Deep palmar arch patterns in Brazilian individuals

The deep palmar arch is very important in the blood supply to the hand. Consequently, the radial artery and the deep palmar arch were studied in 60 hands from 30 cadavers of adult Brazilian individuals, of both sexes. The cadavers belong to the Universidade Federal de São Paulo, Brazil. The hand arteries were injected with red stained latex neoprene the deep palmar arch was observed in 59 preparations (98.3%). The arch conformation was classified in two groups, according to the course of the radial artery through the interosseous spaces from the dorsal to the deep palmar region. In group I the radial artery passed through the first interosseous space, and was observed in 51 preparations (85.0%) in group II, the artery passed through the second interosseous space, and was observed in 8 preparations (13.3%). In each group the arches were subdivided according to the number and origin of the deep palmar branch. In group I the arch was formed by the radial artery anastomosing with one deep palmar branch in 41 cases (68.3%), and with two deep palmar branches in 10 cases (16.7%). These branches originated from the ulnar artery, ulnar proper palmar digital artery of the little finger or the common palmar digital artery of the fourth interosseous space. In group II the deep palmar arch was formed by the radial artery anastomosing with one deep palmar branch in 7 cases (11.7%) and in only one case (1.7%) with two deep palmar branches. Knowledge of the arterial variations is very important for surgical procedures in the palmar region.     

Anatomic study of the deep plantar arch

A thorough knowledge of the topography and relations of the plantar arteries is necessary for further advances in arterial reconstruction in the foot. Such reconstruction often avoids amputation in cases of arterial trauma in industrial and automobile accidents, as well as in patients with diabetes and severe ischemia of the lower limbs. Although several studies have addressed the anatomy of the arteries of the foot, there is a shortage of recent studies on surgical vascular anatomy. The deep plantar arch was studied in 50 adult cadaveric feet. It was present in all feet and formed from the anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 48% of the specimens (Type I arches) and the deep branch of the lateral plantar artery in 38% (Type II) with the contribution of each being approximately equal in 14% (Type III). The location of the deep plantar arch can be estimated. The distance between the deep plantar arch and each interdigital commissure was relatively consistent between the subjects, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the middle II part of this third in 62%. The mean external diameter of the deep branch of lateral plantar artery was 1.7 mm +/- 0.4 mm. The mean external diameter of the deep plantar artery was also 1.7 mm +/- 0.4 mm. We observed a complete superficial plantar arch in only one specimen (2%). Our findings should assist vascular surgeons in estimating the location of the deep plantar arch from the patient's foot length and in providing other data.     

The effect of foot arch on plantar pressure distribution during standing

Abstract

The aim of this study was to explore how foot type affects plantar pressure distribution during standing. In this study, 32 healthy subjects voluntarily participated and the subject feet were classified as: normal feet (n?=?23), flat feet (n?=?14) and high arch feet (n?=?27) according to arch index (AI) values obtained from foot pressure intensity image analysis. Foot pressure intensity images were acquired by a pedopowergraph system to obtain a foot pressure distribution parameter-power ratio (PR) during standing in eight different regions of the foot. Contact area and mean PR were analysed in hind foot, mid-foot and fore foot regions. One-way analysis of variance was used to determine statistical differences between groups. The contact area and mean PR value beneath the mid-foot was significantly increased in the low arch foot when compared to the normal arch foot and high arch foot (p?<?0.001) in both feet. However, subjects with low-arch feet had significantly higher body mass index (BMI) compared to subjects with high-arch feet (p?<?0.05) and subjects with normal arch feet (p?<?0.05) in both feet. In addition, subjects with low-arch feet had significant differences in arch index (AI) value as compared to subjects with high-arch feet (p?<?0.001) and subjects with normal arch feet (p?<?0.05) in both feet. Mean mid-foot PR value were positively (r?=?0.54) correlated with increased arch index (AI) value. A significant (p?<?0.05) change was obtained in PR value beneath the mid-foot of low arch feet when compared with other groups in both feet. The findings suggest that there is an increased mid-foot PR value in the low arch foot as compared to the normal arch foot and high arch foot during standing. Therefore, individuals with low arch feet could be at high risk for mid-foot collapse and Charcot foot problems, indicating that foot type should be assessed when determining an individual’s risk for foot injury.     

Multislice CT angiography of the plantar arch

The aim of this case report is to present a multislice computed tomography angiography (CTA) procedure for viewing the plantar arch. A CTA was requested to determine the vascular sufficiency of the plantar arch of a 64-year-old patient with necrotic and gangrenous toes. The patient had recently undergone a proximal wedge osteotomy procedure for correction of a hallux valgus deformity. A 16-detector row CT scanner with 1.25 mm slice thickness and 0.625 mm reconstruction interval was used to reconstruct multiplanar reformats, maximum intensity projections and three-dimensional volume rendered images of the foot in question in both arterial and venous phases to determine if pathology of the plantar arch was present. The 3D reconstructed images of CTA demonstrated a loss of continuity of the plantar arch between the first and third metatarsals. This case report shows the diagnostic value of multislice CTA, especially 3D visualisation in the assessment of peripheral vascular branches.     

The effects of the communicating branch between medial and lateral plantar nerves on the innervations of the foot lumbrical muscles

Introduction

The communicating branches between the medial (MPN) and lateral (LPN) plantar nerves aren’t frequently observed in relation to the innervation of the foot muscles in previous studies. In this study, the number and localization of the communicating branch on the innervations of foot muscles were evaluated to open a new sight considering the innervations of lumbrical muscles.

足弓第2与第5跖列的肌骨系有限元模型及其临床意义

目的：建立足部内侧纵弓第2跖列与外侧纵弓第5跖列的肌骨系统有限元模型,为研究跖骨应力性骨折与相关足痛症提供生物力学工具。方法：采用中国虚拟人“女性1号”CT图像和MRI图像;应用非线性有限元方法进行生物力学分析。结果：构建了包含皮质骨、松质骨、软骨、韧带、足底腱膜、肌腱、固有肌、脂肪垫、骨髓腔与骨髓窦等10种组织的第2、第5跖列的有限元模型。足弓直立时,最大von Mises应力／应变位于第2、第5跖骨骨干与基底。各种足底软组织中,足底腱膜承担着最大张拉应力,其次为足底长韧带,足底固有肌张拉应力最小。结论：有限元预测的应力应变为研究跖骨应力性骨折,足底腱膜炎引起的慢性跟骨痛,以及足弓塌陷的发生机制提供了生物力学依据。     

足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖

目的　为足内侧岛状皮瓣修复足底外侧皮肤缺损提供解剖学依据。   方法　35侧成年尸体足标本,经动脉灌注红色乳胶,在手术显微镜下(×10)解剖观测母展肌上缘动脉弓与足底内侧动脉深支内侧支吻合的位置、外径及长度。  结果  　母展肌上缘动脉弓与足底内侧动脉深支内侧支在内侧楔骨内侧有一较恒定的吻合,并把这一吻合支暂命名为足内缘动脉弓。形成足内缘动脉弓占82.8%（29侧）,吻合处外径为(0.65±0.21)mm,长度为（2.63±0.71）mm;未发现吻合动脉弓占17.2%（6侧）。  结论　以足内缘动脉弓为蒂的足内侧岛状皮瓣可以修复足底外侧皮肤缺损。     

椎弓根的解剖学观测与临床意义

目的 为临床脊柱手术提供形态学资料.方法 对36具成人尸体的整体脊柱标本,使用游标卡尺测量C_3～L_5椎弓根的高和宽.分别计算各节段椎弓根高和宽的均值和标准差,并分段计算颈椎(C_3～C_7)、胸椎、腰椎各段椎弓根高和宽的平均值.结果 C_3～C_7的高和宽分别为6.77mm和5.50mm;胸椎分别为12.30mm和6.37mm;腰椎平均值分别为15.97mm和9.41mm.结论 提供国人椎弓根的解剖学资料,为临床椎弓根螺钉内固定提供应用解剖学基础.     

Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis

The plantar aponeurosis (PA), in spanning the whole length of the plantar aspect of the foot, is clearly identified as one of the key structures that is likely to affect compliance and stability of the longitudinal arch. A recent study performed in our laboratory showed that tension/elongation in the PA can be predicted from the kinematics of the segments to which the PA is attached. In the present investigation, stereophotogrammetry and inverse kinematics were employed to shed light on the mechanics of the longitudinal arch and its main passive stabilizer, the PA, in relation to walking speed. When compared with a neutral unloaded position, the medial longitudinal arch underwent greater collapse during the weight‐acceptance phase of stance at higher walking speed (0.1°±1.9° in slow walking; 0.9°±2.6° in fast walking; P = 0.0368). During late stance the arch was higher (3.4°±3.1° in slow walking; 2.8°±2.7° in fast walking; P = 0.0227) and the metatarsophalangeal joints more dorsiflexed (e.g. at the first metatarsophalangeal joint, 52°±5° in slow walking; 64°±4° in fast walking; P < 0.001) during fast walking. Early‐stance tension in the PA increased with speed, whereas maximum tension during late stance did not seem to be significantly affected by walking speed. Although, on the one hand, these results give evidence for the existence of a pre‐heel‐strike, speed‐dependent, arch‐stiffening mechanism, on the other hand they suggest that augmentation of arch height in late stance is enhanced by higher forces exerted by the intrinsic muscles on the plantar aspect of the foot when walking at faster speeds.     

趾足底固有动脉趾端动脉弓及其分支的显微解剖

目的　解剖观测趾足底固有动脉趾端动脉弓及其分支的解剖学特点。 方法　选取新鲜成人足标本8只,分别经足背动脉灌注红色乳胶,对第2趾趾足底固有动脉进行显微解剖,观察趾足底固有动脉弓的出现概率,位置及其口径,趾端动脉弓发出的弓上动脉的起始部位,走行方向,分支数目及血管口径情况。 结果　第2趾趾足底固有动脉趾端动脉弓恒定,动脉弓的外径为0.5~0.8 mm,平均外径为0.64 mm,动脉弓距趾端的距离为9.5~13.0 mm,平均为11.1 mm。动脉弓上发出5支恒定的分支,即趾端弓上动脉,我们将其命名为第1~5支趾端弓上动脉（由胫侧至腓侧）。 结论 第2趾趾端动脉弓及其发出的弓上动脉解剖恒定,可以采用弓上动脉为蒂的微型轴型皮瓣改善第2足趾再造后外形。     

足底腱膜的解剖

目的观察足底腱膜的形态结构,为临床应用提供相关的解剖学资料。方法解剖50只10%甲醛固定的足,观察足底腱膜浅层的形态结构;测量足底腱膜中间部(跖腱膜)止于跖骨头处内、外侧纤维束的厚度与长度;跖腱膜中间部的厚度。结果足底腱膜浅层的纤维结构主要参与前外侧部足底脂肪垫的构成,并形成与足底皮纹相似的螺旋纤维板状结构,足跟部足底腱膜浅层的纤维结构较为稀疏。中间部的厚度为(2.168±0.1139)mm;跖腱膜于第1跖骨头处内、外侧纤维束的厚度分别为(1.33±0.08)mm、(1.46±0.07)mm,明显大于止于2~5跖骨头处的内、外侧纤维厚度,P0.05;第5跖骨头处的内、外侧纤维厚度分别为(0.29±0.02)mm、(0.37±0.04)mm,明显小于1~4跖骨头处的内、外侧纤维厚度,P0.05。结论足底腱膜浅层主要参与足前外侧脂肪垫的构成,足底腱膜深层对维持足部纵弓的稳定起着非常重要的作用,在足部受力时有效地避免足前部趾足底总神经、趾足底总血管受压。     

Pseudoganglion on the connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve

The connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve often has an enlarged site. We investigated these enlarged sites of the connecting branches. We observed the 22 human feet of 20 Japanese cadavers. We investigated the connecting branch macroscopically and histologically. We found the connecting branches between the deep branch of the lateral plantar nerve and medial plantar nerve in 19 feet out of 22 feet. This connecting nerve branch was interposed between the tendon of the flexor hallucis longus and the flexor hallucis brevis, and there enlarged in the anteroposterior direction. After penetration, numbers of fascicles of this connecting branch were increased at the enlarged site. In this region, the connective tissues surrounding the nerve fascicles and vessels were more developed compared with the adjoining sides of this branch. A few fascicles at this enlarged site innervated the first metatarsophalangeal joint capsule. Other nerve fascicles arose from the connecting branch and branched off muscular branches to the flexor hallucis brevis. This branch possibly receives the physical exertion or friction during gait due to its position. Deformity and overload of the foot can cause sensory disorders of the foot, but the anatomical basis for the relationship between the deformity/overload and sensory disorders of the foot is unclear. We discussed that this connecting branch can be a potential cause of pressure neuropathies in the human foot.     

足底内侧动脉深支的观测及临床应用

目的 为足底内侧动脉深支的走行及皮瓣动脉提供解剖学资料。方法 在40侧灌注红色乳胶的固定成人下肢标本上解剖观测了足底内侧动脉深支的走行及在足底内侧皮肤和足内侧皮肤的供血。结果 足底内侧动脉深支长(8.7±0.2)cm,起始处血管外径(1.8±0.3)mm;沿途发出3～5条皮穿支分布到足内侧皮肤,外径(1.1±0.3)mm。足底内侧动脉深支内侧皮支分布到足内侧皮肤,外径(1.1±0.3)mm。结论 以足底内侧动脉深支及不同分支为血管蒂可为足底内侧及足内侧皮瓣提供充足的血供。     

Dimensions of the anterior tarsal tunnel and features of the deep peroneal nerve in relation to clinical application

Background The aim of this study was to demonstrate anatomical features of the anterior tarsal tunnel and the deep peroneal nerve and to discuss the importance of these structures for the anterior tarsal tunnel syndrome and some other surgical approaches to minimize the injury risk. Methods Lower limbs of 18 formalin fixed cadavers were examined. The limbs showed no evidence of pathology or trauma. Results The lateral length of the tunnel was 21.7 ± 4.3 mm and the medial length of the tunnel was 55.0 ± 9.0 mm. The width of the tunnel at the inferior border between the extensor hallucis longus and extensor digitorum longus tendons was 12.6 ± 2.1 mm. The location of the deep peroneal nerve bifurcation was in the anterior tarsal tunnel in 31 specimens (86.1%) and distal to the tunnel in two specimens (5.6%). In three specimens (8.3%) there was no bifurcation because of the absence of the medial terminal branch of the deep peroneal nerve. In these three specimens, the superficial peroneal nerve distributed to the adjacent sides of the great and second toes. Bifurcation above the tunnel was not observed in our specimens. There was connection between the deep peroneal nerve and the superficial peroneal nerve in 10 specimens (27.8%) in the first interdigital space. During the observations, the presence of a fibrous band over the nerve and vessel was noted in 22 specimens (61.1%). Conclusions We believe that a detailed anatomic knowledge of the anterior tarsal tunnel and the deep peroneal nerve will be of help during surgical approaches to this area and the diagnosis of the problems related to the peripheral nerves on the dorsum of the foot. This study was presented on the 4th Asian-Pacific International Congress of Anatomists (APICA 2005) in Kusadasi, Turkey on 7-10 September 2005.     

Regeneration of the plantar skin in mammals

Two posterior plantar pads together with the surrounding skin were removed from the hind limb in rats, and one plantar pad each without the surrounding skin was removed from the hind and fore limbs of hedgehogs. As a result of healing of the skin wounds in the rats and hedgehogs, areas of regeneration were formed with the typical stratum papillare of plantar skin. In hedgehogs the regenerating skin covered the restored plantar pad. In rats the plantar pads were not restored.Laboratory of Growth and Development, Institute of Human Morphology, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR N. A. Kraevskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 83, No. 5, pp. 591–595, May, 1977.     

Aortic arch morphometry in living humans

Anatomical features of the aortic arch such as its steepness, the take-off angles and the distances between its supra-aortic branches can influence the feasibility and difficulty of interventional and/or surgical maneuvers. These anatomical characteristics were assessed by means of 3D multiplanar reconstruction of thoracic angio-computed tomography scans of 92 living patients (79 males, 13 females, mean age 69.4 ± 9.9 years) carried out for various indications (gross pathology of the thoracic aorta excluded). There was a significant variation of all measured parameters between the subjects - a standard aortic arch (i.e. with all measured parameters within 2 SD) does not seem to exist. There were no significant differences between genders but some of the parameters correlated significantly to age.     

Defining the position of deep inguinal ring in patients with indirect inguinal hernias

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.Presented at the Association of Surgeons of Great Britain and Ireland (ASGBI, April 2004 Harrogate)     

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

OBJECTIVE:

To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF).

INTRODUCTION:

PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries.

METHODS:

Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images.

RESULTS:

There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners.

CONCLUSIONS:

Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.