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The ankle joint is formed by the articulation of the talus, tibia, and fibula bones. It connects the foot to the lower leg and contains muscles, ligaments, nerves, and blood vessels. The ankle moves in two main directions: plantar flexion (down and away from the body) and dorsiflexion (up towards the body). In addition to these movements, the ankle can also turn in (inversion) and out (eversion). This movement is controlled by muscles that originate in the lower leg. The peroneal muscles (peroneus longus and peroneus brevis) are located on the outside of the ankle and are responsible for eversion, or turning the foot out so that the sole faces away from the midline.
| Characteristics | Values |
|---|---|
| Muscles that evert the ankle | Peroneus longus, Peroneus brevis, Peroneus tertius |
| Location of muscles that control ankle movement | Lower leg |
| Function of peroneal muscles | Allow the ankle to bend downward and outward |
| Muscles that control plantarflexion | Gastrocnemius, Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus, Peroneus brevis, Peroneus longus |
| Muscles that control dorsiflexion | Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus, Peroneus tertius |
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What You'll Learn
Peroneus longus and Peroneus brevis muscles
The Peroneus longus and Peroneus brevis muscles, also known as the Fibularis longus and Fibularis brevis, are crucial muscles involved in the eversion of the ankle joint. These muscles are located in the lateral compartment of the leg and play a significant role in maintaining ankle stability and facilitating various foot movements.
Let's start by discussing the Peroneus brevis muscle, also known as the Fibularis brevis. This is a short muscle that lies in the lateral part of the lower leg, deep to the Fibularis longus. It is one of the three ankle everters, collectively called the fibularis muscles, which include the Fibularis longus, Fibularis brevis, and Fibularis tertius. The Fibularis brevis originates from the distal two-thirds of the lateral fibula, and its tendon passes downwards, looping posteriorly to the lateral malleolus. The muscle then inserts on the styloid process at the proximal end of the fifth metatarsal. This muscle is responsible for generating 63% of the power required to evert the foot, and it also assists in plantar flexion, which involves extending the foot downward away from the body at the ankle.
The Fibularis brevis is susceptible to various injuries, with tendon injuries being particularly common. Lateral ankle sprains can lead to tendon tears and swelling at the lateral ankle. Inversion or supination forces can cause tendinopathy, dislocation, or subluxation of the tendon. During a Supination-Adduction injury, the Peroneus brevis tendon can be injured, potentially resulting in an avulsion fracture known as a Jones Fracture at the base of the fifth metatarsal.
Now, let's focus on the Peroneus longus muscle, also referred to as the Fibularis longus. This muscle is a superficial muscle in the lateral compartment of the leg. It is the longest and most superficial of the three fibularis muscles. The Peroneus longus is attached at its upper end to the head of the fibula, and its "belly" runs along most of this bone. The muscle then transitions into a tendon that wraps around and behind the lateral malleolus of the ankle, continuing under the foot to attach to the medial cuneiform and first metatarsal. This muscle also contributes to eversion by tilting the sole of the foot away from the midline of the body. Additionally, it assists in plantar flexion, helping to extend the foot downward.
The Peroneus longus muscle is prone to injuries, particularly in young, active individuals and those participating in sports such as football, soccer, and running. Tendon injuries to this muscle can cause lateral ankle pain and may lead to ankle instability. Tears in the Peroneus longus tendon commonly occur longitudinally due to subluxation over the fibula, but they can also present as transverse tears. Fibular avulsion fractures can also result from tendon tears.
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Peroneus tertius
The Peroneus Tertius muscle, also called the Fibularis Tertius, is one of the three fibularis muscles (the others being the fibularis longus and fibularis brevis). It is the most superficial muscle in the anterior compartment of the leg. The muscle's presence varies depending on the population studied. In some individuals, the muscle is absent, while in others, it forms part of the extensor digitorum longus, being described as the muscle's "fifth tendon".
The peroneus tertius is located on the lower lateral aspect of the leg. It is part of the anterior, or extensor, compartment of the leg, along with three additional muscles: the extensor digitorum longus, extensor hallucis longus, and tibialis anterior. Together, these muscles are responsible for ankle dorsiflexion. The peroneus tertius extends from the distal end of the fibula to the base of the fifth metatarsal bone, acting on two main joints of the foot: the talocrural (ankle) and subtalar joints.
Due to its relatively small size and poor mechanical leverage, the peroneus tertius is considered a weak dorsiflexor and evertor of the foot. The strength of eversion and dorsiflexion is not compromised in people who lack the peroneus tertius muscle, and the muscle does not appear to provide higher protection against ankle ligamentous injury.
The peroneus tertius muscle fibres course in an inferolateral direction, forming a tendon that travels underneath the superior extensor retinaculum. It then continues towards the inferior extensor retinaculum and courses through its loop, accompanied by the extensor digitorum longus muscle. The peroneus tertius finally inserts onto the dorsal surface (medial part) of the base of the metatarsal bone 5.
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Tibialis anterior
The tibialis anterior muscle is a fusiform muscle found in the anterior part of the leg. It is the primary dorsiflexor of the ankle, with its fibres running vertically downward and ending in a tendon, which is apparent on the anterior surface of the muscle at the lower third of the leg. This muscle is responsible for dorsiflexion and inversion of the foot, which are essential for maintaining the medial arch of the foot and facilitating activities like walking and hiking.
The tibialis anterior is situated on the lateral side of the tibia, overlapping the anterior tibial vessels and deep peroneal nerve in the upper part of the leg. It arises from the upper two-thirds of the lateral surface of the tibia and is inserted into the medial and inferior surface of the medial cuneiform bone, as well as the adjacent portion of the first metatarsal bone. The tendon of the tibialis anterior usually passes beneath the extensor retinaculum, which holds it in place.
The deep fibular (peroneal) nerve (L4, L5), a branch of the common fibular nerve, innervates the tibialis anterior muscle. The body of the muscle is supplied by the branches of the anterior tibial artery, while the tendon is supplied by both the anterior and posterior tibial artery branches. This muscle plays a crucial role in stabilising the ankle joint during various activities. For instance, when the foot hits the ground during walking, the tibialis anterior contracts eccentrically to stabilise the ankle. It then concentrically contracts to pull the foot clear of the ground during the swing phase.
The tibialis anterior also helps to ''lock' the ankle during activities such as toe-kicking a ball, where it undergoes isometric contraction. It is important to note that the actions of the tibialis anterior depend on whether the foot is weight-bearing or not. When the foot is on the ground, this muscle helps to balance the leg and talus on the other tarsal bones, ensuring the leg remains vertical even on uneven ground.
Excessive physical activity, especially in runners and military personnel, can lead to repetitive microtrauma of the tibialis anterior, resulting in a condition known as anterior shin splints or anterior tibial stress syndrome. This condition causes pain along the anterior edge of the tibia and is often treated with rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and ice.
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Extensor digitorum longus
The extensor digitorum longus (EDL) is a feather-like muscle in the anterior (extensor) compartment of the leg. It is one of four muscles in this compartment, the others being the tibialis anterior, extensor hallucis longus, and fibularis (peroneus) tertius. The EDL is the most lateral muscle in the anterior compartment.
The EDL 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 (its most superior part). 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 extinaculum. The EDL is classified as a unipennate muscle because all of its muscle fibres attach to one side of the tendon. Within the inferior extensor retinaculum, the tendon splits into four smaller tendons that are wrapped together in a synovial sheath.
The EDL divides into four slips, which run forward on the dorsum of the foot and are inserted into the second and third phalanges of the four lesser toes. The tendons to the second, third, and fourth toes are each joined, opposite the metatarsophalangeal articulations, on the lateral side by a tendon of the extensor digitorum brevis muscle.
The EDL is involved in dorsiflexion of the foot, as well as eversion of the foot and extension of the toes. It is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve. The leg portion of the muscle is supplied by two arteries of the leg: the proximal part by the anterior tibial artery and the distal part by the fibular artery. The tendons of the muscle are vascularized by the anterior lateral malleolar, lateral tarsal, metatarsal, plantar, and digital arteries.
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Extensor hallucis longus
The extensor hallucis longus (EHL) is a thin skeletal muscle located in the anterior compartment of the lower leg. It is responsible for extending the big toe at both the metatarsophalangeal and interphalangeal joints. The EHL passes deep to the extensor retinaculum before inserting at the base of the distal phalanx of the big toe.
The EHL is involved in three foot joints: the talocrural, metatarsophalangeal, and interphalangeal joints. It extends the metatarsophalangeal and interphalangeal joints of the big toe and assists in the inversion of the foot and dorsiflexion of the ankle. The muscle also assists with foot eversion, which is the movement of the ankle that turns the foot outward.
The EHL originates from the anteromedial aspect of the fibula, which is the lateral bone of the lower leg. It is located between the tibialis anterior and the extensor digitorum longus muscles. The origin of the EHL extends to the anterior aspect of the interosseous membrane of the leg, which is situated between the fibula and tibia. From here, the muscle runs inferomedially towards the foot, ending in a tendon.
The tendon of the EHL passes through a distinct compartment in the inferior extensor retinaculum of the foot. It crosses anterior tibial vessels lateromedially near the bend of the ankle. In the foot, the tendon is situated along the medial side of the dorsum of the foot. Opposite the metatarsophalangeal articulation, the tendon gives off a thin prolongation on either side, covering the surface of the joint.
Weakness of the EHL can cause the toe to fold under the foot when pulling on socks or shoes, leading to tripping. Hyperextension of the big toe can also cause pain and calluses, or corns, on the dorsal surface of the interphalangeal joint.
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Frequently asked questions
The peroneus longus and peroneus brevis muscles, found in the lateral compartment of the leg, function to facilitate eversion of the ankle joint.
Eversion is the tilting of the foot so that the sole faces away from the midline.
The peroneal muscles (peroneus longus and peroneus brevis) are located on the outside edge of the ankle and foot. These muscles allow the ankle to bend downward and outward.
