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The ankle joint is one of the most valuable structures in the human body, with its intricate articulating surfaces and function in ambulation. Dorsiflexion is an essential movement of the ankle joint, where the mid- and forefoot are raised while the tibia and fibula remain static, causing an upward bend at the ankle joint. This movement is facilitated by the muscles in the anterior compartment of the leg, with the tibialis anterior being the strongest dorsiflexor of the foot. Other muscles that contribute to dorsiflexion include the extensor digitorum longus, extensor hallucis longus, and fibularis tertius.
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What You'll Learn
The tibialis anterior is the strongest dorsiflexor of the foot
Dorsiflexion is a critical movement of the ankle joint, which is one of the most valuable structures in the human body. The ankle joint is formed from the tibia and fibula of the lower leg and the talus of the foot. It functions as a hinge, allowing dorsiflexion and plantarflexion. Dorsiflexion is the upward movement of the foot towards the lower leg, while plantarflexion is the downward movement of the foot away from the lower leg.
The tibialis anterior is one of four muscles in the anterior compartment of the leg, the others being the extensor digitorum longus, extensor hallucis longus, and fibularis tertius. These muscles work together to dorsiflex and invert the foot at the ankle joint. The deep peroneal nerve innervates all four muscles and is perfused by the anterior tibial artery.
The tibialis anterior is a powerful muscle that plays a crucial role in gait and locomotion. Its primary function is dorsiflexion, and when this muscle is paralysed or injured, it can result in a condition known as "foot drop". Foot drop is characterised by an inability to dorsiflex or lift the foot during the swing phase of gait, causing the foot to slap the ground during walking or running.
The tibialis anterior muscle is susceptible to overuse injuries, commonly known as shin splints. Anterior tibial stress syndrome (ATSS) is acute and often occurs in new runners or walkers, while medial tibial stress syndrome (MTSS) is more chronic and is seen in athletes. Additionally, the tibialis anterior tendon can become irritated and inflamed, a condition called tibialis anterior tendinitis, usually due to excessive tension from repetitive, high-force activities.
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The extensor digitorum longus is a deep-lying extrinsic muscle
The extensor digitorum longus originates from the inferior part of the lateral tibial condyle, the proximal half of the medial surface of the fibula, and the anterior surface of the interosseus membrane. The muscle then descends inferiorly and, just above the ankle, gives off a tendon that passes under the superior extensor retinaculum and through the inferior extensor retinaculum. The extensor digitorum longus is classified as an unipennate muscle because all the muscle fibres attach to one side of the tendon.
The extensor digitorum longus is innervated by the deep fibular nerve, a branch of the common fibular nerve. The leg portion of the muscle is supplied by two arteries: the proximal part is supplied by the anterior tibial artery, while the distal part receives blood from the fibular artery. The tendons of the muscle are vascularized by the anterior lateral malleolar, lateral tarsal, metatarsal, plantar, and digital arteries.
The extensor digitorum longus is involved in dorsiflexion of the foot, along with the other muscles in the anterior compartment. Dorsiflexion is the superior raising of the mid- and forefoot while the tibia and fibula remain static, causing an upward bend at the ankle joint. The extensor digitorum longus also crosses the subtalar, metatarsophalangeal, and interphalangeal joints of the foot, allowing it to evert the foot and extend the toes.
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The extensor hallucis longus is a deep extrinsic muscle
The extensor hallucis longus is innervated by the deep fibular nerve (root value L5 and S1), with its blood supply mainly coming from the anterior tibial artery and its branches. The venous blood from this compartment is drained by the anterior tibial vein, which empties into the popliteal vein. The tendon of the muscle passes through the dorsal aspect of the foot, specifically deep to the superior extensor retinaculum and through the inferior extensor retinaculum, reaching its insertion point at the base and dorsal surface of the distal phalanx of the big toe.
The primary function of the extensor hallucis longus is the extension of the big toe (hallux), which occurs in both the metatarsophalangeal and interphalangeal joints of the hallux. This extension is crucial for walking and running. In addition to extending the big toe, the extensor hallucis longus also dorsiflexes the foot at the ankle joint. The muscle acts in three foot joints: the talocrural, metatarsophalangeal, and interphalangeal joints.
The extensor hallucis longus is located between two muscles: the tibialis anterior and the extensor digitorum longus. The anterior tibial artery and vein, and the deep peroneal nerve run between the extensor hallucis longus and the tibialis anterior muscles. The tendon of the extensor hallucis longus in the dorsum of the foot runs medially to the tendon of the extensor digitorum longus, and the space between these two tendons is an important clinical location. It serves as an entry point for injections or aspiration procedures in the ankle joint.
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The fibularis tertius is a dorsiflexor
The fibularis tertius is a muscle in the anterior compartment of the leg, or, more specifically, a muscle of the anterior calf. It is also known as the peroneus tertius. The fibularis tertius has a role in the gait cycle, acting with other foot dorsiflexors during the swing phase to clear the foot and toes off the ground. It also has supporting functions for the ankle joint, preventing excessive inversion of the foot during physical activities.
The fibularis tertius arises from the lower third of the front surface of the fibula, the lower part of the interosseous membrane, and the septum, or connective tissue, between it and the fibularis brevis. The septum is sometimes called the intermuscular septum of Otto. The muscle passes downward and ends in a tendon that passes under the superior extensor retinaculum and the inferior extensor retinaculum of the foot in the same canal as the extensor digitorum longus muscle. It may be mistaken as a fifth tendon of the extensor digitorum longus. The tendon inserts into the medial part of the posterior surface of the shaft of the fifth metatarsal bone.
The fibularis tertius is located anterior to the fibularis brevis muscle and the anterior lateral malleolar artery. It also travels laterally to the extensor digitorum longus, with their tendons sharing a common sheath. Throughout its course, the fibularis tertius passes laterally to the distal third of the tibia, posterolaterally to the talocalcaneonavicular joint, and laterally to the tarsometatarsal joint of the foot. The muscle fibres course in an inferolateral direction, forming a tendon that travels underneath the superior extensor retinaculum. Then, it continues toward the inferior extensor retinaculum and courses through its loop, accompanied by the extensor digitorum longus muscle.
The fibularis tertius is not present in all individuals. In two separate studies, the muscle was present in less than 50% of a Chilean sample population and 63% of a south-western Nigerian sample population. It is difficult to assess the true importance of the fibularis tertius because its actions can be completed efficiently by other, more powerful muscles.
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The fibularis brevis is the deeper and shorter of the two fibularis muscles
The fibularis brevis attaches to a tuberosity on the fifth metatarsal, while the fibularis longus attaches to the medial aspect of the foot at the base of the first metatarsal and medial cuneiform bone. The fibularis longus is the longer and more superficial of the two muscles, attaching to the upper half of the fibula bone. The fibularis longus also wraps around the lateral malleolus of the ankle and continues under the foot.
The fibularis muscles help to steady the leg upon the foot, especially when standing on one leg. They are involved in tilting the sole of the foot away from the midline of the body (eversion). The fibularis longus also plays a role in maintaining the transverse arch of the foot.
The primary function of the tibialis anterior muscle is dorsiflexion, which is the upward movement of the mid- and forefoot while the tibia and fibula remain static, causing an upward bend at the ankle joint. Dorsiflexion is critical to gait as it allows the foot to clear off the ground during the swing phase. Paralysis of the tibialis anterior muscle can result in "foot drop", or an inability to dorsiflex.
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Frequently asked questions
Dorsiflexion is the upward movement of the mid- and forefoot while the tibia and fibula remain static, causing an upward bend at the ankle joint.
The muscles that dorsiflex the foot include the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius.
The tibialis anterior (TA) is the strongest dorsiflexor of the foot and its primary function is dorsiflexion.
Paralysis of the tibialis anterior results in a condition called "foot drop", characterised by an inability to dorsiflex the foot. Foot drop can be caused by nerve injury or muscle disorders.
Treatment options for foot drop include conservative methods such as limiting activity, using NSAIDs for pain management, stretching the calf, and wearing an ankle brace. In some cases, surgical repair may be necessary.
