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Proximal and distal are terms referencing the relative distance between objects. Proximal and its derivatives (proximally, proximate) signifying close too and distal (distally), suggests further away
In anatomical terms of location the term proximal (Latin proximus; nearest) describes where the appendage joins the body, and the term distal (Latin distare; to stand away from) is used for the point furthest from the point of attachment to the body. Since appendages often move independently of (and therefore change position with respect to) the main body, these separate directional terms are used when describing them.
As noted above, the standard AP, DV and ML directional axes, can cause some confusion when describing parts of the body that can change position (move) relative to the main body. This is particularly true when considering appendages. "Appendages" would include vertebrate fins (see Fig. 2) and limbs (see Figs. 3 and 4), but properly apply to any structure that extends (and can at least potentially move separately) from the main body. Thus, "appendage" would also include such structures as external ears (pinnae) and hair (in mammals), feathers (in birds) and scales (fish, reptiles and birds). As well, varieties of tentacles or other projections from the body in invertebrates and the male in many vertebrates and some invertebrates, would be included.
By connecting the two points, the proximodistal (sometimes hyphenated to proximo-distal) axis is created. (The abbreviation AB axis is occasionally, but not commonly, used.) As before, the terms "proximal" and "distal" can be used as relative terms to indicate where structures lie along the proximodistal axis. Thus, the "elbow" is proximal to the hoof, but distal to the "shoulder" in Figs. 3 and 4.
Choosing terms for the other two axes perpendicular to the proximodistal axis could be variable, as they would also depend on the position of the limb. For that reason, when considering any organism, the other two axes are considered to be relative to the appendage when in standard anatomical position. This is roughly defined for all organisms, as in the normal position when at rest and not moving. For tetrapod vertebrates, this includes the caveat that they are standing erect and not lying down. Thus, the fish in Fig. 2, and the horse in Figs. 3 and 4 are in standard anatomical position. (Special considerations with respect to limb position are applied in human anatomy—see below).
Proximal and distal explanations in clinical psychology
The notion of proximal and distal factor in the causation of mental health problems is a key component of the thinking of David Smail who emphasises that peoples difficulties are likely to be more influenced by distal, social and economic forces, than proximal forces such as relationship stress that can be addressed in therapy.