Plantar aponeurosis and internal architecture of the ball of the foot

Abstract

On the basis of its internal structure, the ball of the foot can be divided into three transverse areas, each with a different mechanical function: (1) an area proximal to the heads of the metatarsals in which the retinacula cutis are developed into a series of transverse bands, and in which the deep fibres of the plantar aponeurosis form ten sagittal septa connected to the deep transverse metatarsal ligament and through this the proximal phalanges of the toes, (2) an area below the heads of the metatarsals in which vertical fibres from the joint capsules and the sides of the fibrous flexor sheaths form a cushion below each metatarsal head, and in which fat bodies cover the digital nerves and vessels in their passage between the cushions, and (3) a distal area which comprises the interdigital web. The superficial fibres of the plantar aponeurosis are inserted into the skin of this distal area, and deep to them the plantar interdigital ligament forms a series of transverse lamellae connected to the proximal phalanges by a mooring ligament which arches from one fibrous flexor sheath to the next. When the metatarsophalangeal joints are extended, the fibres of the three areas are tensed and the skin is anchored firmly to the skeleton. The direction of the fibres in the distal and proximal area promotes the transfer of forces exerted on the skin during push-off and braking respectively, while the intermediate area is adapted to bear the weight of the body. A concentration of Pacinian corpuscles is found along the digital nerves in the weight-bearing area below the transverse metatarsal ligament. The nerves for the second, and especially for the third, interstice are close to or in contact with the sharp proximal edges of the sagittal septa.