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Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al. | ||
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| the extensor hallucis longus and the extensor digitorum communis deep to the annular ligament or extensor retinaculum. The deep peroneal nerve lies immediately lateral to the vessel. In the foot, the artery passes under the extensor hallucis brevis. At the base of the first intermetatarsal space, the dorsalis pedis artery dives plantar between the heads of the first dorsal interosseous muscle to connect to the plantar arch. Before passing plantar, the dorsalis pedis artery gives off the first dorsal-metatarsal artery, which travels distally in the first metatarsal space to the first web space, where it divides to supply the adjacent sides of the great and second toes. In this course, it usually lies on the first dorsal interosseous muscle, but may lie within the interosseous muscle or deep to it to cross superficial to the first intermetatarsal ligament. In approximately 60% of our patients, the dorsal-metatarsal artery is extremely small. The supply to the great and second toe is dominated by the plant digital system, which runs deep to the first intermetatarsal ligament.
NERVES The superficial peroneal nerve divides into medial and intermediate dorsal cutaneous branches, which pass superficial to the extensor retinaculum. These further divide into a total of five branches that supply the dorsum of the foot and toes. The course of this nerve and its division are extremely variable. The deep peroneal nerve lies just lateral |
to the dorsalis pedis artery in the foot and divides into terminal medial and lateral branches, which supply the adjacent side of the great and second toes. The nerve also gives some articular twigs to the small joints of the first and second rays and, occasionally, a communicating branch to the superficial peroneal nerve.
TENDONS The four tendons of the extensor digitorum communis divide on the anterior surface of the ankle and insert into the four lateral toes. The extensor digitorum brevis arises from the dorsal-lateral surface to the calcaneus and the extensor retinaculum and divides into four tendons that insert into the four medial toes by fusing with the long extensor tendons. The most medial slip of this muscle, the extensor hallucis brevis, is the largest, inserts as a separate tendon at the base the proximal phalanx of the great toe, and usually has a serparate blood supply. JOINTS The metatarsophalangeal joint has a strong capsule a volar plate. Unlike the metacarpophalangeal joint, it goes into hyperextension to approximately 70 degrees. Plantar flexion of the metatarsophalangeal joint is less than the metacarpophalangeal joint approximately 45 degrees. |
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| Ch. 5 Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |||