Role of quadratus plantae in foot funtion

NewsBot · Aug 4, 2011

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An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis.
Hur MS, Kim JH, Woo JS, Choi BY, Kim HJ, Lee KS
Clin Anat. 2011 Sep;24(6):768-73

The aim of this study was to demonstrate the morphology of the quadratus plantae (QP) in relation to the tendinous slips of the flexor hallucis longus (FHL) and their surrounding structures, thereby providing data to understand function of the QP during gait, and for analyzing the movements of the foot and designing postoperative rehabilitation programs. The QP was investigated in 50 specimens of embalmed adult cadavers. The QP inserted into the tendon of the flexor digitorum longus (FDL) and the tendinous slips of the FHL in 96%, and only to the tendon of the FDL in 4%. The tendinous slip of the FHL targeted the tendon for the second toe in 4 of the 50 specimens (8%). The tendinous slip divided into two separate slips to the tendons for the second and third toes in 32 specimens (64%), and for the second, third, and fourth toes in 14 specimens (28%). Thus, the tendon and tendinous slips of the FHL may distribute the load of the great toe to the second toe to the third or fourth toe in the forefoot, especially during toe-off. In addition, the main attachment of the QP to the tendinous slips of the FHL may provide more efficient control of the long flexor tendons in comparison with that of the QP to the tendon of the FDL
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NewsBot · May 20, 2014

The Quadratus Plantae: A Review of Functional Theories Past and Present
Darla Thomas, BA, BS, and Ashley Varner, BS
NYCPM; 2014

Introduction
Of the plantar intrinsic foot muscles, the quadratus plantae counts itself unique due to its structure
and function. In recent years, advances in research methods and technology have brought the
function of this muscle into question. The quadratus plantae is now believed to play an essential
role not just in flexion of the toes, but in gait, posture and compartment syndrome secondary to a
calcaneal fracture. Its role in pronation has also come into question with the emergence of
electromyographic technology. This paper is a systematic review exploring old views and
assessing new beliefs concerning the role and function of the quadratus plantae. !
Study Design
Review of the Literature !
Methods
A general literature search on “quadratus plantae”, “flexor accessorius” and “human foot
anatomy” + “quadratus plantae” was conducted in PubMed, producing 28, 31 and 15 results
respectively, along with four advanced literature searches. In addition, we also reviewed two
anatomy books containing sections committed to the intrinsic plantar muscles, that specifically
discussed the quadratus plantae. Articles based solely on the flexor accessorius longus and the
intrinsic plantar foot muscles as a group were excluded.
Results
A total of 24 articles were selected from the online PubMed and Google Scholar searches (1892
to present). Section 9 of “Gray’s Anatomy, 40th edition” and Chapter 6 of “Clinically Oriented
Anatomy, 5th edition” were also used as references. !
Conclusion
Theories of quadratus plantae’s unique role in gait, posture, and compartment syndrome have
been presented. Since the current literature is limited in its assessment of these various functions
of the quadratus plantae, additional research is required to thoroughly examine these proposed
mechanisms.
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NewsBot · Dec 15, 2014

Fiber type composition of the human quadratus plantae muscle: a comparison of the lateral and medial heads
Kristen L Schroeder, Benjamin W Rosser and Soo Y Kim
Journal of Foot and Ankle Research 2014, 7:54 doi:10.1186/s13047-014-0054-5

BackgroundThe human quadratus plantae muscle has been attributed a variety of functions, however no consensus has been reached on its significance to foot functioning. The architecture of the human quadratus plantae consists of an evolutionarily conserved lateral head, and a medial head thought to be unique to Man. Surveys of human anatomy have demonstrated the absence of either the medial or lateral head in 20% of the population, which may have implications for foot functioning if each muscle head performs a discrete function.
MethodsWe investigated the quadratus plantae from eleven formalin-embalmed specimens with a mean age of 84???9?years. Immunohistochemical methods were used to determine the percentage of Type I and Type II muscle fibers in the medial and lateral heads of the quadratus plantae from these specimens.
ResultsResults showed striking homogeneity in fiber type composition within an individual, with an average difference in Type I fiber content of 4.1% between lateral and medial heads. Between individuals, however, the ratio of fiber types within the quadratus plantae was highly variable, with Type I fiber percentages ranging from 19.1% to 91.6% in the lateral head, and 20.4% to 97.0% within the medial head.
ConclusionsOur finding of similar fiber type composition of lateral and medial heads within an individual supports the hypothesis that the two heads have a singular function.
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NewsBot · Nov 24, 2017

Morphological characteristics and variations of the human quadratus plantae muscle.
Pretterklieber B
Ann Anat. 2017 Nov 19. pii: S0940-9602(17)30145-0. doi: 10.1016/j.aanat.2017.10.006.

The quadratus plantae (QP) is a highly variable structure. A number of partly inexact descriptions of this entity have been provided in textbooks of anatomy. Although several authors have examined the QP, its exact site of origin and type of insertion have hitherto not been specified. The aim of this study has been to provide detailed qualitative and quantitative data about the number of heads, points of origin, and type of insertion of the QP. The QP in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (34%), two (57%) or three heads (9%). The latter condition was observed only in men. The lateral head was absent in 31 feet, and the medial head only in one right foot of a man. The medial head arose, amongst others, in 100% of the examined cases from the medial calcaneal surface, in 93% from the long plantar ligament and in 80% from the plantar calcaneocuboid ligament. The lateral head arose, amongst others, from the long plantar ligament in 90%, and from the lateral process of the calcaneal tuberosity in 64% of the examined feet. The type of insertion was always a mixture of at least two of three types; i.e. muscular (84%), tendinous (89%) and aponeurotic (45%). As additional findings, the flexor digitorum accessorius longus (FDAL) and the peroneocalcaneus internus (PCI) were observed in 12% of all individuals and in 20% of men. The present investigation revealed that the QP may be classified according to the number of heads, but no classification can be given for its points of origin or type of insertion. The present data are mandatory for anatomical and surgical practice and will hopefully lead to further imaging and biomechanical studies.
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NewsBot · Jul 18, 2021

Accessory slip of flexor digitorum accessorius (Quadratus plantae) muscle surrounding the lateral plantar nerve and vessels
S B Nayak, S K Vasudeva
Morphologie. 2021 Jul 8;S1286-0115(21)00186-7

Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists
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NewsBot · Apr 5, 2022

Anatomical variation of quadratus plantae in relation with flexor hallucis longus and flexor digitorum longus: a rare case
S Haratizadeh et al
Folia Morphol (Warsz). 2022 Apr 5

The quadratus plantae (QP) is considered as a part of the plantar intrinsic foot muscles. This muscle has two lateral and medial heads of origin, both of which arise from the plantar surface of calcaneus, and insert into the tendon of flexor digitorum longus (FDL). Various functions have been attributed to the QP muscle, which includes assisting the plantar flexion of the lateral four toes, straightening the oblique pull of FDL and etc. Several anatomical variations of the QP muscle have been reported in the literature. During a routine dissection in the department of anatomy at Kerman University of Medical Sciences, a variant plantar muscle was observed in a 40-year-old male cadaver. In the present case, we report a rare variation associated with the insertion pattern of this muscle, which is reported for the first time in Iran. The tendinous end of the QP muscle was divided into 3 tendons and were then inserted to the inferior surface of 2nd, 3rd and 4th tendons of FDL. Also, a slim tendinous interconnection was also observed between the QP and flexor hallucis longus (FHL). The lack of connection between the FDL and FHL tendons was the other rare variation of this case. Exact knowledge of the possible variations of the QP muscle is of utmost importance to foot surgeons, clinicians and also anatomists.
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NewsBot · Aug 19, 2023

Anatomical variation of quadratus plantae in relation with flexor digitorum brevis
Punnapa Raviteja et al
Anat Cell Biol. 2023 Aug 18

The muscles of the sole have been traditionally categorized into four layers, but it is more practical to divide them into peripheral and central groups. The peripheral groups include medial and lateral groups. The central plantar muscles are more numerous and divided into superficial and deep layers. During routine dissection in the Department of Anatomy, All India Institute of Medical Sciences Bibinagar, Hyderabad, variations are been observed in the plantar intrinsic muscle in the left foot & right foot of a 53-year-old male cadaver. This is the first cadaveric report of a combination of discrepancies especially the inter-tendinous connection between quadratus plantae and flexor digitorum brevis. Similar observations in the literature were not found by us. It is important to identify and study these dissimilarities of muscles of the sole for surgeons, anatomists, radiologists and orthopaedics as these muscles and tendons are used in foot reconstructive procedures, and for the treatment of some congenital anomalies.
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