Foot: Anatomy

Bones and Joints

Bones of the foot

The 26 bones of the foot are divided into 3 groups: tarsals, metatarsals, and phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy.

• Tarsal bones (7):
  • Calcaneus:
    • Largest and strongest
    • Acts as a lever for the strong muscles of the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy, specifically the muscles of the posterior compartment
    • Articulates with the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy at the superior portion, forming the subtalar joint Subtalar Joint Formed by the articulation of the talus with the calcaneus. Ankle Joint: Anatomy
    • Articulates with the cuboid anteriorly
  • Talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy:
    • 2nd largest tarsal bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types
    • The majority of the talar surface is covered with articular cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology. 
    • No tendons or muscles insert to or originate from the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy.
    • Articulates with the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy, fibula Fibula The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. Leg: Anatomy, navicular, and calcaneus bones
  • Cuboid:
    • Anterior to the calcaneus, on the lateral side of the foot
    • Articulates with the calcaneus, lateral cuneiform, 4th–5th metatarsals, and occasionally the navicular
  • Navicular:
    • Anterior to the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy on the medial aspect of the foot
    • Articulates with the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy, medial, middle, and lateral cuneiforms, and occasionally with the cuboid
  • Cuneiforms (3):
    • Medial, middle (intermediate), and lateral
    • Configuration creates a keystone effect that contributes to the stability of the foot
• Metatarsal bones (5):
  • The bases Bases Usually a hydroxide of lithium, sodium, potassium, rubidium or cesium, but also the carbonates of these metals, ammonia, and the amines. Acid-Base Balance articulate with the tarsal bones proximally:
    • 1st–3rd metatarsals articulate with the cuneiforms
    • 3rd–5th metatarsals articulate with the cuboid
  • The distal heads articulate with the proximal phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy.
  • The 1st metatarsal is the shortest and strongest. 
  • The 2nd metatarsal is the longest.
• Phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy (14):
  • Small bones of the digits
  • Each toe has 3 phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy: proximal, middle, and distal
    • The exception is the hallux, which has only a proximal and a distal phalanx.
    • A common variant is a fused middle and distal phalange of the 5th digit.
• Other bones of the foot:
  • Sesamoid bones:
    • 2 sesamoid bones are usually present at the plantar area of the 1st metatarsal phalangeal joint, within the tendon of the flexor hallucis brevis.
    • Increase the mechanical advantage of the 1st digit
  • Common accessory ossicles or accessory bones of the foot:
    • Os trigonum: found at the posterior aspect of the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy
    • Os navicular (accessory navicular): medial aspect of the navicular
    • Os peroneum: accessory bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types within the peroneus longus tendon
    • Bipartite sesamoid: Sesamoids of the 1st digit fail to ossify, resulting in a fibrous Fibrous Fibrocystic Change union.

Mnemonic

From superior to inferior and from medial to lateral in a right foot: Talus, Calcaneus, Navicular, Medial cuneiform, Intermediate or middle cuneiform, Lateral cuneiform, Cuboid

• The Cab in New Mexico Is a Land Cruiser
• The Cub Needs MILC

Joints of the foot

The joints of the foot, from proximal to distal, include the following articulations.

Subtalar or talocalcaneal joint Talocalcaneal joint Formed by the articulation of the talus with the calcaneus. Ankle Joint: Anatomy: 

• Type: synovial joint Synovial joint Jaw and Temporomandibular Joint: Anatomy or plane synovial joint Synovial joint Jaw and Temporomandibular Joint: Anatomy
• Composed of 3 alternating convex–concave areas on each of the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy and calcaneus bones
• Supporting ligaments:
  • Anterior, posterior, lateral, and medial talocalcaneal ligaments 
  • Interosseous talocalcaneal ligament (the strongest of this joint, lies within the sinus tarsi or tunnel between the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy and calcaneus)
• Function:
  • Inversion and eversion Eversion Chronic Apophyseal Injury of the foot
  • Minimal amount of dorsiflexion

Transverse tarsal or midtarsal joint Midtarsal Joint Ankle Joint: Anatomy: 

• Type:
  • The talocalcaneonavicular joint Talocalcaneonavicular joint Ankle Joint: Anatomy is a modified ball-and-socket joint.
  • The calcaneocuboid joint Calcaneocuboid joint Ankle Joint: Anatomy is a modified saddle-type joint.
• Components:
  • Talocalcaneonavicular joint Talocalcaneonavicular joint Ankle Joint: Anatomy:
    • Head of the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy
    • Concavity formed by the posterior area of the navicular and anterior area of the calcaneus 
  • Calcaneocuboid joint Calcaneocuboid joint Ankle Joint: Anatomy:
    • Distal surface of the calcaneus 
    • Proximal area of the cuboid
• Supporting ligaments:
  • Talocalcaneonavicular joint Talocalcaneonavicular joint Ankle Joint: Anatomy: articular capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides, dorsal talonavicular ligament, and plantar calcaneonavicular ligament
  • Calcaneocuboid joint Calcaneocuboid joint Ankle Joint: Anatomy: bifurcate (Y-shaped) ligament superiorly, long plantar ligament inferiorly, and short plantar ligament
• Function:
  • Talocalcaneonavicular joint Talocalcaneonavicular joint Ankle Joint: Anatomy performs inversion and eversion Eversion Chronic Apophyseal Injury of the foot
  • Calcaneocuboid joint Calcaneocuboid joint Ankle Joint: Anatomy performs gliding and rotational movements between the calcaneus and cuboid

Tarsometatarsal or Lisfranc joints: 

• Type: arthrodial joints
• Components:
  • 1st–3rd metatarsals articulate with the cuneiforms
  • 3rd–5th metatarsals articulate with the cuboid
• Supporting ligaments:
  • Dorsal and plantar tarsometatarsal ligaments
  • Interosseous cuneometatarsal ligaments
    • The strongest of these is the Lisfranc ligament, which extends from the 2nd metatarsal to the lateral aspect of medial cuneiform.
• Function:
  • Minimal gliding movement
  • Primarily stability

Metatarsophalangeal joints:

• Type: condyloid joints
• Components: articulations between the metatarsal heads and the base of the proximal phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy of the digits
• Supporting ligaments:
  • A capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides encloses each joint.
  • Medial and lateral collateral ligaments 
  • Plantar ligament 
• Function:
  • Flexion Flexion Examination of the Upper Limbs and extension Extension Examination of the Upper Limbs
  • Abduction Abduction Examination of the Upper Limbs and adduction Adduction Examination of the Upper Limbs
  • Circumduction

Plantar Arches and Ligaments

The foot has 3 primary arches and multiple supporting ligaments.

Plantar arches

The plantar arches function to distribute and absorb the body weight, provide the foot with elasticity Elasticity Resistance and recovery from distortion of shape. Skeletal Muscle Contraction and resilience during locomotion, adapt to uneven surfaces, and protect the neurovasculature on the plantar surface.

• Medial longitudinal arch:
  • Formed by the calcaneus, talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy, navicular, cuneiforms, and 1st–3rd metatarsals
  • Generally the highest arch of the foot
  • Supported by the intrinsic muscles of the foot
• Lateral longitudinal arch:
  • Formed by the calcaneus, cuboid, and 4th–5th metatarsals
• Transverse arch:
  • Formed by the cuboid, cuneiforms, and bases Bases Usually a hydroxide of lithium, sodium, potassium, rubidium or cesium, but also the carbonates of these metals, ammonia, and the amines. Acid-Base Balance of the 1st–4th metatarsal bones
  • Forms the medial to lateral midfoot curvature

Plantar ligaments

The plantar ligaments are essential in the maintenance of the functional integrity of the arches on the sole of the foot.

• Long plantar ligament:
  • Longest and strongest ligament in the body
  • Supports the longitudinal arches
  • Connects the calcaneus and the cuboid bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types/base of 5th metatarsal
  • Converts the cuboid groove into a canal for the fibularis longus tendon
• Short plantar ligament:
  • Deep to the long plantar ligament
• Plantar calcaneonavicular ligament:
  • Also known as the spring ligament
  • Runs from the sustentaculum tali to the plantar surface of the navicular bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types
• Other ligaments that contribute to the structural integrity of the arches:
  • Plantar cuneonavicular ligament 
  • Plantar intercuneiform ligaments 
  • Plantar cuboideonavicular ligament
  • Plantar cuneocuboid ligaments

Plantar fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis or plantar aponeurosis

• Thick band of connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue: Histology that supports the bony arches of the foot
• Extends from the calcaneal tuberosity to the proximal phalanges Phalanges Bones that make up the skeleton of the fingers, consisting of two for the thumb, and three for each of the other fingers. Hand: Anatomy
• Divides the foot into lateral, medial, and central compartments through septa of the plantar aponeurosis

Muscles of the Dorsum of the Foot

Aside from the tendons of the extrinsic muscles from the anterior compartment of the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy ( extensor hallucis longus Extensor hallucis longus Leg: Anatomy, extensor digitorum Extensor digitorum Forearm: Anatomy, tibialis anterior Tibialis anterior Leg: Anatomy, and peroneus tertius Peroneus tertius Leg: Anatomy), which pass under the extensor retinaculum, only 2 intrinsic muscles exist on the dorsum of the foot: 

• Extensor digitorum Extensor digitorum Forearm: Anatomy brevis
• Extensor hallucis brevis

Muscles of the Sole of the Foot

The intrinsic muscles of the plantar surface, or sole, of the foot both originate and insert within the foot. These muscles produce the fine movements of the digits and support the arches of the foot during standing, walking, and running. Commonly, the plantar muscles of the foot are organized into 4 layers, from superficial to deep: 

• 1st layer:
  • Abductor hallucis
  • Flexor digitorum brevis
  • Abductor digiti minimi Abductor digiti minimi Hand: Anatomy
• 2nd layer:
  • Quadratus plantae
  • Lumbricals Lumbricals Hand: Anatomy
• 3rd layer:
  • Flexor hallucis brevis
  • Adductor hallucis
  • Flexor digiti minimi brevis Flexor digiti minimi brevis Hand: Anatomy
• 4th layer:
  • Plantar (3) interossei Interossei Hand: Anatomy
  • Dorsal (4) interossei Interossei Hand: Anatomy

Alternatively, the intrinsic muscles of the plantar surface, or sole, of the foot can be divided into 3 groups, using the medial, lateral and central compartments of the foot.  These compartments are formed by the deep fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis or plantar aponeurosis.

• Lateral plantar muscles act on the 5th toe:
  • Abductor digiti minimi Abductor digiti minimi Hand: Anatomy
  • Flexor digiti minimi brevis Flexor digiti minimi brevis Hand: Anatomy
  • Opponens digiti minimi Opponens digiti minimi Hand: Anatomy ( variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables)
• Central plantar muscles act on the 2nd–5th digits
  • Flexor digitorum brevis
  • Quadratus plantae
  • Lumbrical muscles
  • Dorsal and plantar interossei Interossei Hand: Anatomy muscles
• Medial plantar muscles act on the hallux
  • Abductor hallucis
  • Flexor hallucis brevis
  • Adductor hallucis

Neurovasculature

Innervation

Primarily from branches of the tibial nerve Tibial Nerve The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. Popliteal Fossa: Anatomy and the deep fibular nerve.

Innervation of the plantar surface:

The tibial nerve Tibial Nerve The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. Popliteal Fossa: Anatomy branches into the medial and lateral plantar nerves at the ankle within the tarsal tunnel.

• Medial plantar nerve:
  • Courses posterior to the medial malleolus Medial malleolus Ankle Joint: Anatomy and deep to the abductor hallucis muscle
  • Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology function:
    • 1st lumbrical 
    • Abductor hallucis
    • Flexor hallucis brevis 
    • Flexor digitorum brevis
  • Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology function:
    • Anterior ⅔ of the medial sole
    • Medial 3½ digits, including the nail beds
• Lateral plantar nerve:
  • Runs deep to the abductor hallucis muscle and between the flexor digitorum brevis and quadratus plantae muscles
  • Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology function:
    • Lumbricals Lumbricals Hand: Anatomy (2–4)
    • Dorsal and plantar interossei Interossei Hand: Anatomy 
    • Abductor digiti minimi Abductor digiti minimi Hand: Anatomy
    • Quadratus plantae
    • Adductor hallucis
    • Flexor digiti minimi brevis Flexor digiti minimi brevis Hand: Anatomy
  • Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology function:
    • ⅔ of the lateral sole
    • Lateral 1½ digits

Innervation of the dorsal surface:

• Superficial fibular or peroneal nerve Peroneal nerve The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. Popliteal Fossa: Anatomy:
  • Originates from the common fibular nerve Common Fibular Nerve The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. Popliteal Fossa: Anatomy
  • Supplies the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions of the dorsum of the foot, excluding digits 1, 2, and 5
• Deep fibular or peroneal nerve Peroneal nerve The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. Popliteal Fossa: Anatomy:
  • Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology innervation to the 1st web space (1st and 2nd digits)
  • Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology innervation to the extensor digitorum Extensor digitorum Forearm: Anatomy brevis and extensor hallucis brevis
• Saphenous nerve:
  • Originates from the femoral nerve Femoral Nerve A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints. Femoral Region and Hernias: Anatomy
  • Supplies the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions of the medial side of the ankle joint Ankle joint The ankle is a hinged synovial joint formed between the articular surfaces of the distal tibia, distal fibula, and talus. The ankle primarily allows plantar flexion and dorsiflexion of the foot. and foot
  • Supplies the distal aspect of the 1st metatarsal
• Sural nerve:
  • Lateral dorsal cutaneous
  • Lateral calcaneal

Blood supply

Posterior tibial artery:

• Origin:
  • The most proximal posterior tibial artery 
  • The largest terminal branch of the popliteal artery Popliteal Artery The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries. Popliteal Fossa: Anatomy
  • Enters the foot by passing behind the medial malleolus Medial malleolus Ankle Joint: Anatomy of the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy, where it provides branches to the ankle joint Ankle joint The ankle is a hinged synovial joint formed between the articular surfaces of the distal tibia, distal fibula, and talus. The ankle primarily allows plantar flexion and dorsiflexion of the foot.
  • The terminal branches are the lateral and medial plantar arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology.
• Location:
  • Palpated posterior to the medial malleolus Medial malleolus Ankle Joint: Anatomy 
  • Courses through the tarsal tunnel behind the medial malleolus Medial malleolus Ankle Joint: Anatomy.
• Function:
  • Supplies the posterior compartment of the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy via the tarsal tunnel
  • Supplies the entire plantar surface of the foot via the medial plantar and lateral plantar arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology:
    • Medial plantar artery: supplies medial aspect of the 1st metatarsal and the 1st digit
    • Lateral plantar artery: supplies the majority of the sole of the foot and gives rise to the deep plantar arch

Anterior tibial artery:

• Origin:
  • A terminal branch of the popliteal artery Popliteal Artery The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries. Popliteal Fossa: Anatomy
  • Passes in front of the ankle joint Ankle joint The ankle is a hinged synovial joint formed between the articular surfaces of the distal tibia, distal fibula, and talus. The ankle primarily allows plantar flexion and dorsiflexion of the foot. and becomes the dorsalis pedis artery in the foot
  • Reaches the 1st intermetatarsal space and branches into:
    • Lateral tarsal artery → arcuate artery
    • 1st dorsal metatarsal artery  
    • Forms an anastomosis with the lateral plantar artery → deep plantar arch
• Location:
  • Lateral to the extensor hallucis longus Extensor hallucis longus Leg: Anatomy tendon
  • Medial to the extensor digitorum longus Extensor digitorum longus Leg: Anatomy and deep peroneal nerve Peroneal nerve The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. Popliteal Fossa: Anatomy
  • Pulse is palpated between the extensor hallucis longus Extensor hallucis longus Leg: Anatomy and the extensor digitorum longus Extensor digitorum longus Leg: Anatomy tendons on the dorsum of the foot.
• Function:
  • Supplies the tarsal bones 
  • Supplies the dorsal aspect of the metatarsals

Venous drainage

Venous drainage of the foot begins with the digital veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology, which run proximally to form both a deep plantar venous arch and a dorsal venous arch. These veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology drain into the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy via the anterior and posterior tibial veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology and the peroneal vein.

Clinical Relevance

Foot deformities Foot deformities Foot deformities in children include congenital or acquired malformations of the feet. Two common examples are talipes equinovarus, commonly known as clubfoot, and metatarsus adductus, also called metatarsus varus. Foot Deformities

• Bunion: hallux valgus deformity Deformity Examination of the Upper Limbs that presents as pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways at the medial aspect of the 1st metatarsal phalangeal joint as well as associated deformity Deformity Examination of the Upper Limbs.
• Hammer toe: common flexion Flexion Examination of the Upper Limbs deformity Deformity Examination of the Upper Limbs of the proximal interphalangeal joints Interphalangeal joints Hand: Anatomy of the 2nd–4th digits. Hammer toe is caused by shoe wear, trauma, rheumatologic disorders, and neurologic conditions. Initial treatment includes shoe modification, padding, orthotics, and surgical intervention to correct the deformity Deformity Examination of the Upper Limbs if medical management fails.
• Lisfranc injury: fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures/dislocation of the tarsal–metatarsal articulations at the junction of the midfoot and forefoot. This injury commonly occurs when there is indirect loading on a plantar-flexed foot or with a crush injury Crush injury Excessive compression of parts of the body that causes muscle swelling, fracture, and/or neurological disturbances in the affected areas. Crush injury with systemic manifestations is referred to as crush syndrome. Crush Syndrome. The Lisfranc ligament, which is found between the medial cuneiform and the base of the 2nd metatarsal bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types, is disrupted. This type of injury commonly needs a CT scan for detection, as it may be missed with an x-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests. A Lisfranc injury may lead to chronic injury.
• Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura cavus: excessively arched foot or “claw foot.” Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura cavus is usually caused by neurologic disorders, resulting in plantar hyperflexion of the 1st metatarsal. 
• Pes planus Pes Planus Ehlers-Danlos Syndrome: Also known as “flat foot,” pes planus Pes Planus Ehlers-Danlos Syndrome is due to a collapse of the longitudinal arches, especially the medial longitudinal arch. Pes planus Pes Planus Ehlers-Danlos Syndrome can be a common congenital nonpathologic condition, or it can develop in adults (adult-acquired flatfoot deformity Deformity Examination of the Upper Limbs).
• Plantar metatarsophalangeal sprain or turf toe: sprain or disruption of the plantar stabilizers of the 1st metatarsal phalangeal joint.
• Plantar fasciitis Plantar fasciitis Inflammation of the plantar fascia (aponeurosis) on the bottom of the foot causing heel pain. The etiology of plantar fasciitis remains controversial but is likely to involve a biomechanical imbalance. Though often presenting along with heel spur, they do not appear to be causally related. Ankle and Foot Pain: common degenerative condition of the proximal plantar fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis. Presentation is with heel pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways with the 1st step in the morning or with prolonged standing.
• Tarsal coalitions: union of ≥ 2 tarsal bones. Tarsal coalitions occur most commonly between the talus Talus The second largest of the tarsal bones. It articulates with the tibia and fibula to form the ankle joint. Ankle Joint: Anatomy and calcaneus or the navicular and calcaneus and are usually asymptomatic until adolescence.