FOOT

PRE-LESSON

Instruction: Answer this question in

a sheet of paper in 5 minutes.

What are the 3 groups of bones in

the foot?
OBJECTIVES FOR THE DAY

Know the importance of the foot in relation

to the different parts of the organ.
Relate the different ailments of the foot.
Creation of a schematic diagram showing
the relations of the bones of the foot.
 A 37-year-old male is admitted to the hospital after an injury to his
foot while playing flag football with friends on a Saturday morning. A
series of radiographs demonstrates a fracture involving the talocrural
(tibiotalar, ankle) joint. Which movements are the major ones to be
affected by this injury?

A. Plantar flexion and dorsiflexion

B. Inversion and eversion
C. Plantar flexion, dorsiflexion, inversion, and eversion
D. Plantar flexion and inversion
E. Dorsiflexion and eversion
A. The talocrural (tibiotalar, ankle) joint is a
hinge-type synovial joint between the tibia
and talus. It permits dorsiflexion and plantar
flexion, and fracture of this joint would affect
these movements.
WHAT COMPRISES THE FOOT?
The foot may look simple but is a complex structure with 26
bones, 33 joints, numerous muscles, nerves and different ligament
types.

Some foot disorders may present with just a mild ache, but other
foot disorders can be very serious and limit ability to walk or bear
weight.

Most minor cases of foot pain respond to home care treatments

except when severe pain is present as it is a disabling condition
and usually needs some type of medical attention. If foot pain is
not treated in time, it can lead to long term disability and
continuing damage to the foot.
Anatomy of The Foot
The foot is the region of the
lower limb distal to the ankle
joint.

It is subdivided into the tarsus,

the metatarsus, and the digits.
The foot has a superior surface
(dorsum of foot) and an inferior
surface (sole)
Anatomy of The Foot
Bones
There are three groups of bones in
the foot :
The seven tarsal bones.
Metatarsals (1 to 5).
The phalanges, which are the
bones of the toes-each toe has
three phalanges, except for the
great toe, which has two.
Anatomy of The Foot
Tarsal bones:
The tarsal bones are arranged in
a proximal group and a distal
group with an intermediate
bone between the two groups
on the medial side .
Anatomy of The Foot
The proximal group consists of
two large bones, the talus and
the calcaneus.
The intermediate tarsal bone on
the medial side of the foot is the
navicular.
The distal group of tarsal bones
consists of cuboid and three
cuneiforms bones.
Anatomy of The Foot
Metatarsals:
There are 5 metatarsals in the
foot, numbered I to V from
medial to lateral.
1st Metatarsal bone associated
with the great toe, is shortest
and thickest.
The 2nd is the longest.
Anatomy of The Foot
Phalanges
The phalanges are the bones of
the toes.
Each toe has three phalanges
(proximal, middle, and distal),
except for the great toe, which
has only two (proximal and
distal).
 Read about

Foots Joints
Tarsal tunnel
The 'tarsal tunnel' is formed on
the posteromedial side of the
ankle by:
A depression formed by the
medial malleolus of the tibia, the
medial and posterior surfaces of
the talus, the medial surface of
the calcaneus, and the inferior
surface of the sustentaculum tali
of the calcaneus.
An overlying flexor retinaculum .
Tarsal tunnel
The flexor retinaculum is a strap-
like layer of connective tissue.
It attaches above to the medial
malleolus and below and behind
to the inferomedial margin of
the calcaneus.
Contents of Tarsal tunnel
Tibialis posterior muscle
Flexor digitorum longus muscle
Posterior tibial artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus muscle
(mnemonic used is "Tiny Dogs Are
Not Hunters)
Extensor retinacula
Two extensor retinacula strap the
tendons of the extensor muscles
to the ankle region and prevent
tendon bowing during extension
of the foot and toes:
Superior extensor retinaculum
Inferior retinaculum
Plantar Aponeurosis
It is a thickening of deep fascia in
the sole of the foot.
It is firmly anchored to the medial
process of the calcaneal tuberosity
and extends forward as a thick
band of longitudinally arranged
connective tissue fibers.
The plantar aponeurosis supports
the longitudinal arch of the foot
and protects deeper structures in
the sole.
Arches of the foot
The bones of the foot form
longitudinal and transverse
arches relative to the ground
which absorb and distribute
downward forces from the body
during standing and moving on
different surfaces.
Arches of the foot
Longitudinal arch
It is formed between the
posterior end of the calcaneus
and the heads of the
metatarsals.
It is highest on the medial side
where it forms the medial part
of the longitudinal arch and
lowest on the lateral side where
it forms the lateral part.
Arches of the foot
Arches of the foot

Longitudinal arch
Medial longitudinal arch
Lateral longitudinal arch
Arches of the foot
Transverse arch
It runs from medial to lateral
direction on the plantar surface
of the foot. This arch also
provides support and flexibility
to the foot.
Arches of the foot
Muscles of the foot
Muscles of the foot are classed as:
Intrinsic muscles
Extrinsic muscles
Muscles of the foot
Intrinsic muscles originate and
insert in the foot and control the
movement of the toes.

Extrinsic muscles originate from

anywhere in the lower leg, their
long tendons cross the ankle
joint and insert onto one of the
bones of the foot.
Arteries of the foot
Blood supply to the foot is by
branches of the posterior tibial
and dorsalis pedis (dorsal artery
of the foot) arteries
Arteries of the foot
Posterior tibial artery and plantar
arch:
The posterior tibial artery enters
the foot through the tarsal
tunnel on the medial side of the
ankle and posterior to the
medial malleolus.
It bifurcates into a small medial
plantar artery and a much larger
lateral plantar artery.
Arteries of the foot
Dorsalis pedis artery :
It is the continuation of the
anterior tibial artery and begins as
the anterior tibial artery crosses
the ankle joint .
It passes anteriorly over the dorsal
aspect of the talus, navicular, and
intermediate cuneiform bones, and
then passes inferiorly, as the deep
plantar artery, between the two
heads of the first dorsal
interosseous muscle to join the
deep plantar arch in the sole of the
foot.
Arteries of the foot
Dorsalis pedis artery :
Pulse of the dorsalis pedis artery
on the dorsal surface of the foot
can be felt by gently palpating
the vessel against the underlying
tarsal bones between the
tendons of extensor hallucis
longus and the tendon of
extensor digitorum longus to
the second toe.
Veins of the foot
Veins of the foot :
Deep veins
Superficial veins

The deep veins follow the arteries.

Veins of the foot
Superficial veins drain into a dorsal
venous arch on the dorsal surface
of the foot over the metatarsals:
The great saphenous vein
originates from the medial side of
the arch and passes anterior to the
medial malleolus and onto the
medial side of the leg
The small saphenous vein
originates from the lateral side of
the arch and passes posterior to
the lateral malleolus and onto the
back of the leg.
Nerves of the foot
The foot is supplied by the tibial,
deep peroneal, superficial
peroneal, sural, and saphenous
nerves.
WHAT GENDER IS MORE PRONE
TO FOOT INJURIES?
The most common cause of foot pain is wearing ill fitting
shoes.

Women often wear tight shoes that are narrow and

constrictive, and thus are most prone to foot problems.

Tight shoes often cause overcrowding of toes and result in a

variety of structural defects.

The next most common cause of feet disease is overuse or

traumatic injuries
HOW DO YOU DIAGNOSE FOOT
INJURY?
Besides a physical examination, an x-ray MRI
or an ultrasound study may be obtained to
assess the soft tissues and blood vessels.
WHAT ARE THE DIFFERENT
ARTHROIDAL CONDITIONS OF THE
FOOT?
Achilles tendinitis results from stress on calf
muscles and Achilles tendon.

This strong tendon often gets inflamed while

playing sports like basketball.
Bunion is an abnormal bony mass that forms
on the big toe and points outwards.

This deformity is unsightly and painful.

When the big toe enlarges at the base, it can

force the other toes to crowd against each
other.
Gout often presents with pain and tenderness at the
base of the big toe.

Generally women are more prone to gout after

menopause.

An acute attack of gout is intensely painful and

walking on the foot is impossible.

Gout is essentially a disorder caused by precipitation

of uric acid crystals in the joint.
Plantar fasciitis is a very common cause of heel pain.

The thick fibrous bands at the bottom of the heel get

inflamed and cause excruciating pain.

The pain occurs the moment you step out of bed.

After a few hours, the pain does subside but can

return after prolonged periods of standing.