Arches of foot ,layers of
sole
Presented by: Dr Sunil rouniyar
PG 1st YR, Orthopaedic
Moderator: Dr Robin Yadav
Learning Objectives
Arches of foot
Classification
Mechanism of Arch Support
Deformities of Foot
Layers of sole
Applied anatomy
Foot
• Function of foot
– Support body weight
– Serves as a lever to propel
the body forward in
walking and running
Foot divison
• Hind-foot
• Mid foot
• forefoot
Why there are arches?
• A segmented structure can hold
up weight only if it is built in the
form of arch
• Weight will be distributed on
– The heel (behind)
– The head of metatarsal
• Minimise the pressure on nerve
and vessel
• Forward propulsive action will
be easier
• Serves as shock absorber –act
as spring
Arches of foot
• The foot has three
arches
-two longitudinal (medial
and lateral) arch
-one transverse arch
Medial longitudinal arch
Lateral longitudinal arch
Comparing between medial and
lateral longitudinal arch
Medial longitudinal arch Lateral longitudinal arch
Formed by more bones and more Formed by less bones and less
joints joints
Characteristics features is resilency Characteristics features is rigidity
Higher and more mobile Lower and less mobile
Involved in porpulsion during Involved in receiving and
locomotion (i.e initiating the next supporting the body weight
step during walking)
Transverse arch
• Anterior transverse
arch
– It’s whole arch
because during
standing position the
heads of first and
fitth metatarsal come
into contact to earth
and create 2 end of
arch
• Posterior transverse arch
– It’s incomplete arch
because only its lateral
end enters into contact
with all the earth during
standing position.
– It creates only half of the
dome in a single foot. The
entire dome is composed
when both feet are
brought together
Integrity of bony arch
• Maintained by
Passive factors Dyanamic support
Shape of united bones Active bracing action of intrinsic muscles
of foot
Four succcessive layers of fibrous Active and tonic contraction of muscles
tissue with long tendons extending into foot
Planter aponeurosis Flexor hallusis and digitorium
Long planter ligament longus-longitudinal arch
Planter calcaneonavicular Fibularsi longus and tibialis
(short planter) ligament posterior-transverse arch
Panter calcaneonavicular
(spring) ligament
Variables keeping the arches of foot
• The apparatus
utilized to support
a stone bridge are:
– Shape of bones
– Intersegmental
ties(staples)
– Slings
– Tie beams
Shape of bone
• Bones are wedge
shaped with thin
edge lying inferiorly
• This applies
particularly to the
bone occupying the
center of the arch
“keystone”
Pes cavus/cavovarus(high arched foot)
Pes cavus is a foot condition characterised
by an unusually high medial longitudinal
arch, planter flexion, of first ray, forefoot
pronation , valgus and adduction hindfoot
varus
Due to the higher arch, the ability to shock
absorb during walking is diminished and
an increased degree of stress is placed on
the ball and heel of the foot.
Causes of pes cavus can be idiopathic,
hereditary, due to an underlying
congenital foot problem such as club foot,
or secondary to neuromuscular damage
such as in poliomyelitis
• Symptoms generally include pain in
the foot, which can radiate to the
ankle, leg, thigh and hip. This pain is
transmitted up the lower limb from
the foot due to the unusually high
stress placed on the hindfoot during
the heel strike of the gait cycle.
• treatment ranges from orthotics to
operative soft tissue release and
operative osteotomies depending on
patient age and flexibilty of foot
deformity
Pes planus(flat foot)
• Pes planus is the loss of the medial
longitudinal arch of the foot ,heel
valgus and medial talar prominence
• Classification based on (arch height
and heel eversion angle)
1. flexible flat foot-developmental
2. Rigid flat foot
• Etiology
-congenital
-tarsal coalition
inflammatory joint disease
neurological disorder
Clinical assessment
- Medial arch of the foot is depressed (reproducible/non-reproducible)
- Heel bone, when viewed from the rear is everted or in valgus
- Forefootis abducted relative to the hindfoot
-“too many toes sign”
• Treatment
– Conservative-in asympotomatic peadiatric patient
- education and reassurane
stretching exersice in achilies tendon contracture
Surgery—intractable symptoms unresponsive to shoe or orthotic
-- in individual who are unable to modify the activities that
produce pain
Xray finding
Pes planus Pes clavus
•Beaking of head of talus •On weight bearing lateral view
•meary’s angle will be apex planter •Calcaeneum pitch greater than 30
degree
•Meary’s angle
Layers of sole
Skin
Skin
Thick and hairless.Firmly
bound down to the
underlying deep fascia by
numerous fibrous bands.
Shows a few flexure creases
at the sites of skin
movement.
Sweat glands are present in
large numbers.
SUPERFICIAL FASCIA
Cutaneous Nerves
Cutaneus Arteries
CUTANEOUS NERVES
Medial calcaneal
branch of the tibial
nerve
Medial plantar nerve
Lateral plantar nerve
Sural & saphenous
nerve
DEEP FASCIA
--Planter Aponeurosis
--Deep transverse metatarsal
Ligament
--Fibrous flexor sheath
--Septae
Plantar aponeurosis
Definition:
Thickened band of deep
fascia in the sole of the foot.
Attachment:
Posteriorly: Medial tubercle
of calcaneus.
Anteriorly: Divides into 5
slips which pass to the 5
toes.
On each side: Attached to
the metatarsal bones by
medial and lateral
intermuscular septa.
Plantar aponeurosis
Functions:
Protects the underlying nerves
and vessels.
Maintains the longitudinal
arches of the foot.
MUSCLES FOUR LAYERS
FIRST(SUPERFICIAL)
SECOND
THIRD
FOURTH
1st Layer
Three Muscles:
1) Abductor hallucis
2) Flexor digitorum brevis
3) Abductor digiti minimi
1st Layer
SECOND LAYER
1. QUADRATUS
PLANTAE/FLEXOR
DIGITORUM
ACCESSORIOUS
2. LUMBRICALS
3. TENDON OF FLEXOR
DIGITORUM LONGUS
4. TENDON OF FLEXOR
HALLUCIS LONGUS
1st & 2nd Layers
3rd Layer
Three Muscles:
1)Flexor hallucis
brevis.
2)Adductor
hallucis
3)Flexor digiti
minimi brevis
FOURTH LAYER
1. DORSAL
INTEROSSEI (4)
2. PLANTER
INTEROSSEI(3)
3. TENDON OF
PERONEUS LONGUS
4. TENDON OF
TIBIALIS POSTERIOR
3rd & 4th Layers
NERVES
MEDIAL PLANTER
LATERAL PLANTER
Medial Plantar Nerve
It is larger of the two terminal
branch of the posterior tibial
nerve.
Enter the foot midway
between the medial malleolus
and the medial tubercle of the
calcaneus, under cover the
flexor retinaculum. Passes
forwards deep to the abductor
hallucis muscle.
Terminate at the bases of the
metatarsal bones by dividing
into 3 planter digital nerves.
Lateral Plantar Nerve
Branches: Muscular :
1) Flexor digitoum accessorius
muscle
2) Abductor digiti minimi
3) Flexor digiti minimi brevis
4) Adductor halucis muscle.
5) Interossei
6) 2nd, 3rd & 4th lumbricals.
Cutaneous:
1) Skin of the lat. 1/3 of the sole
2) Skin on the lat.side of the planter
surface of the little toe and the
adjoining sides of the 4th & 5th
toes.
3) The planter digital branches, also,
supply the skin on the dorsum of
the terminal phalanges of the
lateral one and half toes.
Medial Plantar Artery
One of the two terminal
branches of the posterior
tibial artery.
Enter the foot midway
between the medial malleolus
and the medial tubercle of the
calcaneus, under cover the
flexor retinaculum. Passes
forwards deep to the abductor
hallucis muscle. Passes b/w
the abd.hallucis and flexor
digitorum brevis.
Lateral Plantar Artery
lateral side of the little toe.
Three planter metatarsal arteries
APPLIED ANATOMY
• MTEATARSALGIA
• PLANTAR FASCITIS
• INFECTION
• INJURY
• DIABETIC FOOT
• CALCANEAL SPUR
references
• BD chaurasia Human anatomy, 5th
edition
• Netter’s concise orthopaedics
anatomy, 2nd edition
Thank you
