feet by dr. armaan singh
TRANSCRIPT
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Anatomy of Feet
By- Dr. Armaan Singh
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FootFoot
Tarsal bonesCalcaneusTalusNavicularCuboidCuneiformsFive metatarsalsPhalanges
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Tarsal Canal and Tarsal SinusTarsal Canal and Tarsal Sinus
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Inversion and EversionInversion and Eversion
Inversion is raising the medial border of the foot
Sole of the foot looks medially
Close packEversion is raising the
lateral border of the foot Sole of the foot looks
laterallyLeast pack
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Initiated at the transverse tarsal joint
CalcaneocuboidAnterior portion of
the talocalcaneonavicular
Last, 1963
Inversion and Eversion
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Main movement takes place at the clinical sub-talar joint i.e.• Talocalcaneal • Inferior portion of the
talocalcaneonavicularThe pivot is the
ligament of the neck of the talus
Inversion and Eversion
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AxisAxis
Upwards forwards and medially
Middle of most convex posterior facet on superior surface of calcaneus
Middle of most convex of the anterior head of talus
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Talocalcaneal Anatomical Talocalcaneal Anatomical SubTalar JointSubTalar Joint
Synovial plane jointConcave inferior aspect
of body of talusConvex posterior facet
on superior surface of the calcaneus
Articular surface is covered with hyaline cartilage
Part of the clinical subtalar joint
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Capsule attached just beyond the articular margins
Synovial membrane lines capsule and non articular structures
Interosseous ligament
Talocalcaneal Anatomical SubTalar Joint
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Subtalar InterosseosusSubtalar Interosseosus
Capsule of both talocalcaneal
Posterior portion of the talocalcaneonavicular joint
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Talocalcaneonavicular JointTalocalcaneonavicular Joint
Synovial ball and socket joint
Ball is anterior and inferior aspect of the head of the talus
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SocketTwo anterior facets
on the superior surface of the calcaneus
Posterior aspect of the navicular
Spring ligament Medial limb of
birfurcate i.e. lateral calcaneonavicular (LCN)
Talocalcaneonavicular Joint
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Capsule attached just beyond the articular margin
Interosseous ligament post
Medial are theSpring ligament and
superficial portion deltoid ligament
Lateral are the lateral calcaneo navicular ligament of bifurcate
Ligament neck of talus
Talocalcaneonavicular Joint
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Plantar Calcaneonavicular LigamentPlantar Calcaneonavicular Ligament
Plantar calcaneonavicular or spring ligament is attached to
Sustentaculum taliTuberosity of navicularCovered by articular
cartilage
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Ligaments of Sub-Talar JointLigaments of Sub-Talar Joint
Inferior extensor retinaculum
Ligament of the neck of talus
Interosseous ligamentBifurcate ligament
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Ligament of Neck of TalusLigament of Neck of Talus
Sinus tarsi toLateral aspect of neck
of talusPivot of inversion and
eversionLast,1963
*
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Inferior Extensor RetinaculumInferior Extensor Retinaculum
Medial root inside the tarsal sinus
Intermediate to talus with the interosseous ligament, inside sinus
Lateral root to calcaneus outside sinus
Klein & Spreitzer, 1993
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Tarsal Canal and Tarsal SinusTarsal Canal and Tarsal Sinus
FatNerve endingsBranches of posterior
tibial and peroneal arteries
Capsules and ligaments of talocalcaneal and talocalcaneonavicular joints
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Ligament AttachmentsLigament Attachments
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Bifurcate LigamentBifurcate Ligament
Lateral calcaneonavicular ligament (CNL) is medial limb
Medial calcaneocuboid ligament (CCL) is lateral limb
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Two individual ligaments
Separate attachmentsDifferent fiber
orientationDifferent histologySmith, 2001
Bifurcate Ligament
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Lateral Calcaneonavicular LigamentLateral Calcaneonavicular Ligament
Folded and twisted appearance
Prominent medial and lateral edges/folds
Three groups of fibres• Medial• Lateral (deep)• Intra-articular
Smith 2001
N
A
C
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Intra-capsular CC jointSmaller than CNL, always
presentHourglass shaped fibres,
twisted mediallySmith 2001
Medial Calcaneo Cuboid Ligament
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Talocalcaneonavicular JointTalocalcaneonavicular Joint
Synovial membrane lines the capsule and non-articular structures nerve supply
Tibial nerveDeep and superficial
peroneal nerves
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InvertorsIn dorsi-flexionTibialis anteriorIn plantar-flexionTibialis posterior
Talocalcaneonavicular Joint
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EvertorsIn dorsi-flexionPeroneus tertius In plantar-flexionPeroneus longusPeroneus brevis
Talocalcaneonavicular Joint
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Calcaneo Cuboid JointCalcaneo Cuboid Joint
Plane synovialLigamentsCapsularLigament of neck of
talusLong and short
plantar ligamentBifurcate ligament
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The long plantar ligamentShort plantar ligamentSupport the calcaneo cuboid
portion of the transverse tarsal joint
Calcaneo Cuboid Joint
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Long Plantar LigamentLong Plantar Ligament
Long plantar is attached toMedial, lateral and anterior
tubercles of calcaneusEither side of the groove on
the cuboidBase of middle three Metatarsals
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Short Plantar LigamentShort Plantar Ligament
Short plantar Broader and wider and
deep to long plantarAnterior to anterior tubercle
of calcaneusPosterior to posterior ridge
on cuboid
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Inferior SurfaceInferior Surface
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Cutaneous Supply of SoleCutaneous Supply of Sole
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Sole of FootSole of Foot
SkinPlantar aponeurosisAttached toMedial and lateral tubercles of
calcaneusFive slips Divide into twoFuse deep transverse ligament of
sole Abduction and adduction from a line
drawn through the middle of second toe
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First Layer of SoleFirst Layer of Sole
Abductor hallucisMedial plantar nerveFlexor digitorum brevisMedial plantar nerveAbductor digiti minimiLateral plantar nerve
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Long flexor tendonsTibial nerveFlexor hallucis longusTibial nerveFlexor digitorum longusTibial nerveFour lumbricalsUnipennate medial plantar nerveBipennate lateral plantar nerveFlexor accessoriusLateral plantar nerve
Second Layer of Sole
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Flexor hallucis brevisMedial plantar nerveAdductor hallucisFlexor digiti minimi Lateral plantar nerveVessels run between
1st and 2nd layer3rd and 4th layers
Third Layer of Sole
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Tendons Tibialis posteriorTibial nervePeroneus longusSuperficial peroneal nerveDorsal interosseiLateral plantar nerve
Fourth Layer of Sole
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Seasmoid BonesSeasmoid BonesLarger medial inAbductor hallucis and
medial half of flexor hallucis brevis
Smaller lateral inAdductor hallucis and Lateral half of flexor
hallucis brevis
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FootFoot
If sesamoid bones are bipartite
It is always bilateralIf fracture singleTake off point of
walking is hallux Flexor hallucis
longusTibial nerve
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Joints of FootJoints of FootMid-tarsal compound synovialMetatarso-phalangeal jointSynovial condylar jointDeep transverse ligament of
soleInterphangeal jointsSynovial hinge
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Second MetatarsalSecond MetatarsalSecond metatarsal is
the most fixedThinnest Longest Stress fractures
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Longitudinal ArchesLongitudinal Arches
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ArchesArches
LongitudinalMedialLateralTransverse TarsalMetatarsal heads
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Posterior pillarCalcaneusKeystoneTalusNavicular, medial,
intermediate and lateral cuneiforms
Anterior pillarsHeads of medial three
metatarsals
Medial Longitudinal Arches
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Tie beamPlantar aponeurosis
Medial Longitudinal Arches
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Spring ligamentDeltoid ligamentTibialis anteriorDeep peroneal nerveTibialis posteriorFlexor hallucis longusTibial nerve
Medial Longitudinal Arches
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Tibialis anteriorTibialis posteriorFlexor hallucis longusFlexor medial longus
(medial 3)Short flexor muscles
Medial Longitudinal Arches
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Supports of Arches
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Posterior pillarCalcaneusAnterior pillarsHeads of lateral two
metatarsalsKeystoneCuboid
Lateral Longitudinal Arches
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Tie beamPlantar aponeurosis
Lateral Longitudinal Arches
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Peroneus longusPeroneus brevisShort flexor muscles on lateral
aspectLong and short plantar ligaments
Supports of Lateral Arches
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Supports of Lateral Arches
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Transverse Arch
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Medial pillarHead of first
metatarsal Lateral pillarDeep transverse
ligament of soleTransverse head of
adductor hallucis
Transverse Arch
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Depressed archHead of the third
metatarsal compresses the lateral branch of medial digital nerve
Morton’s metatarsalgia Pain increased by tight
shoes, relieved by taking shoes off
Transverse Arch
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Morton’s MetatarsalgiaMorton’s Metatarsalgia
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Second MetatarsalSecond Metatarsal
Second metatarsal is the most fixed
Thinnest Longest Stress fracturesCan effect any other
bone
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Foot ProblemsFoot Problems
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Nerve Supply of the FootNerve Supply of the FootMedial calcaneal nerveMedial plantar nerveThree and half toesLateral plantar nervesOne and half toes
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Nerve Supply of Dorsum Nerve Supply of Dorsum Superficial peroneal
nerveDeep peroneal nerve, first
cleftSaphenous nerve, medial
border to base of big toeSural nerve, lateral
border
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Nerve SupplyNerve Supply
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Feet Feet
Pronated or flat footIncrease knee and back
painMedial tibial syndromeCuboid syndromePes cavus rigid footAchilles tendonosis
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Pronated FootPronated Foot
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Foot PrintsFoot Prints
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Pes CavusPes Cavus
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Foot ProblemsFoot Problems
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Foot ProblemsFoot Problems
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Foot ProblemsFoot Problems
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Foot ProblemsFoot Problems
Server’s
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Netter
Heel Pain
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Heel Pain
Netter
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