Lateral plantar nerve
By : Aisha MohammedDefinition
It is one of the small nerves of the lower limb located at the sole of foot and supplies it. It’s the smaller and more posterior branch of the two terminal branches of the tibial nerve. It is an essential motor nerve in the foot, because it innervates all of the intrinsic muscles in the sole, except for the muscles which are supplied by the medial plantar nerve. It’s accompanied by the lateral plantar nerve. The lateral plantar nerve supplies less skin area and more muscles, comparingly to its counterpart (the medial plantar nerve). Its resembles the ulnar nerve of the hand in its distribution to both skin and muscles but to the foot.
Origin
The lateral plantar nerve is the smallest terminal division of the tibial nerve. The tibial nerve is the larger component of the sciatic nerve(L4 -S3).
(Spinal cord > Lumbosacral plexus > Sciatic nerve > Tibial nerve > Lateral plantar nerve)
(Spinal cord > Lumbosacral plexus > Sciatic nerve > Tibial nerve > Lateral plantar nerve)
Course and Relations
Beginning
The lateral plantar nerve arises deep to flexor retinaculum of foot. It enters the sole of the foot and start passing anterolaterally towards the tubercle of the fifth metatarsal,relating to :
1. Deep to : the insertion of the abductor hallucis muscle.
2. Between :
A)Firstly: between the flexor digitorum brevis and quadratus plantae muscles
B)Finally: between flexor digiti minimi brevis and abductor digiti minimi muscles
3. Laterally : lateral plantar artery Before its division, the main trunk supplies quadratus plantae and abductor digiti minimi muscles by muscular branches and the skin of the lateral part of the sole by cutaneous branches which pierce the plantar aponeurosis.
The lateral plantar nerve arises deep to flexor retinaculum of foot. It enters the sole of the foot and start passing anterolaterally towards the tubercle of the fifth metatarsal,relating to :
1. Deep to : the insertion of the abductor hallucis muscle.
2. Between :
A)Firstly: between the flexor digitorum brevis and quadratus plantae muscles
B)Finally: between flexor digiti minimi brevis and abductor digiti minimi muscles
3. Laterally : lateral plantar artery Before its division, the main trunk supplies quadratus plantae and abductor digiti minimi muscles by muscular branches and the skin of the lateral part of the sole by cutaneous branches which pierce the plantar aponeurosis.
Termination
When it reaches the lateral compartment of foot, it ends by bifurcating into superficial and deep branches.
Branches
1- Superficial branch
It splits into two branches :
1- Proper plantar digital nerve
it supplies :
-The lateral side of the fifth toe (little toe).
-Flexor digiti minimi brevis.
-Two interossei in the fourth intermetatarsal space.
2- Common plantar digital nerve
It divides into two proper digital nerves which supply the skin of the adjacent sides of the fifth and the fourth toes and communicates with the third common plantar digital nerve of the medial plantar nerve.
2- Deep branch
It accompanies with the lateral plantar artery deep to the flexor tendons (tendons of flexor muscles) and the adductor hallucis muscles and courses with the plantar arch between the 3rd and the 4th muscle layers.
It gives branches and supplies :
-adductor hallucis.
-second to fourth lumbrical muscles.
-all the interossei muscles except those of the fourth intermetatarsal space.
It splits into two branches :
1- Proper plantar digital nerve
it supplies :
-The lateral side of the fifth toe (little toe).
-Flexor digiti minimi brevis.
-Two interossei in the fourth intermetatarsal space.
2- Common plantar digital nerve
It divides into two proper digital nerves which supply the skin of the adjacent sides of the fifth and the fourth toes and communicates with the third common plantar digital nerve of the medial plantar nerve.
2- Deep branch
It accompanies with the lateral plantar artery deep to the flexor tendons (tendons of flexor muscles) and the adductor hallucis muscles and courses with the plantar arch between the 3rd and the 4th muscle layers.
It gives branches and supplies :
-adductor hallucis.
-second to fourth lumbrical muscles.
-all the interossei muscles except those of the fourth intermetatarsal space.
Clinical notes
Lateral Plantar Nerve Entrapment
It’s the compression of lateral plantar nerve in the foot which causes pain on the inside of the ankle and heel.
Often, its pain is chronic, intractable and it could get worse especially
during running and other high impact exercises.
It could causes:
1. Burning
2. Numbness
3. Paresthesias
Treatment
1. Immobilization
2. Foot orthoses
3. Cryotherapy
4. Physical therapy
All of them are the best techniques to prevent irritating motion and pressure.
It’s the compression of lateral plantar nerve in the foot which causes pain on the inside of the ankle and heel.
Often, its pain is chronic, intractable and it could get worse especially
during running and other high impact exercises.
It could causes:
1. Burning
2. Numbness
3. Paresthesias
Treatment
1. Immobilization
2. Foot orthoses
3. Cryotherapy
4. Physical therapy
All of them are the best techniques to prevent irritating motion and pressure.
Cadavers
Cadaver shows the lateral plantar nerve (sole of foot)
References
• Anne MR Agur, Arthur F Dalley, and Keith L. Moore’s Clinically Oriented Anatomy 8th edition/ Copyright © 2018 Wolters Kluwer / pages (776)
• Susan Standring, Neel Anand, Rolfe Birch, Patricia Collins, Alan R Crossman, Michael Gleeson , Girish Jawaheer, Ariana L Smith, Jonathan D Spratt, Mark D Stringer, R Shane Tubbs, Richard Tunstall, Alan J Wein, Caroline B Wigley ‘s Gray's Anatomy The Anatomical Basis of Clinical Practice. copyright © 2016, Elsevier Limited. Forty-first edition. Pages(1447)
• Adam W. M. Mitchell, Richard L. Drake, and Wayne Vogl’s Gray's Anatomy for Students. 4th edition/ Copyright © 2020 Elsevier Inc. / pages (656-657)
• Kenneth Prakash Moses, John C. Banks, Jr., Pedro B. Nava, Darrell K. Petersen, ‘ s ATLAS OF CLINICAL GROSS ANATOMY.Copyright © 2013, 2005, by Saunders, an imprint of Elsevier Inc.second eidtion.pages(604.FIGURE 47.12)
• Adam W. M. Mitchell, Richard L. Drake, Richard M. Tibbitts, Paul E. Richardson ,and Wayne Vogl’s Gray's atlas of Anatomy 2nd edition/ Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. / pages (361)
• Medial and Lateral Plantar Nerve Entrapment By Kendrick Alan Whitney for MSD Manual
https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/ foot-and-ankle-disorders/medial-and-lateral-plantar-nerve-entrapment
• Susan Standring, Neel Anand, Rolfe Birch, Patricia Collins, Alan R Crossman, Michael Gleeson , Girish Jawaheer, Ariana L Smith, Jonathan D Spratt, Mark D Stringer, R Shane Tubbs, Richard Tunstall, Alan J Wein, Caroline B Wigley ‘s Gray's Anatomy The Anatomical Basis of Clinical Practice. copyright © 2016, Elsevier Limited. Forty-first edition. Pages(1447)
• Adam W. M. Mitchell, Richard L. Drake, and Wayne Vogl’s Gray's Anatomy for Students. 4th edition/ Copyright © 2020 Elsevier Inc. / pages (656-657)
• Kenneth Prakash Moses, John C. Banks, Jr., Pedro B. Nava, Darrell K. Petersen, ‘ s ATLAS OF CLINICAL GROSS ANATOMY.Copyright © 2013, 2005, by Saunders, an imprint of Elsevier Inc.second eidtion.pages(604.FIGURE 47.12)
• Adam W. M. Mitchell, Richard L. Drake, Richard M. Tibbitts, Paul E. Richardson ,and Wayne Vogl’s Gray's atlas of Anatomy 2nd edition/ Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. / pages (361)
• Medial and Lateral Plantar Nerve Entrapment By Kendrick Alan Whitney for MSD Manual
https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/ foot-and-ankle-disorders/medial-and-lateral-plantar-nerve-entrapment
