The Blood and Nerve Supply of the Foot – Anatomy


Anatomically, the foot is divided into three regions: the heel (calcaneal regions), the dorsum of the foot (dorsum pedis) and the plantar (the sole of the foot). Important landmarks in the anatomy of the foot are the medial ankle (malleolus) (on the inside of the foot) and the lateral one (located on the outside of the foot). There are small skin nerves and thin veins and arteries in the layer just under the skin (the subcutaneous layer), which supply the skin with oxygen. A visible and saphenous vein runs through the skin in the area of the medial malleolus.


Basically, the arteries and veins are almost always side by side. Thus, the pulse of the arteries supports the transport of blood from the veins back to the heart, for example. The peripheral nervous squirm is partially reticulated around the blood vessels. We speak of neurovascular bundles or strands that run together through the body and that often bear the same name.


The supply of the leg with fresh oxygen-rich blood is assured via the arteries. The blood in the major bundles of trunk arteries flows in the femoral artery in the femur. This goes a few centimeters into the deep femoral artery (supplying the adductor muscles of the thigh). The femoral artery runs down to the knee and from there on to the back of the leg as the popliteal artery. The anterior tibial artery supplies the skin and muscles of the lower leg. A little later, the popliteal artery is divided in the peroneal artery, which goes to the inside leg (medial), and the posterior tibial artery, which goes to the outside leg (lateral). The neurovascular bundle supplies the sole of the foot in a deeper layer and consists of the posterior tibial artery, its accompanying veins (posterior tibial Venea) and the N. tibialis. The pulse of the posterior tibial artery is palpable on the back of the medial malleolus. This artery also supplies the heel region of the sole. There is another important palpable pulse (dorsalis pedis) between the big toe and second toe.


The flow of blood in the veins is exactly opposite as compared to that of the arteries. Many small-caliber veins gather the blood into larger veins and finally go back to the heart... There is a superficial venous network in the lower leg, which directs the blood from the skin into a network of deep leg veins. The great saphenous vein and the small saphenous vein (the lateral border of the foot) are interconnected by numerous veins, sheets and form the main branches of the superficial (subcutaneous) veins. The venous network is clearly visible through the skin. The blood runs into the deep leg veins (anterior tibial veins, posterior tibial veins, peroneal veins) run via small connecting veins (perforating veins). From here, it flows back to the heart through the large veins of the thigh and the trunk. Varicose veins are formed by a tissue deficiency (insufficiency) of the superficial veins (Vv and saphenous veins), whereas fluid retention (edema) and lower leg ulcers are caused by the insufficiency of the connecting veins (perforating veins) and the deep leg veins (Vv, anterior tibial veins, posterior tibial veins, peroneal veins).


Peripheral nerves also arise from the spinal cord apart from all the cranial nerves. They come out as thick 2-3 cm long spinal nerves between the vertebrae of the spine and then circulate through the body through a complicated network. The peripheral nerves are classified according to their emission level in the spinal cord and specific skin areas. The so-called dermatomes drag strips all over the body and are essential for the level diagnosis of spinal cord damage. According to anatomy lessons, the loss of touch sensations in a particular area of the skin (dermatome) suggests a certain amount of damage close to the spinal cord. Touch or pain stimuli that impinge on the skin of the foot are routed to the spinal cord from different nerves. The nerves come from the lumbar (lumbar) region and the sacrum (sacral) spine (L 4 to S 3). Each nerve has its own particular area of supply, but some skin areas are supplied by several overlapping nerves. A key for foot nerves is the N. tibialis. It is the head of the sole and sends the heel stimuli to the spinal cord and innervates the flex muscles of the toes and foot.

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