FOOT

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FOOT

• TARSALS, METATARSALS PHALANGES

The human foot is a complex structure containing
26 bones, 33 joints and more than 100 tendons,
muscles, and ligaments.
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Tarsus ankle

• Proximal region of the foot
• 7 tarsal bones
• Talus ankle bone
• Calcaneus heel bone
• Navicular like a little boat
• 3 Cuniform bones wedge shaped - lateral,
  intermediate, medial
• Cuboid cube shaped

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Ankle

• Talus is the only bone that articulates with the
  fibula and tibia to form the ankle joint
  talocrural joint
• tibia medial malleolus
• Fibula lateral malleolus
• During walking the talus distributes about half
  the weight to the calcaneus the rest to the other
  tarsal bones

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Metatarsus

• 5 metatarsal bones numbered I V 1 5
  medial to lateral
• Each has a proximal base, an intermediate shaft
  and a distal head
• articulate proximally with the first second and
  third cuneiform bones and the cuboid to form the
  tarsometatarsal joints
• Articulate distally with the phalanges to form
  the metatarsophalangeal joint

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Phalanges digits

• Numbered I V medial to lateral
• Each phalanx proximal base, intermediate shaft
  and distal head.
• Hallux has two phalanges proximal distal
• Other toes have three phalanges proximal, middle
  and distal
• Interphalangeal joints between phalanges

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Sesamoid bones are always present at the
metatarsophalangeal joint of the great toe.
Function protect the tendon that flexes the toe,
flexor hallicus longus/brevis by protecting it
from the body's weight.
At the upper and forepart of the medial surface
of the calcaneusis a horizontal eminence, the
sustentaculum tali, which gives attachment to a
slip of the tendon of the Tibialis posterior.
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Arches of Foot

• Two arches held by tendons ligaments
• Allow foot to support weight of the body ball of
  foot 40 weight. Heel 60 weight
• Leverage for walking
• Fully developed by age 13
• Longitudinal arch medial and lateral parts
• Transverse arch

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The longitudinal arch of the foot is higher on
the medial side, where it forms the instep as can
be seen on a foot-print. It is made up of the 1st
three digits and their metatarsals, the
cuneiforms, the navicular bone and the
talus.The lateral longitudinal arch is made up
of digits 4 and 5 and their metatarsals, the
cuboid and the calcaneum. It is much shallower
than the medial arch. The transverse arch of
the foot is primarily formed by the 5 metatarsal
bones.
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Every ligament that connects the bones of the
foot plays a part in the maintenance of the
arches, but some which pass across two or more
joints are especially important. Among these are
the long plantar ligament, the plantar
calcaneocuboid ligament and the plantar
calcaneonavicular ligament, on which the head of
the talus rests.While the normal tone of the
small intrinsic muscles of the foot also plays an
essential part in keeping the arches intact, the
long muscles which are inserted by tendons into
the bones of the foot have an even more important
role. These are the tendon of the tibialis
anterior muscle, the tendon of the tibialis
posterior muscle, the tendon of the peroneus
longus and the tendons of the flexor hallucis
longus and flexor digitorum longus
muscles.Finally, more superficially, the
plantar aponeurosis also plays an important part
in maintaining the medial longitudinal arch.
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Once the skin of the sole of the foot has been
removed, there is a very dense organized layer of
deep fascia that runs down the middle of the
sole this is the plantar aponeurosis. There is
also deep fascia covering the medial and lateral
muscle groups but it has been removed in this
image.The plantar aponeurosis is thought to
help maintain the medial longitudinal arch of the
foot.
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• Plantar Fasciitis"heel spurs an overuse injury
  affecting the sole or flexor surface (plantar) of
  the foot. A diagnosis of plantar fasciitis means
  you have inflamed the tough, fibrous band of
  tissue (fascia) connecting your heel bone to the
  base of your toes.
• Higher risk female, overweight, a job that
  requires a lot of walking or standing on hard
  surfaces walk or run for exercise, especially if
  you have tight calf muscles that limit how far
  you can flex your ankles. People with very flat
  feet or very high arches are also more prone to
  plantar fasciitis.
• starts gradually with mild pain at the heel bone
  often referred to as a stone bruise.
• more likely to feel it after (not during)
  exercise.
• The pain classically occurs again after arising
  from a midday lunch break.
• If you don't treat plantar fasciitis, it may
  become a chronic condition. You may not be able
  to keep up your level of activity and you may
  also develop symptoms of foot, knee, hip and back
  problems because of the way plantar fasciitis
  changes the way you walk.

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• In order for these flexor and extensor tendons to
  perform their duty properly, they must be kept
  close to the bones of the ankle. The structures
  that keep them close are the retinaculae
• superior extensor retinaculum
• flexor retinaculum
• inferior extensor retinaculum

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the superior and inferior peroneal retinaculaem
keep the tendons of the peroneus longus and
brevis close to the lateral malleolus.
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After the plantar aponeurosis has been removed
you can see the muscles that make up the first
layer of the sole of the foot and the arteries
and nerves entering the foot. The muscles of
the first layer are abductor hallucis flexor
digitorum brevis abductor digiti minimi
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When the flexor digitorum brevis is removed, the
muscles of the second layer can be seen
accessory flexor (quadratus plantae) lumbricals
tendons of the flexor digitorum longus from
which the lumbricals arise
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The muscles of the third layer include the
flexor hallucis brevis adductor hallucis
oblique head transverse head flexor digiti
minimi brevis
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The fourth layer of muscles are the dorsal
interossei (dab) meaning dorsal abduct plantar
interossei (pad) meaning plantar adduct At
this level, you can also see the tendon of the
peroneus longus crossing the sole of the foot.
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