SUMMARY:The plantar arterial arch provides the dominant vascular supply to the digits of the foot, with variability in length, shape, and dominant blood supply from the contributing arteries. According to the standard definition, the plantar arterial arch is formed from the continuation of the lateral plantar artery and the anastomoses between the deep branch of dorsalis pedis artery. In this study, 40 adult feet were dissected and the plantar arch with variations in shape and arterial supply was observed. The standard description of the plantar arch was observed in 55% of the specimens with variations present in 45%. Variations in terms of shape were classified into three types: Type A (10%): plantar arterial arch formed a sharp irregular curve; type B (60%): obtuse curve; type C (3%): spiral curve. Variation in the dominant contributing artery was classified into six types: type A (25%), predominance in the deep branch of dorsalis pedis artery supplying all digits; type B (5%), predominance in the lateral plantar artery supplying digits 3 and 4; and type C (20%), predominance in the deep branch of dorsalis pedis artery supplying digits 2 to 4; type D (24%), equal dominance showed; type E (10%), predominance in the lateral plantar artery supplying digits 3 to 5; and type F (21%), predominance of all digits supplied by lateral plantar artery. The foot was divided into three parts to determine the location of the plantar arterial arch. The second part was further divided into three parts: middle anterior (90%), intermediate middle (10%), and middle posterior (0%). Knowledge of the vascular anatomy of the plantar arterial arch is crucial for understanding sites of partial amputations.
SUMMARY:The plantar aponeurosis (PA), which is a thickened layer of deep fascia located on the plantar surface of the foot, is comprised of three parts. There are differing opinions on its nomenclature since various authors use the terms PA and plantar fascia (PF) interchangeably. In addition, the variable classifications of its parts has led to confusion. In order to assess the nature of the PA, this study documented its morphology. Furthermore, a pilot histological analysis was conducted to examine whether the structure is an aponeurosis or fascia. This study comprised of a morphological analysis of the three parts of the PA by micro-and macro-dissection of 50 fetal and 50 adult cadaveric feet, respectively (total n=100). Furthermore, a pilot histological analysis was conducted on five fetuses (n=10) and five adults (n=10) (total n=20). In each foot, the histological analysis was conducted on the three parts of the plantar aponeurosis, i.e. the central, lateral, and medial at their calcaneal origin (total n=60). Fetuses: i) Morphology: In 66 % (33/50) of the specimens, the standard anatomical pattern was observed, viz. three parts (i.e. central, lateral, medial) that originated from the medial and lateral processes of the calcaneal tuberosity and inserted onto the metatarsals. In 18 % (9/50) of the specimens, a two-part structure was observed. Variable origins of the medial part were noted in 16 % (8/50) of the specimens. In order to document these variations, the central part of the PA was divided into three segments (i.e. upper, middle, lower): a) In 63 % (5/8) of the specimens, the medial part arose from the middle segment; b) In 37 % (3/8) of the specimens, the medial part arose from the middle and upper segments. ii) Histological analysis: a) The central part contained longitudinally arranged semi-dense type I collagen fibres with fibroblasts; b) The lateral part displayed semi-dense type I collagen fibres with fibroblasts, hyaluronic acid, corpusculum sensorium fusiforme (Ruffini corpuscle) and corpusculum lamellosum (Pacinian corpuscle); c) The medial part comprised of loose connective tissue with elastic and reticular fibres. Adults: i) Morphology: In 100 % of the specimens, the standard anatomical pattern was observed. ii) Histological Analysis: a) In the central part, longitudinally arranged type I collagen fibres with fibroblasts were visible; b) The lateral part contained longitudinally arranged type I collagen fibres with fibroblasts; c) The medial part comprised of loose connective tissue, type I and type III collagen fibres, elastic and reticular fibres. In the current study, the morphology of the PA in fetuses and adults conformed to the standard anatomical description with variations in the origin of the medial part observed in fetuses. In addition, the fetal specimens displayed a two-part structure of the PA when the medial part was absent. Microscopically, the findings suggest that only the central and lateral parts may be considered as the PA, whilst the medial part may be termed the PF.
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