Novel Investigation of the Deep Band of the Lateral Plantar Aponeurosis and Its Relationship with the Lateral Plantar Nerve
Cohen, Zach DPM
Fisher, Cara PhD
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Purpose: The plantar foot is separated into medial, central and lateral compartments by the plantar aponeurosis (PA). The PA functions to support the arch of the foot and transmit forces during the gait cycle. A recent dissection of a cadaveric foot uncovered a fascial band arising from the medial aspect of the lateral PA and diving deep into the foot. A branch of the lateral plantar nerve passed deep to this fascial band. A review of current literature turned up limited and outdated sources, while some of the most commonly used anatomy textbooks and atlases failed to describe or depict this band. As such, our study objectives were twofold. First, determine the frequency among cadavers that possess this fascial band. Second, determine the location where the lateral plantar nerve passed deep to it. Methods: 50 pairs of cadaveric feet were dissected by removing the skin and superficial fascia on the plantar foot. If the medial portion of the lateral PA was present, the fascial band was dissected further to determine if it dove deep to the central PA and the tendons of the flexor digitorum brevis and longus muscles to insert on the plantar plates of the 3rd and 4th metatarsophalangeal joints. Images were taken when the lateral plantar nerve passed deep to the band. ImageJ was used to take two measurements assessing the relationship of the tuberosity at the base of the 5th metatarsal to where the nerve crossed deep to the fascial band. Measurements were also taken from the great toe to the heel to assess foot length. Results: The fascial band was found unilaterally in 10 pairs and bilaterally in 14 pairs. Therefore, 38% of feet possessed the deep band of the lateral PA. On average, the point at which the lateral plantar nerve passed deep to the fascial band was 2.0037 cm medial and 1.6637 cm anterior to the tuberosity at the base of the 5th metatarsal. When separated by sex, both distances were not significantly different (p Conclusion: Based on results, the deep band of the lateral PA should be included in textbooks and atlases because of the frequency at which it was discovered and its relationship to the lateral plantar nerve. The clinical implications of this study should be applied to the care of podiatry patients.