Foot, Arches, and Gait - A Partial Study Guide

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Overview

• plantar aponeurosis
• four layers of muscles
• 3 compartments

Compartments

• intermuscular septae - medial and lateral
• Layer 1
  1. medial - abductor hallucis longus
  2. lateral - abductor digiti minimi
  3. fdb - mpn
• Layer 2
  1. fdl
  2. fhl
  3. qp
  4. 4lumbricals, first by mpn
• Layer 3
  1. fhb medial
  2. fdmb lateral
  3. ah central
• Layer 4 - all by lpn
  1. dorsal and plantar interosseous mm
• Nerves
  1. medial and lateral plantar nerves derived from tibial nerve

Interosseous muscles - 3 pad and 4 dab

• abduction/adduction defined by 2nd digit, second digit cannot, by definition, adduct, any lateral/medial movement is abduction
• 3 planter interosseous mm - adduction - toward second digit
• 4 dorsal interosseous mm - abduction - away from second digit

Cross section of foot

• dorsal interossei are bipennate and that the plantar interossei are monopennate

Arches of the foot

1. medial longitudinal arch - from calcaneous to heads of metatarsals
   • calcaneous, talus, navicular, 3 cuneiforms, medial 3 metatarsals
   • plantar calcaneonavicular ligament, long plantar ligament
   • shape of bones, bridge analogy,
2. lateral longitudinal arch
   • calcaneous, cuboid, lateral 2 metatarsals
3. transverse arch
   • tendon of peroneus longus
4. weight distribution 12 point system
   • gravity: posterior to hip, anterior to knee, anterior to ankle
   • calcaneus - 6 of 12
   • 1st metatarsal - 2
   • 2-5 metatarsal - 1

Gait

• stance phase
• swing phase
• heel strike
• weight shift - calcaneous to 5th mt to 1st mt to distal phalanx digit 1
• hip stability
  • gluteus medius and minimus switch origin and insertion - insertion is on ilium
  • ipsilateral pull on ilium by gluteus medius prevents pelvic sag
  • lesioned superior gluteal nerve - pelvic sag, Trendelenburg gait
• Common peroneal nerve injury - bumper height
  • common, superficial, deep, or all three, or one of three
  • deep peroneal n. - plantar flexed, foot drop, foot slap due to exaggerated hip flexion
  • superficial peroneal n. - inverted foot, walk on lateral edge,
  • common peroneal n. - foot drop of inverted foot

Questions for the Foot, Arches, and Gate

True/False - August 12, 2011

1. The plantar aponeurosis contributes support to the medial, lateral, and transverse plantar arches.
2. Both the plantar aponeurosis and the tendon of flexor hallucis longus contribute to the lateral longitudinal arch.
3. The plantar interossei adduct digits 1,3,4,5 toward digit 2.
4. The dorsal interossei abduct digits 1, 3, 4, 5 away from digit 2.
5. The first and second dorsal interosseous muscles attach to digit 2.
6. The plantar interossei, but not the dorsal interossei, flex the metacarpophalangeal joint.
7. The dorsal and plantar interossei extend the proximal and distal interphalangeal joints.
8. The tendon of flexor hallucis longus crosses the inferior surface of the flexor digitorum longus.
9. The longitudinal plantar arches extend distally to the bases of the distal phalanges.
10. The plantarcalcaneonavicular (spring) ligament stabilizes both the medial plantar arch and the subtalar joint.
11. The spring ligament attaches to the anterior surface of the sustentaculum tali.
12. The deltoid ligament attaches to the superior surface of the sustentaculum.
13. The tendon of the flexor hallucis longus is applied to the inferior surface of the sustentaculum tali.
14. The peroneus longus muscle provides suspension support to the lateral longitudinal arch, tie beam support to the transverse arch, and staple support to the medial longitudinal arch. in
15. The plantar arch crosses the superior parts of the adductor hallucis and the inferior surfaces of the plantar and dorsal interossei.

Definition and Short Answer

1. talocalcaneonavicular joint
2. The plantar aponeurosis predominately contributes support to which arches?
3. Crossing transversely across the sole of the foot between flexor digitorum brevis and quadratus plantae are what structures?
4. What observations distinguish whether an injury is to the common, superfical, or deep peroneal nerves?
5. Both plantar and dorsal interosseous muscles can be viewed for a dissection of the plantar (inferior) side of the foot. Dorsal interosseoi, but not plantar interosseoi, can be viewed from the dorsal (superior) side of the foot. This is because the dorsal interosseoi are (blank) whereas the the plantar interosseoi are monopennate.
6. The primary "staple" to the medial longitudinal arch is the (blank) ligament. This ligament extends from the sustentaculum tali of the (blank) to the (blank) bone. Immediately superior to this ligament is the (blank) of the (blank) known as the "keystone" of the medial longitudinal arch. Immediately inferior the to this ligament is a long tendon providing a "tie-beam" for the medial longitudinal arch. This is the tendon of (blank). Another tie-beam is provided by an intrinsic muscle of the foot. This muscle is the (blank). In addition to the aforementioned muscular "tie-beams," fascial tie-beams are provided by the (blank) and even the (blank) of the sole of the foot. The major "suspension" support of the medial longitudinal arch is provided by the (blank). This muscle, in addition to suspending the arch also provides a "staple" because of the splaying out of the tendonous insertions near the base of the (blank).
7. The (blank) provides a "staple" for the medial longitudinal arch (due to a splaying out of tendonous insertions near the (blank)), a "tie-beam" for the transverse arch, and a "suspension" for the lateral longitudinal arch.
8. The superior aspect of the sustentaculum tali provides a site of attachment for the (blank) ligament. The anterioinferior aspect of the sustentaculum tali provides a site of attachment for the (blank) ligament. The inferior aspect of the sustentaculum tali provides a groove for the (blank). Immediately medial (superficial) to the sustentaculum tale are the (blank), (blank), and (blank). The sustentaculum tali is a bony process derived from the (blank).
9. The dorsalis pedis has as its terminal branches the (blank) and (blank) arterys. The (blank) artery crosses the superior aspects of the base of the metatarsals whereas the other terminal branch passes inferiorly between the heads of origin of the (blank) to from the medial aspect of the (blank).
10. The lateral plantar artery is a terminal branch of the (blank) artery. From its origin at the flexor retinaculum of the ankle the lateral plantar artery passes superior and then deep (lateral) to the (blank) muscle to enter the sole of the foot. The lateral plantar artery crosses the sole obliquely in a fascial plane immediately superior to (blank) and inferior to (blank). Upon reaching the lateral side of the sole the lateral plantar artery passes superiorly toward the base of the 5th (blank). At this location, the lateral plantar artery becomes the (blank) and lies superior to the (blank) head of the adductor hallucis and inferior to the (blank) muscles.
11. The tendon of peroneus longus crosses the lateral aspect of the sole through an osseofibrous canal. The superior wall of this canal is the (blank). The inferior wall of this canal is the (blank).
12. What structures arise from the dorsal venous arch? What are their relations to the malleoli?
13. A dorsal expansion has insertions as follows. Which toe of which foot is involved? * a long tendon inserts along a longitudinal path * a short tendon inserts along a transverse path from the right * a tendon crossing anterior the mp joint inserts on the medial side * a tendon from a monopennate muscle inserts on the medial side * a tendon from a bipennate muscle inserts on the lateral side

Essay

1. What branch of the dorsalis pedis artery contributes blood supply to the plantar aspect of the foot? Explain the relations of this arterial branch.
2. Discuss why flexion of the toes is more controlled than extension. Which digit has the most overall control and why?
3. Discuss the support of the medial longitudinal arch. Please be systematic in your answer by working from the deepest structures outward.
4. Does a strong pulse of the dorsalis pedis artery guarantee that the anterior compartment of the leg is receiving an adequate blood supply? Explain your answer. (hint: no it doesn't)
5. What arterial branches course distally (anterior) from the plantar arch? What are the relations of these arteries. What arterial branches course proximal (posterior) from the plantar arch. What are the relations of these arteries? What arterial branches course superior (toward dorsum of foot)? What are the relations of these arteries?
6. Consider that some unfortunate person steps on a nail. The nail penetrates straight into the sole of the foot. Ultimately the spring ligament is pierced and the penetration is arrested. What structures (fascia, muscles, neurovascular, bone) were possibly damaged. What finally stopped the penetration?
7. In accord with the "bridge" analogy, can you think of a structure that participates as a staple for the medial longitudinal arch, a tie-beam for the transverse arch, and a suspension for the lateral longitudinal arch? Explain.

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