Skin 皮膚

The skin of the sole of the foot is highly specialized, tough, and resilient. It responds to abnormal stresses by hypertrophying in the keratinized layer, forming callosities. In cases of severe metatarsalgia, the skin over the protruding metatarsal heads becomes thin and attenuated. In Fowler procedure (a transverse incision), the lips of pathologic skin are removed, and the thicker, normal skin is sutured back into its correct position. The skin also may atrophy in patients with ischemic or neuropathic conditions.

腳底的皮膚非常獨特，堅韌且有彈性。它通過角質(zhì)化層中的肥大反應(yīng)來應(yīng)對異常應(yīng)激，形成胼胼胝體。在嚴重的跖骨痛的情況下，突出的跖骨頭部上方的皮膚變得纖薄。在Fowler手術(shù)中(橫向切口)，切除病理性唇狀皮膚，將較厚的正常皮膚縫合回正確的位置。在缺血性或神經(jīng)性疾病的患者中，皮膚也可能萎縮。

Deep Fascia  深筋膜

The deep fascia of the sole is similar to the deep palmar fascia of the hand; it also may suffer Dupuytren contracture. The fascia is much thicker in its central parts and thinner where it covers the intrinsic muscles of the hallux and little toe. Its central part, the plantar aponeurosis, originates from the medial tubercle of the calcaneus and runs forward to attach to the proximal phalanges of each of the toes.

鞋底的深筋膜類似于手掌的深掌筋膜; 它也可能遭受Dupuytren攣縮。筋膜中央部分較厚，覆蓋拇趾和小趾的內(nèi)在肌肉處較薄。中心部分的足底腱膜，起源于跟骨的內(nèi)側(cè)結(jié)節(jié)，向前延伸以附著于每個足趾的近節(jié)趾骨。

The attachment of the plantar aponeurosis to the medial tubercle of the calcaneus often is a site for the inflammatory degeneration that produces a painful heel. The point of maximal tenderness in this condition corresponds to the anatomic insertion of the plantar aponeurosis. On rare occasions, this condition, which is known as plantar fasciitis (“policeman’s heel”), may necessitate surgical detachment of the origin of the fascia.

足底腱膜附著在跟骨內(nèi)側(cè)結(jié)節(jié)上，常常是引起足跟疼痛炎癥性、退行性病變的部位。在這種情況下，最大的壓痛點是足底腱膜對應(yīng)的解剖連接點。在少數(shù)情況下，這種情況被稱為足底筋膜炎(“警察的腳后跟”)，可能需要手術(shù)剝離筋膜的起源。

Medial and lateral fibrous septa originate from the medial and lateral borders of the plantar fascia to attach to the first and fifth metatarsal bones. These septa divide the foot into three compartments, much as the septa do in the hand. The compartments may limit areas of infection within the foot.

內(nèi)側(cè)和外側(cè)纖維隔起源于足底筋膜的內(nèi)側(cè)和外側(cè)邊界，附著于第一和第五跖骨。這些隔膜把腳分成三個隔間，就像在手上的隔膜一樣。這些隔室可以限制足部的感染擴散。

First Layer of Muscles  第一層肌肉

The superficial layer consists of three muscles: The flexor digitorum brevis, abductor hallucis, and abductor digiti minimi.

第一層由趾短屈肌、拇外展肌和小趾展肌三部分組成。

The flexor digitorum brevis arises mainly from the plantar aponeurosis and partly from the medial calcaneal tubercle. It divides into four tendons that insert into the middle phalanx of the lateral four toes and flexes the toes independent of the position of the ankle.

趾短屈肌主要來自足底腱膜，部分來自跟骨結(jié)節(jié)內(nèi)側(cè)。它分為四個肌腱，連接四個腳趾的中間趾骨，并彎曲腳趾，與腳踝的位置無關(guān)。

The abductor hallucis takes origin from the medial tubercle of the calcaneus, inserts into the medial side of the proximal phalanx of the great toe, and abducts the great toe. It is the only muscle whose action tends to oppose the deformity of hallux valgus .

拇外展肌起源于跟骨的內(nèi)側(cè)結(jié)節(jié)，連接拇趾近節(jié)指骨的內(nèi)側(cè)，并外展大腳趾。它是唯一能夠抵抗拇外翻畸形的肌肉。

Superficial Nerves and Vessels  淺層神經(jīng)和血管

The medial and lateral plantar arteries and nerves lie between the first and second layers of muscle. They are relatively superficial, but, as in the hand, rarely are injured, because of the toughness of the overlying plantar fascia.

內(nèi)側(cè)和外側(cè)足底動脈和神經(jīng)位于第一和第二層肌肉之間。它們相對表淺，由于上覆蓋足底筋膜的韌性，很少受傷。

Second Layer of Muscles  第二層肌肉

The second layer of muscles consists of the long flexor tendons (the flexor hallucis longus, flexor digitorum longus, and flexor accessorius), which are critical in maintaining the longitudinal arch of the foot . Helping these muscles are the lumbricals, which arise from the tendons of the flexor digitorum longus. As they do in the hand, the lumbricals flex the metatarsophalangeal joints while they keep the interphalangeal joint extended. Weakness results in clawing of the toes, producing the equivalent in the foot of the intrinsic minus hand. A persistent extension deformity of the metatarsophalangeal joint eventually causes this joint to undergo subluxation, and the metatarsal head has to bear weight that no longer is distributed to the displaced toe during toe-off in walking. Pain (metatarsalgia) is the result.

第二層肌肉由長屈肌腱(拇長屈肌腱、趾長屈肌腱和足底方肌)組成，它們對維持足部縱弓至關(guān)重要。幫助這些肌肉的是蚓狀肌，它來自趾長屈肌的肌腱。運動時，蚓狀肌彎曲跖趾關(guān)節(jié)，同時保持趾間關(guān)節(jié)伸展。無力會導(dǎo)致腳趾的受傷，從而導(dǎo)致足部產(chǎn)生與手萎縮相同的癥狀。跖趾關(guān)節(jié)的持續(xù)伸展畸形最終導(dǎo)致該關(guān)節(jié)發(fā)生半脫位，在趾脫位下跖骨承受行走時不能分布到移位腳趾的重量。結(jié)果導(dǎo)致疼痛(跖骨痛)。

Third Layer of Muscles 第三層肌肉

The third layer of muscles consists of the flexor hallucis brevis, adductor hallucis, and flexor digiti minimi brevis.

第三層肌肉由拇短屈肌、拇內(nèi)收肌和小趾短屈肌組成。

The flexor hallucis brevis inserts into the base of the proximal phalanx of the great toe via medial and lateral sesamoid bones. The medial sesamoid also receives slips from the abductor hallucis, and the lateral sesamoid from the adductor hallucis. The sesamoid bones may be displaced in cases of hallux valgus, with the lateral sesamoid moving to a position between the first and second metatarsal bones. If that happens, the lateral sesamoid can block mechanically the realignment of the first ray. The joint between the sesamoid bones and the metatarsal head may degenerate and become painful.

拇短屈肌通過內(nèi)側(cè)和外側(cè)籽骨連接拇指近節(jié)指骨的基部。內(nèi)側(cè)籽骨也會從拇外展肌滑脫，外側(cè)籽骨也會從拇內(nèi)收肌滑脫。在拇外翻的病例中，籽骨可能移位，外側(cè)籽骨移動到第一和第二跖骨之間的位置。如果發(fā)生這種情況，外側(cè)籽骨可以機械地阻止第一趾序列的排列。籽骨和跖骨頭之間的關(guān)節(jié)可能會退化并疼痛。

The adductor hallucis, which inserts into the proximal phalanx via the lateral sesamoid bone, is the most important deforming force in hallux valgus. Many operations for this condition involve detaching the muscle from its insertion and reinserting it into the head of the metatarsal so that it can act as a dynamic corrector of metatarsus varus.

拇內(nèi)收肌是拇外翻最重要的變形力，它通過外側(cè)籽骨連接近節(jié)指骨。許多針對這種情況的手術(shù)包括將肌肉從其連接處分離出來，重新接入跖骨頭部，這樣它就可以作為跖骨內(nèi)翻的動態(tài)矯正器。

Fourth Layer of Muscles  第四層肌肉

The fourth and deepest layer of muscles consists of the interosseous muscles attached to the metatarsal bones, and two tendons, those of the peroneus longus and tibialis posterior muscles, which are major supports of the longitudinal arch of the foot.

第四層也是最深的一層肌肉，由附著在跖骨上的骨間肌和兩根肌腱組成，這兩根肌腱分別是腓骨長肌和脛骨后肌，它們是縱向足弓的主要支撐。

足的解剖視頻講解