SOLE OF FOOT — Transcript

Hello students.

Today we'll talk about the sole of the foot. Now this is one of the complicated topic from the lower limb.

But today we'll talk about the conceptual components of this topic. Is topic ko conceptually kaise yaad rakhna hai aur what are the important things in relation to the exam.

So jo sabse important question aapko is topic se milta hai, draw the label diagram of cutaneous supply of the skin.

So this is the first that we'll discuss. Second you will have the modification of the deep fascia and that is the aponeurosis. And this aponeurosis is known as plantar aponeurosis.

Then we'll see the muscles which are important and neurovascular bundle and last is its clinical and applied anatomy. So we'll read this topic under the following headings. Now whenever we are talking about the cutaneous supply of the sole, now this is your sole.

Now this sole is divided by with the help of a inverted Y. theek hai. Now this inverted Y divide this whole area of the sole into the three part.

Now ye aapko banana kaise hai ki ye aap jab bhi dekhoge to pehle hum is digits ko divide karenge. So there are 1, 2, 3, 4, 5 digits. theek hai. So we'll divide them into the three and a half. So this is the medial three and a half and lateral one and a half fingers, toes, sorry.

So when you will see the skin in the sole, first you have to divide here and then we'll draw the area which separates the whole part of the sole from the heel. So this is your heel.

Clear? So heel ke upar ki jo skin hai usko aap remaining area se alag karoge and now you have to join these two lines. Now this will actually demarcate the area of the cutaneous supply. So ye jo medial side bana, this is supplied by the medial plantar nerve. It is supplied by medial plantar nerve. Another thing is that,

this remaining part over the heel is supplied by medial calcaneal branch of tibial nerve. theek hai. Dekhiye ek chota sa concept yahan aapko yaad rakhna hai ki basically ye teeno kiski branch hai tibial nerve ki.

So major supply of your sole, skin of the sole comes from the tibial nerve. Tibial nerve ki hi ye dono branch hai medial lateral plantar nerve aur ye bhi tibial nerve ki branch hai.

Now apart from that, ye jo medial side hai, theek hai, yahan pe ek aur nerve ka contribution hai aur lateral side bhi ek nerve ka contribution hai. Aapko pata hai ki medially hamare paas ek nerve hoti hai great saphenous vein ke along run karti hai. Uska naam hota hai saphenous nerve.

theek hai. So there is a small contribution of saphenous nerve. Aur medially kiska contribution hota hai saphenous nerve ka. Saphenous kiske saath run karti hai great saphenous ke saath. theek hai. Laterally we have the vein and that vein is known as short saphenous or small saphenous aur small saphenous ke saath jo nerve run karti hai that is sural nerve. theek hai.

So sural nerve ka contribution kidhar hota hai lateral side pe. Sural nerve kiske saath run karti hai short saphenous ke saath. theek hai. Medially kiska contribution hota hai saphenous nerve ka. Saphenous kiske saath run karti hai great saphenous ke saath. theek hai. To aapne basically kiya kya tha is skin ko ek Y form mein divide kiya. So heel ka jo area hai wo pehle is pure sole se separate ho gaya aur phir aapne sole ko bhi medial aur lateral mein divide kar diya. theek hai. Laterally ho gayi lateral plantar nerve, medially ho gayi medial plantar nerve, heel pe ho gayi direct calcaneal branch of tibial nerve. theek hai. Contribution ho gaya saphenous aur sural nerve ka. So it is very easy to understand and you can remember it very well.

theek hai. Now we'll talk about the next point is the aponeurosis. Now when you will see the aponeurosis in the sole, you will realize that jab bhi hum aponeurosis ki baat karte hain, aponeurosis kya hota hai hamesha ek tendon hai aur ye jo tendon hai isko humne flat kar diya hai. theek hai. It is a flattened tendon.

To yahan pe jo aap aponeurosis padh rahe ho, that is known as plantar aponeurosis. And plantar aponeurosis morphologically represent the tendon of plantaris muscle. It is a part of plantaris muscle. theek hai.

Aur ye jo aponeurosis hai, ye kis-kis se connect hai? Ye connect hai heel heel yani calcaneum bone se posteriorly aur aage ye toes tak ja raha hai. It is going till the toes. theek hai. Aur aponeurosis jo hai, ye hamesha hum kya bolte hain that aponeurosis are always modification of deep fascia. It is a mainly contributed by deep fascia. theek hai. To jab aap dissection karte ho to you will realize ki sole ki skin bahut thick hai.

Us thick skin ke neeche humein ek aur thick structure mila that is plantar aponeurosis. Ye aponeurosis kya kar raha hai? Pehli cheez ye aponeurosis jo bhi aapke sole ke andar nerve and vessels hain unko protect karta hai. theek hai. Because sole is a weight bearing area. So it protect the nerve and vessels. Second ye jo plantar aponeurosis hai, ye toes ke upar ja ke aapki digital nerve and vessels ko bhi protect karta hai. Digital N/V ko bhi special protection deta hai.

theek hai. Saath hi ye plantar aponeurosis overlying skin ke saath attached rehta hai with the skin ligament. With the skin ligaments. theek hai. So jo jis tarah se aapki ye palm ki skin less movable hoti hai, isi tarah se sole ki jo skin hoti hai that also become less movable because these ligaments connect the deep fascia that is the palmar aponeurosis with your skin. theek hai. Iske alawa iska ek aur function hai wo kya hai ki ye jo deep fascia hai jisko hum plantar aponeurosis bol rahe hain, ye triangular in shape hota hai.

theek hai. Triangular in shape iska major component hai. Iska jo central part hai wo triangular hota hai. theek hai. Base kahan attached hai calcaneum pe. Aage kahan chala gaya toes pe. To iski jo medial aur lateral borders hoti hain, ye jo respective borders hoti hain, in borders se kya nikalte hain expansions nikalte hain. theek hai. Ye jo expansions hain, ye remaining part of the sole ko cover karte hain. Plus isse deep yani towards the inner part of the sole expansions nikalte hain jo kehte hain intermuscular septa. So ye jo aponeurosis hai, is aponeurosis se kya bante hain intermuscular septa in the sole. That I will tell you in the coming part of this video.

Ab is sole ke andar aapko jab bhi ye plantar aponeurosis ke upar kuch pucha jata hai, wahan pe isse related do clinical anatomy ke questions aate hain. Pehla hai plantar fasciitis aur dusra calcaneal spur. Kya-kya hai? Plantar fasciitis and calcaneal spur. Ye dono cheezein kya hoti hain?

Dekhiye plantar fasciitis iske apex pe hota hai. Apex matlab jahan pe ye calcaneum se attached hai heel pe. theek hai. To jab aap calcaneum pe plantar aponeurosis ka attachment dekhte hain, us point pe kayi baar repeated trauma hota hai. There is a repeated trauma. Aur ye jo repeated long standing trauma hota hai, iski wajah se jo aapka suppose ye this is your calcaneum. theek hai. Aur yahan pe ye aapka kya hai aponeurosis. theek hai. So ye jo point of attachment hai, theek hai, is point of attachment pe repeated trauma agar hoga to patient ko dheere-dheere yahan pain hone lagta hai. Patient complain karta hai pain ki and he is having difficulty in the weight bearing. theek hai. Usse usko chalte time bada pain hota hai, wo comfortable nahi feel karta.

theek hai. Aisa hota kya hai? Ye repeated trauma ke cause kya hai? Repeated trauma ke cause hain undue running, excessive undue running, undue jumping, excessive jumping aur very long standing. theek hai. Jin professions mein bahut lambe time tak khada rehna padta hai ya when the person is having very undue runnings, theek hai, very excessive jumping, us case mein there is a problem with the attachment of the plantar fascia, plantar aponeurosis with the calcaneum. theek hai.

Ab yahan pe kya hua ki because of the repeated minor traumas, jo iski periosteum hai, ye jo bone ki periosteal layer hai, ye periosteal layer mein minor-minor injuries ho jati hain. hai na. There is a minor injury into the membrane periosteal membrane of this bone. Uski wajah se kya hota hai ki is tendon is aponeurosis ke part ke along bone formation hone lagti hai. Kya bone formation hone lagti hai? Bone. theek hai. To agar aap is patient ka x-ray loge, when you will take the x-ray of this person, to yahan pe x-ray mein aapko calcaneum ke saath is tarah ka ek chota projection nazar aayega. theek hai.

This projection is known as calcaneal spur. This projection is known as calcaneal spur. Aur what is the cause of calcaneal spur? Long standing plantar fasciitis. Usse kya hua? There is a repeated trauma. Repeated trauma se kya hua? Jo overlying membrane thi wo rupture ho jati hai and it is one of the cause of the ossification at the attachment of plantar aponeurosis. So patient ko yahan pe continuously long standing pain hota rehta hai. theek hai. So this is the calcaneal spur aur and the plantar fasciitis. theek hai.

Now we'll see the next component that is the muscle layers of your sole.

Now we'll talk about the muscle layers of sole.

Now this part, the muscle layer is the most difficult thing to remember. So yahan pe ye jo maine diagram banaya hai, this is the section of the foot.

theek hai. So ye jo aapka foot hai, now this is the foot. theek hai. Agar hum iska section lein middle side se, so this is your sole. Ye jo neeche surface hai, this is the sole. This is your dorsum. Clear? And these are the five metatarsals. theek hai. So this is your great toe, metatarsal for great toe, first, second, third, fourth and this is for little toe. So these are the five metatarsals from great toe to the little toe.

Now what are the layers of your muscle layers in the sole? So jab bhi aap layers ki baat karte ho to there are four layers. Muscle ki form mein four layers hain. theek hai.

Some books says there are six layers. If you are reading the six layers, then you have to remember that we are including the two neurovascular planes also. theek hai. Neurovascular plane which are two in number. theek hai. So you have the first layer, second layer, third layer and fourth layer.

Clear? Now fourth layer is the deepest one. theek hai. Yani agar hum sole se dissection karte hue in bones tak pahunchenge to jo andar layer milegi that is the fourth one. Aur jo sole ke bilkul adjacent hogi, theek hai, that is the first layer.

So first layer is the superficial layer. theek hai. And the fourth layer is the deepest layer. Now when you are reading the six layers, you have to remember that between the first and second we have a neurovascular plane and between the third and fourth we have a neurovascular plane. So you have one plane between the first and second layer and you have the one plane between the third and fourth layer. In this way, some books says that there are six layers in the sole. Now what are the muscles and how to remember these muscles and what are the importance of these muscles?

So isko samajhne ke liye first we'll see the name of muscles which are present in the sole. So the first layer of the sole is made up of three muscles. Pehli layer mein teen muscles hoti hain aur ye teeno kya hain short muscles hain. Short matlab these are the intrinsic muscles and these intrinsic muscles connects your calcaneum to your toes.

Clear? To ye jo short muscles hoti hain, ye calcaneum ko toes se connect karti hain, intrinsic muscles hoti hain. Ab what is what are the name of these muscles? So you will see ki sabse neeche humne pehle kya dekha tha? Humne sabse pehle neeche sole ka jab aap dissection karoge to you are able to see the central part of your thick aponeurosis. So ye to maine banaya aponeurosis. What is the name of this aponeurosis? Plantar aponeurosis. theek hai. Aur ye skin se overlying skin se connect hai. So these are the skin ligaments. Clear? So this is the one thing.

Ab iske upar is muscle ki iske upar center mein aapko ek muscle layer milta hai. Now this muscle is just lies deep to this aponeurosis. Aur what is the name of this muscle which is the muscle of the first layer present in the center is known as flexor digitorum brevis. This muscle is flexor digitorum brevis. theek hai. So jab aap dissection kar rahe ho, when you are removing the skin of the sole, you will find the aponeurosis. Deep to the aponeurosis, the first muscle which is present in the center is flexor digitorum brevis. That's why it is said that the center portion of aponeurosis overlie the flexor digitorum brevis muscle.

Now in the same plane of the flexor digitorum brevis, we'll find the two other short muscles. Humein kitni short muscles milti hain? Do short muscles milti hain. Ek short muscle jo aapke great toe ki taraf jati hai. Now this short muscle is known as abductor. It is abductor hallucis. It is abductor hallucis. Clear? And ek muscle jo aapke little or you can say the most lateral toe ke liye hoti hai and this is known as abductor digiti minimi. So here you will have the muscle is known as abductor. This is abductor digiti minimi. Clear? So in this way you will find that the first layer is having the three muscles.

What are the name? Flexor digitorum brevis, abductor digiti minimi and abductor hallucis.

Now we'll see the muscles in the second layer of the sole.

So what are the muscles in the second layer? In the second layer you will find the muscles those are having long tendons of extrinsic muscles and it is having a combination of short muscles of your sole.

theek hai. Ab jo long tendons hain, wo long tendons kahan se aa rahe hain? Posterior compartment se aa rahe hain. Posterior compartment of leg ke do long tendons humein second layer mein milte hain. First is known as flexor hallucis longus and second is known as flexor digitorum longus. theek hai. So long extrinsic tendons kaun-kaun se hain? Flexor hallucis longus and flexor digitorum longus.

Now ye jo flexor digitorum longus hai, is flexor digitorum longus se short muscles arise hoti hain. These are known as lumbricals. These are lumbricals. Clear? Plus you will have a very important short muscle is known as accessorius muscle. This is accessorius muscle is also known as quadratus plantae.

What is that? Quadratus plantae. Now ye jo quadratus plantae muscle hai, iska aapke paas do teen information hai jo important hain. theek hai.

So pehle to hum ye dekhein ki second layer kya hai. Second layer of the muscle do set of muscles se banta hai. Ek to wo muscle jo long muscles hain. And ye long muscles actually arise kahan hui? Back of your leg mein. Inka naam kya hai? Flexor hallucis longus and flexor digitorum longus. Plus ye jo flexor digitorum longus hai, this flexor digitorum longus se short muscles arise hoti hain. These are known as lumbricals. theek hai. Lumbricals is a very important short muscle. Plus you will have a one more muscle that is known as flexor digitorum accessorius or you can have the other name of this muscle is quadratus plantae.

So second layer mein aapko ye char naam yaad rakhne hain. Do long muscles and do set of short muscles. theek hai. Ab yahan pe is quadratus plantae lumbricals ke bare mein jo information hai jo aapko yaad rakhni hai usko main aapko samjhaun. So the pehli cheez ye hai ki jab bhi hum sole ko dekhte hain, when you will see the sole, is sole ka jo medial side hota hai, theek hai, ye jo medial border hai, is medial border pe yahan se you have the entry point and this point is known as tarsal tunnel.

theek hai. Ye jo tunnel hoti hai, ye medial malleolus ke peeche hoti hai aur jitna bhi structure aapke sole mein aa raha hai, wo isi point se aata hai. theek hai. To jaise hi ye aapki posterior tibial artery yahan aati hai to deep to this flexor retinaculum jaise hi ye sole mein enter karegi, it will divide into the two branches like this.

Ye jo branch medial border pe run kar rahi hai, this is known as medial plantar artery. Aur jo branch laterally jati hai, fifth metatarsal ki taraf ja ke phir turn mar rahi hai, this is your lateral plantar artery. theek hai. In this way you have seen that there are two arteries, medial plantar artery and lateral plantar artery. And you have the two sets of the nerve, medial plantar nerve and lateral plantar nerve. Clear? So ye jo medial plantar artery hoti hai, it is a smaller branch and lateral plantar artery is a bigger branch.

In this way, the medial plantar nerve is again a small nerve in term of the number of muscles supplied and the lateral plantar nerve is a more prominent nerve of the sole. Ye lateral plantar nerve do part mein divide hoti hai. Iska hum dekhte hain ki superficial branch and deep branch. theek hai.

To ye jo deep branch hai, ye medial plantar nerve ki branch nahi hoti hai. Ye cheez aapko yahan pe sole mein yaad rakhni hai ki ye jitne bhi structure aap nerve supply mein padhte ho, for example if I am talking about these interossei. So ye interossei agar mujhe supply karne hain to lateral plantar nerve ko mujhe yahan pe jab main padhunga to I am talking about the deep branch.

Aur jab main first aur second layer ke beech mein padh raha hun, when I am reading in this plane, then I am talking about the trunk of your lateral plantar nerve. So lateral plantar nerve yahan pe to kya hai trunk se supply karta hai. theek hai. Aur jab wo third aur fourth layer ke beech mein pahuncha to hum phir kya padhte hain lateral plantar nerve ki deep branches padhte hain. theek hai.

So yahan pe aapko itna concept rakhna hai ki agar aap six layers count kar rahe ho to first layer mein muscle hai, second mein neurovascular bundle hai, third mein phir muscle hain, theek hai, aur third aur fourth layer ke beech mein wapas se kya hai? Phir se neurovascular bundle hai. theek hai.

So this is all about the arrangement of the layers. theek hai. So jab bhi aap sole padhte ho, you should know about the skin, you should know about the aponeurosis and you should know about the four layers, the name of the muscles and where you will find the neurovascular bundle.