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Anatomy

Lower Limb

Question 44 of 180

A 65 year woman presents to ED with a laceration to her right foot. On further assessment, it is determined she has cut through the first layer of the sole of her foot only. Which of the following structures is most likely damaged in this type of injury:

Answer:

The plantar arteries and nerves lie between the first and second layers. The long flexor tendons of the flexor hallucis longus and flexor digitorum longus muscles lie within the second layer. The tendons of the tibialis posterior and fibularis longus muscles are part of the fourth layer.

Plantar Foot Layers

Anatomy / Lower Limb / Sole of Foot

Last Updated: 29th January 2019

The muscles of the sole of the foot are organised into four layers, from superficial to deep. Detailed knowledge of the muscles which lie within a given layer is not required, but the following is required knowledge and has implications for the structures likely to compromised when the sole is injured.

The plantar arteries and nerves lie between the first and second layers.

The long flexor tendons of the flexor hallucis longus and flexor digitorum longus muscles lie within the second layer.

The tendons of the tibialis posterior and fibularis longus muscles are part of the fourth layer.

Muscles of the Foot. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

 

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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