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Plantar layers of the foot
Scenario 1: A muscle, which is not supplied by the tibial nerve or its branches.
Clinical Rationale:
Fourth layer.
Scenario 2: A group of muscles supplied by both the medial and lateral plantar nerves.
Clinical Rationale:
Second layer.
Scenario 3: The muscles related to the knot of Henry.
Clinical Rationale:
Second layer. The layers of the foot are as follows: Dorsal layer – extensor digitorum brevis First plantar layer – abductor hallucis, flexor digitorum brevis, abductor digiti minimi Second plantar layer – quadratus plantae, lumbricals, flexor digitorum longus, flexor hallucis longus Third plantar layer – flexor hallucis brevis, adductor hallucis, flexor digit minimi brevis Fourth plantar layer – interossei, peroneus longus, tibialis posterior The peroneus longus is in layer 4 and supplied by the superficial peroneal nerve. The lumbricals, in layer 2, are supplied by both the medial (first) and lateral (second to fourth) plantar nerves. The flexor hallucis longus and flexor digitorum longus cross at the knot of Henry.
Angles on radiographs
Scenario 1: On a lateral radiograph, this is the angle between the downward slope of the
Clinical Rationale:
Angle of Gissane.
Scenario 2: On a standing lateral radiograph, this is the angle between the plantar cortex
Clinical Rationale:
Calcaneal pitch angle.
Scenario 3: On an anteroposterior radiograph of the foot, the angle between a line bisecting the
Clinical Rationale:
Kite’s angle. The hallux valgus angle (anteroposterior (AP)) is the angle between the longitudinal axes of the first metatarsal and proximal phalanx, and is normally less than 15. It is increased in hallux valgus. The intermetatarsal angle (AP) is the angle between the longitudinal axes of the first and second metatarsal, and is normally less than 10. It is increased in hallux valgus. The distal metatarsal articular angle (AP) is the angle between the distal articular surface of the first metatarsal head and the long axis of the first metatarsal. It is normally less than 10, and is increased in congruent hallux valgus. It is also known as the proximal articular set angle. Kite’s talocalcaneal angle (AP) is the angle between a line bisecting the head and neck of the talus and a line running parallel with the lateral surface of the calcaneum, it is normally less than 20–40. It is decreased in clubfoot. Bohler’s angle is the angle between a line between the anterior process of the calcaneum and the highest point of the posterior articular surface, and a line connecting the highest point on the posterior articular surface and superior tuberosity on the lateral radiograph. It is normally 25–40, and is decreased in intra-articular calcaneal fractures. The angle of Gissane is the angle between the downward slope of the posterior facet of the calcaneum and the upward slope of the anterior calcaneal process. It is normally 120–145 if increased in joint depression fractures of the calcaneum. The calcaneal pitch angle is the angle between the plantar cortex of the calcaneum and a line parallel to the floor. It is normally 10–30 if decreased in pes planus and increased in pes cavus. Fowler–Philip’s angle is the angle between a line tangential to the anterior tubercle and the plantar tuberosity of the calcaneum and a line tangential to the posterior prominence at the insertionoftheAchillestendon.Itisnormally45–70,andincreasedwithaHaglund’sdeformity. Hibbs’ angle is the angle between the axes of the calcaneum and the first metatarsal, on a lateral radiograph, and is normally less than 130. It is decreased in pes cavus and increased in pes planus. Meary’s angle is the angle measured on a lateral weight-bearing radiograph, between the long axes of the talus and first metatarsal, and is normally 0. It flattens with pes planus and steepens with pes cavus. 138
