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Skin 皮肤 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. 脚底的皮肤非常独特，坚韧且有弹性。它通过角质化层中的肥大反应来应对异常应激，形成胼胼胝体。在严重的跖骨痛的情况下，突出的跖骨头部上方的皮肤变得纤薄。在Fowler手术中(横向切口)，切除病理性唇状皮肤，将较厚的正常皮肤缝合回正确的位置。在缺血性或神经性疾病的患者中，皮肤也可能萎缩。 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. 鞋底的深筋膜类似于手掌的深掌筋膜; 它也可能遭受Dupuytren挛缩。筋膜中央部分较厚，覆盖拇趾和小趾的内在肌肉处较薄。中心部分的足底腱膜，起源于跟骨的内侧结节，向前延伸以附着于每个足趾的近节趾骨。 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. 足底腱膜附着在跟骨内侧结节上，常常是引起足跟疼痛炎症性、退行性病变的部位。在这种情况下，最大的压痛点是足底腱膜对应的解剖连接点。在少数情况下，这种情况被称为足底筋膜炎(“警察的脚后跟”)，可能需要手术剥离筋膜的起源。 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. 内侧和外侧纤维隔起源于足底筋膜的内侧和外侧边界，附着于第一和第五跖骨。这些隔膜把脚分成三个隔间，就像在手上的隔膜一样。这些隔室可以限制足部的感染扩散。 First Layer of Muscles 第一层肌肉 The superficial layer consists of three muscles: The flexor digitorum brevis, abductor hallucis, and abductor digiti minimi. 第一层由趾短屈肌、拇外展肌和小趾展肌三部分组成。 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. 趾短屈肌主要来自足底腱膜，部分来自跟骨结节内侧。它分为四个肌腱，连接四个脚趾的中间趾骨，并弯曲脚趾，与脚踝的位置无关。 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内侧结节，连接拇趾近节指骨的内侧，并外展大脚趾。它是唯一能够抵抗拇外翻畸形的肌肉。 Superficial Nerves and Vessels 浅层神经和血管 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. 内侧和外侧足底动脉和神经位于第一和第二层肌肉之间。它们相对表浅，由于上覆盖足底筋膜的韧性，很少受伤。 Second Layer of Muscles 第二层肌肉 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. 第二层肌肉由长屈肌腱(拇长屈肌腱、趾长屈肌腱和足底方肌)组成，它们对维持足部纵弓至关重要。帮助这些肌肉的是蚓状肌，它来自趾长屈肌的肌腱。运动时，蚓状肌弯曲跖趾关节，同时保持趾间关节伸展。无力会导致脚趾的受伤，从而导致足部产生与手萎缩相同的症状。跖趾关节的持续伸展畸形最终导致该关节发生半脱位，在趾脱位下跖骨承受行走时不能分布到移位脚趾的重量。结果导致疼痛(跖骨痛)。 Third Layer of Muscles 第三层肌肉 The third layer of muscles consists of the flexor hallucis brevis, adductor hallucis, and flexor digiti minimi brevis. 第三层肌肉由拇短屈肌、拇内收肌和小趾短屈肌组成。 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. 拇短屈肌通过内侧和外侧籽骨连接拇指近节指骨的基部。内侧籽骨也会从拇外展肌滑脱，外侧籽骨也会从拇内收肌滑脱。在拇外翻的病例中，籽骨可能移位，外侧籽骨移动到第一和第二跖骨之间的位置。如果发生这种情况，外侧籽骨可以机械地阻止第一趾序列的排列。籽骨和跖骨头之间的关节可能会退化并疼痛。 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. 拇内收肌是拇外翻最重要的变形力，它通过外侧籽骨连接近节指骨。许多针对这种情况的手术包括将肌肉从其连接处分离出来，重新接入跖骨头部，这样它就可以作为跖骨内翻的动态矫正器。 Fourth Layer of Muscles 第四层肌肉 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. 第四层也是最深的一层肌肉，由附着在跖骨上的骨间肌和两根肌腱组成，这两根肌腱分别是腓骨长肌和胫骨后肌，它们是纵向足弓的主要支撑。 足的解剖视频讲解
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