the Soft Tissue Support of the Medial Longitudinal ArchMedial Longitudinal Arch

A: Tibialis anteriorA: Tibialis anterior B: Tibialis posteriorB: Tibialis posterior C: Flexor hallucis longusC: Flexor hallucis longus

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NEUROANTOMYNEUROANTOMY

Plantar neuro structuresPlantar neuro structures

Dorsal neuro structuresDorsal neuro structures

Dermatomes Dermatomes

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Plantar Neuro StructuresPlantar Neuro Structures

Tibial nerve Tibial nerve branches into branches into medial and lateral medial and lateral plantar nerves plantar nerves which in turn which in turn branch into digital branch into digital nervesnerves

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Dorsal Neuro StructuresDorsal Neuro Structures

Superficial peroneal Superficial peroneal nerve and its nerve and its branches – lateralbranches – lateral

Deep peroneal Deep peroneal nerve and its nerve and its branches – branches – dorsal/medialdorsal/medial

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DORSALIS PEDIS ARTERYDORSALIS PEDIS ARTERY

Dorsal surface of foot Dorsal surface of foot and branches and branches terminating as digital terminating as digital branchesbranches

Dorsalis pedis pulse Dorsalis pedis pulse located between located between extensor digitorum extensor digitorum and hallucis longus and hallucis longus tendons on dorsal tendons on dorsal aspect of footaspect of foot

4747

POTERIOR TIBIAL ARTERYPOTERIOR TIBIAL ARTERY On plantar surface of On plantar surface of

foot branches intofoot branches into Medal and Lateral Medal and Lateral

plantar arteries which plantar arteries which in turn branch into in turn branch into

• Digital arteriesDigital arteries

Posterior tibial pulse Posterior tibial pulse located behind medial located behind medial malleolus along malleolus along Achilles tendonAchilles tendon

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DORSALIS PEDIS DORSALIS PEDIS PULSEPULSE

POTERIOR TIBIAL POTERIOR TIBIAL PULSEPULSE