Plantar Medial

Fig. 20.10. The muscles of the lower hind limb in cross-section. In this image, anterior is down and medial is left. Abbreviations are as follows MG, medial gastrocnemius LG, lateral gastrocnemius Plant, plantaris PN, plantar nerve Sol, soleus Fib, fibula EDL, extensor digitorum longii TA, tibialis anterior Tib, tibia. The mouse muscles are predominantly fast muscle fibers, but the soleus is valuable for its high percentage of slow fibers. Note, the darker mass on the posterior portion of the leg is a lymph node that provides a convenient landmark when sectioning to establish that reproducible sections are examined in the proximal/distal axis. Also, the peripheral muscles in the section are the hamstrings, which insert along the tibia in the lower leg in the mouse. (Color figure is available online).

There are variations in the thickness of the epidermis and dermis within species in different regions of the body (Table 35.1). Skin is the thickest over the dorsal and lateral surfaces of limbs, and thinner on the ventral and medial surfaces of limbs. The back (thoracolumbar lumbar junction) is usually thicker than the abdomen. In areas possessing high hair density, the epidermis is thin whereas in glabrous areas such as mucocutaneous junctions, the epidermis is thicker. The palmar and plantar surfaces consist of extremely thick stratum corneum because it is an area where abrasive action occurs. 

An 83-year-old woman developed coma, respiratory depression, hypotonia with generalized hyporeflexia, bilateral extensor plantar responses, and bullous eruptions containing serous fluid over the medial aspects of the knees after taking seven temazepam tablets (12). 

Posterior medial third of foot (plantar aspect)... 

Massicotie, C., Barber, D. S., Jortner, B. S., and Ehrich, M. (2001). Nerve conduction and ATP concentrations in sciaiic-tibial and medial plantar nerves of hens given phenyl saligenin phosphate. NeumToxicology 22, 91-98. 

Skin is usually thickest over the dorsal surface of the body and on the lateral surfaces of the limbs. It is thin on the ventral side of the body and medial surfaces of the limbs. In regions with a protective coat of hair, the epidermis is thin in nonhairy skin, such as that of the mucocutaneous junctions, the epidermis is thicker. On the palmar and plantar surfaces, where considerable abrasive action occurs, the stratum corneum is usually the thickest. The epidermis may be smooth in some areas but has ridges or folds in other regions that reflect the contour of the underlying superficial dermal layer (Monteiro-Riviere, 1998). 

There are typically two sesamoids located on the plantar aspect of the head of the first metatarsal. The medial sesamoid is usually larger than the lateral. On occasion it can he bipartite and should not be mistaken for fracture. 

Dorsiflexion and plantar flexion of the ankle automatically create motion in both tibiofibular joints. Dorsiflexion causes the lateral malleolus to move laterally, to move vertically in a cephalad direction, and to rotate medially. This causes the superior tibiofibular joint to move in an upward posterior direction while rotating medially. The reverse occurs in plantar flexion. 

One channel Ankle plantar-flexion Lateral/ Medial gastrocnemius... 

At the medial ankle, the tibial nerve, a continuation of the medial trunk of the sciatic nerve, passes deep to the flexor retinaculum in the space between the medial malleolus and the medial wall of the calcaneus (Fig. 16.10a). The retinaculum consists of a thin fascia and forms the roof of the tarsal tunnel (Fig. 16.10). In addition to the nerve, the tarsal tunnel encloses the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons, the posterior tibial artery and two veins (Fig. 16.10a,b). Posteroinferior to the medial malleolus, the tibial nerve divides into the medial and lateral plantar nerves and the calcaneal nerve, which is responsible for the sensitive supply of the heel (Fig. 16.11). The plantar nerves supply the intrinsic foot muscles, except for the extensor digitorum brevis, which is innervated by the deep peroneal nerve. The posterior tibial artery accompanies the nerve deep to the flexor retinaculum and, inferior to the medial malleolus, it divides into medial and lateral plantar arteries (Fig. 16.11). 

Fig.16.11. Normal tibial nerve at the tarsal tunneL Gross dissection of the tarsal tunnel gives a closer look to the tibial nerve (arrows) and its divisional branches, the medial (1) and lateral (2) plantar nerves, and the calcaneal branches (arrowheads), a, posterior tibial artery. The insert on the left of the figure indicates the site of the anatomic specimen illustrated...

For examination of the ligamentous complex and tendons of the medial ankle, the patient is supine or seated with the plantar surface of the foot rolled externally or in a frog-leg position. 

Fig. 16.30 a,b. Normal tarsal tunnel, a Transverse 12-5 MHz US image obtained posterior to the medial malleolus (MM) demonstrates the tibial nerve (arrow) located close to the posterior tibial artery (a) and veins (v) and posterior to the tibialis posterior (tp) and flexor digitorum longus (fdl) tendons. All these structures lies in the tarsal tunnel and are covered by the flexor retinaculum (arrowheads), b Oblique transverse 12-5 MHz US scan at the medial heel shows the medial and lateral plantar nerves (arrows) as a result of division of the main trunk of the tibial nerve. The photographs at the upper left of the figures indicate probe positioning... 

Clinical features include limited plantar flexion of the foot compared with that of the nonaffected side and posterior ankle pain exacerbated hy plantar and dorsal flexion of the foot, anterior to and not involving the Achilles tendon. Bony abnormalities in this area, and especially at the level of the posterior talus, may predispose to this syndrome. From the anatomic point of view, the posterior aspect of the talus has two tubercles, the medial and the lateral tubercle, between which the osteofibrous tunnel of the flexor hallucis longus tendon lies. In the ossification process of the... 

Tarsal tunnel syndrome refers to the entrapment of the main trunk of the tihial nerve and/or of its divisional branches (medial plantar nerve, lateral plantar nerve, calcaneal nerve) at the medial aspect of the ankle. This syndrome has an insidious clinical onset with numbness or pain in the foot and ankle and paresthesias in the sole of the foot, often with the heel being spared. However, clinical and electromyographic diagnosis of tarsal tunnel syndrome is often not straightforward, especially when a soft-tissue swelling on the medial ankle is absent. Depending on the site of compression, tarsal tunnel syndrome produces different clinical syndromes that can be classified as proximal or distal. The proximal syndrome consists of entrapment of the main trunk of the tibial nerve in the... 

The foot is characterized by a complex anatomy it is formed by 28 bones, 30 joints, and more than 100 muscles, tendons, and ligaments. Specific anatomic references are conventionally used when examining the foot, movements in the transverse plane being referred to the midline of the foot, vdiich is defined as the long axis of the second toe, and not to the midline of the body. As a consequence, adduction means movement toward the second toe and abduction means motion away from it. The abductor hal-lucis muscle, which lies on the medial edge of the plantar foot, is referred to as an abductor muscle... 

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