Intrinsic Muscles of the Foot

mmulipilwa
Intrinsic muscles of the foot
• They originate and insert within the foot.
• There is only one intrinsic muscle on the dorsum of the foot -extensor
digitorum brevis.
• The plantar surface has the following muscles:- flexor digiti minimi brevis,
flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, abductor
digiti minimi, abductor hallucis and lumbricals
• All intrinsic muscles of the foot are innervated by the medial and lateral
branches of the tibial nerve except the extensor digitorum brevis and first
two interossei.
• They modify the actions of the long tendons and generate fine movements of
the toes.
On the dorsal aspect- extensor digitorum
brevis (and extensor hallucis brevis)
• Originates from the calcaneus.
• Its belly is deep to the tendon of extensor
digitorum longus.
• Its four tendons insert on the medial four
digits.
• The part of the muscle associated with the
great toe is considered as a separate
muscle-extensor hallucis brevis.
• It extends the metatarsophalangeal joint
of the great toe and the medial three toes.
• It is innervated by the deep fibular nerve.
On the plantar surface
• Muscles on the plantar
surface of the foot are
organised in four layers,
these are:- first layer,
second layer, third layer and
fourth layer.
First layer
• There are three components
in the first layer of muscles.
• From medial to lateral these
are the abductor hallucis,
flexor digitorum brevis and
abductor digiti minimi.
Abductor hallucis
• Originates from the calcaneus and
inserts onto the base of the
proximal phalanx of the great toe.
• It forms the medial margin of the
foot and contributes to the soft
tissue bulge on the medial side of
the foot.
• It abduct and flexes the great toe at
the metatarsophalangeal joint.
• It is innervated by the medial
plantar branch of the tibial nerve.
Flexor digitorum brevis
• Originates from the calcaneal
tuberosity and its four tendons inserts
on to the dorsal aspect of the meddle
phalanx of the lateral four digits.
• Each tendon split into two and pass
around the tendon of the flexor
digitorum longus before inserting onto
the dorsal aspect.
• It flexes the lateral four toes at the
proximal interphalangeal joints.
• It is innervated by the medial plantar
branch of the tibial nerve.
Abductor digiti minimi
• Is on the lateral side of the foot.
• It originates from the lateral and
medial processes of the calcaneal
tuberosity.
• It inserts onto the lateral side on the
base of proximal phalanx of the little
toe.
• It abduct the little toe at the
metatarsophalangeal joint.
• It is innervated by the lateral plantar
branch of the tibial nerve.
Second layer of muscles of the sole of the
foot
• Is associated with the tendons of
the flexor digitorum longus
muscle
• It consist of the quadratus
plantae muscle and the four
lumbricals
Quadratus plantae
• Is a quadrangular muscle originating
from the calcaneus with two heads.
• It inserts onto the lateral side of the
tendon of the flexor digitorum
longus muscle.
• It assist the flexor digitorum longus
in flexing the toes. It may also adjust
the ‘line of pull’ of the flexor
digitorum longus tendon.
• It is innervated by the lateral
plantar branch of the tibial nerve.
Lumbricals
• Are four worm like muscles in
originating from the tendons of
the flexor digitorum longus and
inserts onto the free medial
margin of the extensor hoods of
the four lateral toes.
• The first lumbrical originate from
the medial side of the tendon of
the flexor digitorum longus that is
associated with the second toe.
Lumbricals
• The remaining three lumbricals are
bipennate and originate from the
sides of adjacent tendons.
• They act through extensor hoods to
resist the excessive extension of the
metatarsophalangeal joints and flexion
of the interphalangeal joints when the
heel leave the ground during walking.
• The first lumbrical is innervated by the
medial plantar nerve while the lateral
three lumbricals are innervated by the
lateral plantar nerve
Third layer of muscles of the sole of the foot
• There are three muscle in
the third layer in the sole of
the foot.
• These include:-
The two, (flexor hallucis
brevis and adductor
hallucis).
Flexor digiti minimi brevis
Flexor hallucis brevis
• Has two tendinous heads of origin- the
lateral head originates from the plantar
surface of the cuboid and the medial
head from the tendon of tibialis
posterior.
• It inserts onto the base of the proximal
phalanx by two tendons.
• Each tendon contains a sessamoid bone.
• It flexes the metatarsophalangeal joint
of the great toe.
• It is innervated by the medial plantar
nerve.
Adductor hallucis
• Originates by two muscular heads, the
oblique head from the plantar surface of
the basses of metatarsal II to IV and the
transverse head from the ligaments
associated with the metatarsophalangeal
joint.
• It inserts onto the lateral side of the base
of the proximal phalanx of the great toe.
• It adducts the great toe at the
metatarsophalangeal joint.
• It is innervated by the lateral plantar
nerve.
Flexor digiti minimi
• Originates from the plantar
surface of the base of metatarsal
V.
• It inserts onto the lateral side of
the base of proximal phalanx of
the little toe.
• It flexes the little toe at the
metatarsophalangeal joint.
• It is innervated by the lateral
plantar nerve.
Fourth layer of muscles of the plantar surface
of the foot
• There are only two
muscles in the fourth
layer in the sole of the
foot.
• These are the dorsal and
the plantar interossei
muscles.
Dorsal interossei
• They are the most superior muscles in the
sole of the foot and abduct the second to
fourth toes.
• They are all bipennate muscles originating
from the sides of adjacent metatarsals.
• They inserts onto the free margin of the
extensor hoods and bases of the proximal
phalanges of the toes.
• They are innervated by the lateral plantar
nerve except the first and second
interossei which are innervated by the
deep fibular nerve.
Plantar interossei
• There are only three plantar
interossei muscles.
• They adduct the third, fourth
and little toe towards the long
axis through the second toe.
• They originate from the medial
side of its associated metatarsal
and inserts into the medial free
margin of the extensor hoods.
Plantar interossei
• They adduct and assist in extension
of the metatarsophalangeal joint
and flexion of interphalangeal joint.
• They are innervated by the lateral
plantar nerve.
• The great toe has its own adductor
called adductor hallucis in the third
layer of muscles.
• The second toe is adducted to its
own axis by the use of the dorsal
interosei.
Blood and Nerve supply to
the foot
Arteries, veins, lymphatics and nerves.
Arteries
• Blood supply to the foot is by branches
from the posterior tibial artery and
dorsalis pedis artery.
• The posterior tibial artery bifurcates
into two arteries, the lateral plantar
artery and medial plantar artery.
• The lateral plantar artery joins the
terminal end of the dorsalis pedis
artery to form the deep plantar arch.
• The dorsalis pedis artery is a
continuation of the anterior tibial
artery.
Posterior tibial artery
• Enters the foot through the
tarsal tunnel on the medial side
of the foot.
• Its palpable as it is only covered
by the retinaculum, superficial
fascia and skin.
• It bifurcates into a much larger
lateral plantar artery and small
medial plantar artery.
Dorsalis pedis artery
• Is a continuation of the anterior
tibial artery after crossing the ankle
joint.
• It passes between the two heads of
the first dorsal interossei to become
the deep plantar artery where it
joins the deep plantar arch.
• It is palpable on the dorsal surface
of the foot between the tendons of
the extensor hallucis longus and
extensor digitorum longus
Veins
• There are interconnected network of
deep and superficial veins in he foot.
• The deep veins follow the artery while
the 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
pass on the medial side of the leg.
• The small saphenous vein originates
from the lateral side of the arch and
pass onto the lateral surface of the leg.
Nerves
• The following nerves supply the
foot:-
Tibial nerve
deep fibular nerve
Superficial fibular nerve
Sural nerve
Saphenous nerve.
Tibial nerve
• It enters the foot through the tarsal
tunnel posterior to the medial
malleolus.
• It gives off the medial calcaneal nerves
that innervate the heel
• The terminal branches of the tibial
nerve are the large medial plantar
nerve and a smaller lateral plantar
nerve.
• Both the lateral and medial plantar
nerves travel together with their
corresponding arteries.
Medial plantar nerve
• Is the major sensory nerve in the
sole of the foot.
• It innervates skin on the anterior
2/3 of the sole and adjacent
surfaces of the medial three and
one half of the toes.
• It also innervates four intrinsic
muscles namely –the abductor
halluces, flexor hallucis brevis,
flexor digitorum brevis and the
first lumbrical.
Lateral plantar nerve
• Is an important motor nerve in
the foot as it innervates all
intrinsic muscles except for
those innervated by the medial
plantar nerve.
• It also innervate the skin on the
lateral side of the anterior 2/3 of
the sole of the foot and adjacent
plantar surface of the lateral one
and one half of the digits.
Deep fibular nerve
• Innervates the extensor digitorum
brevis and contribute to the
innervation of the first two dorsal
interossei muscles and supplies
general sensory branches to the
skin on the adjacent dorsal side of
the first and second toes.
• It travels lateral to the dorsalis
pedis artery in the foot and is
lateral and parallel to the tendon
of the extensor hallucis longus
Superficial fibular nerve
• Is sensory to most of the
skin on the dorsal aspect of
the foot and toes except for
skin on the adjacent sides of
toes I and II which is
innervated by the deep
fibular nerve.
Sural nerve
• Is a cutaneous branch of the tibial
nerve originating high in the leg.
• It enters the foot in the superficial
fascia posterior to the lateral
malleolus close to the short
saphenous vein.
• It innervates the skin on the
lateral side of the foot and
dorsolateral surface of the little
toe.
Saphenous nerve
• Is a cutaneous branch of the
femoral nerve that originate
in the thigh.
• Its terminal branches
innervate the skin on the
medial side of the proximal
foot