Foot Anatomy – Bones, Tendons And Other Parts Of The Foot

Anatomy Of The Foot The foot has 26 bones, 33 joints, and more than 100 muscles, ligaments, and tendons. These important structures strengthen the foot and help to maintain its posture. Some of the important structures of the foot are discussed below Bones In the foot, we have three groups of bones 1. Tarsals 2. Metatarsals 3. Phalanges Tarsal bones These are divided into three groups
Proximal group

The proximal group has two bones namely the talus (ankle bone) and calcaneus (heel bone). The talus articulates superiorly with tibia and fibula making the back of the foot known as hindfoot
Intermediate group

Navicular bone- It lies between the proximal and distal group of tarsal bones
Distal group

In the distal group from lateral to medial, we have one cuboid bone and three cuneiforms (lateral, intermediate, and medial) Metatarsal bones We have five metatarsal bones, they are numbered from one through five from medial to lateral. The head of the first metatarsal bone articulates with two sesamoid bones The sides of the bases of metatarsal bones (from two to five) articulate with each other The fifth metatarsal bone has a prominent tuberosity on its lateral side Phalanges These are the bones of toes. We have 14 phalanges in total, two in the great toe and 3 in each other toe Joints There are 33 joints in the foot Ankle joint It is a synovial hinge joint. It involves talus of tarsal bones and tibia fibula (bones of the leg region) Articular surfaces are covered with hyaline cartilage Plantarflexion and dorsiflexion are possible at this joint Intertarsal joint There are several intertarsal joints. These joints are synovial in nature The following movements are possible here • Inversion • Eversion • Supination • Pronation Transverse tarsal joint This joint is formed between talocalcaneonavicular and calcaneocuboid joint Muscles The muscles of the foot are arranged in two groups 1. Muscles of sole of the foot 2. Muscles of the dorsum of the foot There are four layers of the muscles of the sole of the foot First layer- Abductor hallucis, Flexor digitorium brevis, Abductor digiti minimi Second layer- Quadratus plantae, Lumbricals (4), Flexor digitorium longus tendon, Flexor hallucis longus tendon Third layer- Flexor digiti minimi brevis, Flexor hallucis brevis, Adductor hallucis Fourth layer- Interossei, Dorsal (4), Planter (3), Paroneus longus tendon, Tibialis posterior tendon Muscles of the dorsum of the foot This group has two muscles 1. Extensor hallucis brevis 2. Extensor digitorium brevis Tendons and ligaments Tendons and ligaments are very much similar to each other These are soft tissues made up of collagen fibers Ligaments attach muscles to muscles while tendons attach muscles to bones Tendons Achilles tendon or Calcaneal tendon It is an important tendon of the foot It is the tough band of fibrous tissue, it connects the calf muscles to the calcaneus (heel) bone The other tendons of the foot are listed below • The tendon of fibularis longus muscle • The tendon of fibularis brevis muscle • The tendon of tibialis posterior muscle Ligaments Some ligaments of the foot are listed below • Long plantar ligament • Lateral ligament • Anterior talofibular ligament • Medial deltoid ligament Blood supply Arteries The blood is supplied to the foot by the branches of two main arteries namely posterior tibial artery and dorsalis pedis Posterior Tibial Artery The posterior tibial artery bifurcates into lateral and medial plantar arteries by entering into the sole. Then the lateral plantar artery joins with the deep plantar artery (the terminal end of dorsalis pedis) and forms deep plantar arch whose branches supply the toes of the foot Dorsalis pedis artery The anterior tibial artery continues to form the dorsalis pedis artery. It enters into the dorsum of the foot and continues as the deep plantar artery and then enters in the sole of the foot by passing between the metatarsal one and two Veins There is an interconnected network of deep and superficial veins in the foot. Deep veins follow the course of arteries and superficial veins drain into the dorsal venous arch. The great saphenous vein and the small saphenous vein arise from the two sides of the dorsal venous arch. These two veins drain a large amount of blood of the foot Nerve supply There are five main nerves that innervate the foot namely 1. Tibial nerve 2. Deep fibular nerve 3. Superficial fibular nerve 4. Sural nerve 5. Saphenous nerve These five nerves are responsible for the cutaneous or general sensory innervation of the foot Read more about Foot Anatomy

Ways to Rest Sore Muscles

Exercising plays a major role in increasing the chances of sore muscles. This is ideally true for people who have recently started working out and whose body is not very accustomed to indulging in any kind of physical activities. Muscle soreness comes with extreme discomfort and pain. However, it is not entirely dangerous to your health. Most of the times, all you have to do is take some days off and let your muscles recover from the soreness completely.

The amount of rest your muscles need in order to recover from the soreness depends entirely on the type of soreness you are suffering from. For instance, if you’re dealing with acute muscle soreness, you’ll only have to rest the muscles for several hours after workout, and the discomfort will also only last for several hours after training. In fact, you will be able to get back to your training the next day. In case of delayed onset muscle soreness, you will most probably have to rest for 1-3 days after your workout. Since it is delayed, it lasts longer than normal, which is why you will need to rest longer. At this time, you can take on some mild exercise like walking or cycling instead of the intense exercises.

There are a number of ways in which you can relieve muscle soreness, one of the most preferred in this fast-running world is simply applying a fast relief gel. However, the very first effective way is rest, which, as learned earlier, depends solely on the type of soreness. Now, by resting, it doesn’t mean you should stop all your physical activities and lay on bed all day. Doing so is sure to make your muscles weaker, which is why it is very important to make sure you continue with your physical activities while ensuring minimum movements. You could walk instead of running and swim instead of jogging. Indulging in different physical activities plays a major role in keeping your blood circulation good while also helping the muscles recover faster. Another way is to keep your body hydrated, no matter what. Drinking enough water is ideal to make your body toxins flush out of our system. These toxins are known to hinder in your active muscle recovery, which is why it is important to eliminate them from your bloodstream. Third way is active recovery – if you you’re your muscles are recovering before the expected time and you’re feeling better already, you can get back to your routine, gradually. The fourth way is to keep your body healthy by providing it with all the required nutrients. In order to recover faster, it is important to eat nutritious food all the time. Your muscles need all the nutrients to get back to normal. Your muscles specifically need potassium and protein in order to ensure faster and better healing.

Muscle soreness is normal. However, it sure does bring a lot of discomfort in your life. It’s not always that a cool pack gel or a pain relief spray will help you heal your pain. Thus, the above tips will help you prevent the condition while also ensuring quick recovery.

Gingival Depigmentation with Dental Lasers for Management of Gingival Hyperpigmentation

Introduction – Gingival hyperpigmentation is a common esthetical concern in patients with gummy smile or excessive gingival display. It is an overproduction of melanin, beyond the normal expected degree in the oral mucosa, induced by various causes.

Etiology – Several physiologic and/or pathologic factors can cause hyperpigmentation. Gingival hyperpigmentation is mostly caused by the physiologic deposition of a brown pigment, melanin produced by melanocytes in the basal and supra-basal cell layer of the gingival epithelium. The colour of gingiva depends on the intensity of the melanogenesis, degree of epithelial cornification, depth of epithelialization and the arrangement of gingival vascularity.

Treatment Modalities – Gingival depigmentation is a treatment to remove melanin hyperpigmentation of the gingiva and various methods have been used for this procedure with different degrees of success including gingivectomy, gingivectomy with free gingival autografting, electrosurgery, cryosurgery, chemotherapy with 90% phenol and 95% alcohol and abrasion with diamond bur. Moreover some of these techniques are prone to side effects and complications.

However, Laser therapy is an effective and noninvasive treatment option for Gingival Depigmentation. In depigmentation process the epithelial tissue exhibiting excessive melanin pigments is ablated using diode lasers. PIOON Laser offers different wavelengths like 450nm, 810nm/980nm which can either be used in contact or non-contact manner to perform this procedure.

Most recommended for an effective treatment procedure is the blue light (450nm) which can be backed by a report by Kenneth Luk in 2017 where he studied the comparison between the 810nm and 445nm working in a noncontact mode to perform depigmentation of gingiva. He stated that 445nm is much better absorbed by melanin and haemoglobin than 810 nm and hence, a much lower power density can be used for the treatment. Manaf Agha in 2020 concluded that lesser the power settings used for the procedure, faster would be the healing with much less discomfort to the patient leading to greater acceptance of the procedure.

Before laser irradiation, the operating staff, assistant and the patient wears special laser-protective eye glasses corresponding to laser wavelength, highly reflective instruments or instruments with mirrored surfaces are avoided and most of the times only the use of topical anesthesia suffices for a painless laser tissue ablation.

Rationale behind Use of Lasers – Laser ablation has been recognized as a pleasant and reliable technique. It has the advantage of easy handling of tissues because of bloodless field, shorter chairside time, treatment finishes in single visit and property of potential decontamination. Additionally, protein coagulum formed on the depigmented surface as a result of irradiation act as a biological wound dressing sealing the ends of sensory nerve endings and hence lesser pain and discomfort is experienced by the patients.

Conclusion – Diode dental laser is a safe and effective treatment modality that provides optimal aesthetics with minimal discomfort to patients with gingival hyperpigmentation.

Reference – Luk K. Non-ablative melanin depigmentation of gingiva. Cosmetic dentistry. 2017. 36-39 and Agha M. Laser Treatment for Melanin Gingival Pigmentations: A Comparison Study for 3 Laser Wavelengths 2780, 940, and 445nm. Int J Dent.2020. March: 3896386.