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Category: Gray’s Anatomy, 40th ed

INNERVATION OF THE FOOT Superficial fibular nerve The superficial fibular nerve is described in Chapter 83. Deep fibular nerve The deep fibular nerve is described in Chapter 83. Tibial nerve The branches of the tibial nerve that innervate structures in the ankle and foot are articular, muscular, sural, medial calcaneal and medial and lateral plantar […]

BIOMECHANICS OF STANDING, WALKING AND RUNNING PLANES OF MOTION Much confusion surrounds the descriptive terms for movement in the foot and ankle. Plantar flexion and dorsiflexion refer to movement in the sagittal plane and occur principally, but not exclusively, at the ankle, metatarsophalangeal and interphalangeal joints. Inversion is tilting of the plantar surface of the […]

STANDING Humans are bipedal: we stand and walk with an erect trunk and knees which are almost straight. Moreover, we are plantigrade, i.e. we set the whole length of the foot down on the ground, whereas most medium to large mammals are digitigrade, i.e. they stand and walk on their toes, and ungulates stand on […]

PROPULSION The contraction of tibialis posterior, gastrocnemius and soleus is the chief factor responsible for propulsion in walking, running and jumping. The propulsive action of these calf muscles is enhanced by arching of the foot and flexion of the toes. In walking, the weight of the foot is taken successively on the heel, lateral border […]

SOFT TISSUES The tendons that cross the ankle joint are all deflected to some degree from a straight course, and must therefore be held down by retinacula and enclosed in synovial sheaths. Retinacula at the ankle In the vicinity of the ankle joint, the tendons of the muscles of the leg are bound down by […]

METATARSALS The five metatarsal bones lie in the distal half of the foot and connect the tarsus and phalanges. Like the metacarpals, they are miniature long bones, and have a shaft, proximal base and distal head. Except for the first and fifth, the shafts are long and slender, longitudinally convex dorsally, and concave on their […]

INTRINSIC MUSCLES The intrinsic muscles, i.e. those contained entirely within the foot, follow the primitive limb pattern of plantar flexors and dorsal extensors. The plantar muscles in the foot can be divided into medial, lateral and intermediate groups. The medial and lateral groups consist of the intrinsic muscles of the hallux and minimus, respectively, and […]

TARSUS The seven tarsal bones occupy the proximal half of the foot (Figs 84.5A,B; 84.6). The tarsus and carpus are homologous, but the tarsal elements are larger, reflecting their role in supporting and distributing body weight. As in the carpus, tarsal bones are arranged in proximal and distal rows, but medially there is an additional […]

VASCULAR SUPPLY ARTERIES Dorsalis pedis artery The dorsalis pedis artery is the dorsal artery of the foot (Figs 84.1; 84.23), and is the continuation of the anterior tibial artery distal to the ankle. It passes to the proximal end of the first intermetatarsal space, where it turns into the sole between the heads of the […]

DEEP AND SUPERFICIAL VENOUS SYSTEMS IN THE FOOT Plantar digital veins arise from plexuses in the plantar regions of the toes. They connect with dorsal digital veins to form four plantar metatarsal veins which run proximally in the intermetatarsal spaces and connect via perforating veins with dorsal veins, then continue to form the deep plantar […]

MUSCLES The muscles acting on the foot may be divided into extrinsic and intrinsic groups. EXTRINSIC MUSCLES The extrinsic muscles are described in Chapter 83. Their tendons cross the ankle, and move and stabilize this joint. Distally, the tendons also act on the small joints of the foot and help to stabilize these joints. The […]

DISTAL FIBULA The distal end of the fibula or lateral malleolus projects distally and posteriorly relative to the medial malleolus (see Figs 83.2A,B; 83.3A,B). Its lateral aspect is subcutaneous, the posterior surface has a broad groove with a prominent lateral border, and the anterior surface is rough and somewhat rounded and articulates with the anteroinferior […]

CHAPTER 84 – Ankle and foot The ankle joint (talocrural joint) is a diarthrodial articulation involving the distal tibia and fibula and the body of the talus: it is the only example in the human body of a true mortise joint. The human foot is a complex structure adapted to allow orthograde bipedal stance and locomotion and […]

BONE Functionally, the skeleton of the foot may be divided into tarsus, metatarsus and phalanges. With regard to nomenclature of the surfaces of the foot, the terms ‘plantar’ and ‘dorsal’ are used, to denote the inferior and superior surfaces respectively. The terms ‘proximal’ and ‘distal’ are used with the same significance as in limbs generally. […]

ARCHES OF THE FOOT Three main arches are recognized in the foot. They are the medial longitudinal, the lateral longitudinal and the transverse arch. The roles of the arches of the foot in standing, walking and running are discussed later in this chapter. MEDIAL LONGITUDINAL ARCH The medial margin of the foot arches up between […]

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