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Medial & Lateral Plantar Nerve

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Medial & Lateral Plantar Nerve Intrinsic muscles • Arise and insert with in foot •Modify actions of long tendons •Generate fine movements of toes •Nerve supply: medial & lateral plantar nerve Flexors Abductors • Digitorum brevis • A. hallucis • Digiti minimi brevis • A. digiti minimi • Hallucis brevis • Accessorius • Lumbricals • Interossei Plantar Aponeurosis • Attached to medial & lateral calcaneal tubercles • Fans out & is inserted by five slips. • Slips bifurcate for flexor tendons • Insert in to flexor sheath & transverse ligaments. • 1st layer - Short muscles covering the sole. • 2nd layer- Long flexor tendons,flexor accessorius, lumbricals • 3rd layer-Short muscle of great & little toes (confined to metatarsal region). • 4th layer- Interossei- plantar & dorsal tendons of tibilias posterior & peroneus longus. Plantar nerves & vessels between 1st and 2nd layer First Layer • Abductor Hallucis • Flexor digitorum brevis • Abductor Digiti minimi First Layer Abductor Flexor digitorum Abductor digiti hallucis brevis minimi O- Medial tubercle O- Medial tubercle O- Medial & lateral of calcaneum of calcaneum tubercle of I- Proximal phalanx I- four tendons calcaneum of great toe. pass to lateral 4 I- proximal A- Abduction of toes – middle phalanx of little great toe phalanx toe. N- Medical plantar A - Flexion of toes A- Abduction of nerve N- Medial plantar little toe. nerve N- lateral plantar nerve Second layer • Tendon of flexor dig. Longus • Lumbricals • Flexor accessorius Second layer Tendon of flexor Flexor Tendon of flexor hallucis longus Accessorius D.L • Lies in a groove O- Medial & • Divides in to four below sustentaculum lateral tubercles slips tali of calcaneum • Receives the •Inserted in to distal I- Gets inserted insertion of flexor phalanx of big toe into tendon of accessorius •Synovial sheath F.D.L. •Gives off •Sesamoid bones A- Straightens lumbricals the pull of •Each slip pierces F.D.L; flexion F.D.B. & inserts on N- Lateral distal phalanx of plantar nerve. lateral 4 toes Lumbricals • Arise from the tendons of flexor D.L. ;each arises by two heads( Except 1st). • Pass on to medial side of metatarso- phalangeal joints of lateral four toes. • Insert to the extensor expansions. •N-1st – Medial plantar nerve – 2-4 – lateral plantar nerve • To maintain extension of digits at interphalangeal joints. Third layer • Flexor hallucis brevis • Adductor hallucis • Flexor digiti minimi Third layer Adductor Flexor hallucis Flexor digiti hallucis brevis minimi brevis O- 2,3,4, O- cuboid & O- 5th metatarsal metatarsal heads cuneiforms I- Proximal & ligaments I- Proximal phalanx of little toe I- Proximal phalanx of big toe N- Lateral plantar phalanx of big toe (two slips) nerve (lateral) N- Medial plantar N- Lateral plantar nerve nerve A- flexion of A- Maintain the proximal phalanx transverse arch of big toe Fourth layer • Interossei Dorsal- 4 Plantar- 3 • Tendons of Peroneus longus Tibialis posterior Fourth layer Tendon of peroneus Interosseus Muscles Tendon of tibialis longus posterior • Crosses the sole • PAD(3) DAB(4) • inserted into obliquely •O- Plantar from its own navicular tuberosity, (lateral to medial) metatarsal ,dorsal from two to three cuniforms •Inserted at the base metatarsal cuboid. of 1st metatarsal. •I- Plantar – 3,4,5 digits •2,3,4, metatarsal dorsal extensor expansions base. •Dorsal-each arises by two metatarsal. - 2 are inserted on 2nd toe. -3,4 are inserted on 3rd and 4th toe. -Proximal phalanges & dorsal extensor expansion •N- lateral plantar nerve Vessels and nerves Arteries: post. Tibial artery Medial and lateral plantar arteries Nerves: Tibial nerve- Medial and lateral plantar nerves Plantar arch- lateral plantar and dorsalis pedis artery Applied Anatomy • Plantar fascitis • Calcaneal spur • Plantar reflex • Medial plantar nerve entrapment (Jogger’s foot) • Infections / puncture wounds .
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