Dominic Stone
The foot is a complex structure consisting of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. The foot can be divided into three categories: the forefoot, midfoot, and hind foot. The forefoot consists of metatarsals and phalanges, the midfoot of the cuboid, navicular, and cuneiform bones, and the hind foot of the talus and calcaneus. The foot is responsible for providing support, balance, and mobility, with muscles, tendons, and ligaments working together to achieve this. The anterior tibialis muscle, for example, allows the foot to move upward, while the peroneal tibialis controls the movement on the outside of the ankle. The foot's arch is supported by the posterior tibialis, and the extensors raise the toes, enabling us to take steps.
| Characteristics | Values |
|---|---|
| Number of bones in each foot | 26 |
| Number of joints in each foot | 33 |
| Number of muscles, tendons, and ligaments in each foot | Over 100 |
| Muscles that lift the arches of the feet | Fibularis muscles, brevis, and longus |
| Muscles that lift the foot | Anterior muscles |
| Muscles that lift the toes | Extensors |
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The fibularis muscles
The fibularis longus and brevis muscles start their descent to the foot on the outside of the shin, just below the knee. The fibularis brevis attaches to the fifth metatarsal, a knob of bone in the middle of the outer foot, and is responsible for lifting the outer arch of the foot. These two muscles work together to extend the foot downward away from the body (plantar flexion) and move the sole of the foot outward, away from the midline of the body (eversion).
The fibularis longus muscle is innervated by the superficial fibular nerve (L5, S1) and receives its blood supply from the fibular artery, a branch of the posterior tibial artery. It arises from the head and superior two-thirds of the lateral fibular shaft, occasionally from the lateral condyle of the tibia, and descends down the leg. It passes posterior to the lateral malleolus and turns under the foot, inserting onto the lateral surface of the medial cuneiform and first metatarsal. This muscle plays a role in maintaining the transverse arch of the foot.
The fibularis tertius, on the other hand, pulls the foot upward toward the body (dorsiflexion). It is supplied by the anterior tibial artery and the deep fibular nerve. Together, these three muscles help stabilize and move the foot, contributing to effective lower limb function.
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Anterior tibialis
The tibialis anterior muscle is situated on the lateral side of the tibia, with its fibres running vertically downward and ending in a tendon at the lower third of the leg. This muscle is thick and fleshy above, and tendinous below. It is a fusiform muscle, meaning that it is shaped like a spindle, and is found in the anterior part of the leg. The tibialis anterior is easily palpable lateral to the anterior border of the tibia.
The tibialis anterior is the primary dorsiflexor of the ankle, and it also inverses the foot at the subtalar joint. This muscle helps to maintain the medial longitudinal arch of the foot and draws up and holds the toe in a locked position. It is involved in any activity that requires moving the leg or keeping the leg vertical. For example, it stabilises the ankle as the foot hits the ground during the contact phase of walking and acts to pull the foot clear of the ground during the swing phase. It also functions to 'lock' the ankle during activities such as toe-kicking a ball.
The tibialis anterior is innervated by the deep fibular nerve, and the recurrent genicular nerve (L4). The body of the muscle is supplied by the branches of the anterior tibial artery, while the tendon is supplied by the branches of both the anterior and posterior tibial arteries.
Excessive physical activity can result in repetitive microtrauma of the tibialis anterior, causing pain along the anterior edge of the tibia known as anterior shin splints or anterior tibial stress syndrome. This can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and ice, and it generally resolves during rest periods.
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Peroneal tibialis
The tibialis anterior is a muscle situated on the lateral side of the tibia. It is thick and fleshy above and tendinous below, with fibres that run vertically downward and end in a tendon. This muscle is one of four muscles in the anterior compartment of the leg, along with the extensor digitorum longus, extensor hallucis longus, and fibularis tertius. The tibialis anterior is innervated by the deep peroneal nerve, also known as the deep fibular nerve, which is a branch of the common peroneal nerve.
The primary function of the tibialis anterior is dorsiflexion, which is the lifting of the foot upward toward the shin. This muscle also contributes to inversion of the foot, adduction of the foot, and maintaining the medial arch of the foot. During gait initiation, the tibialis anterior favours knee flexion at the stance limb by causing forward displacement of the tibia. Additionally, it plays a role in eccentric deceleration of foot plantarflexion, eversion, and foot pronation.
Paralysis of the tibialis anterior muscle can result in "foot drop", or an inability to dorsiflex the foot. This paralysis can be caused by nerve injury, such as direct damage to the deep peroneal nerve, or a muscle disorder like ALS. "Foot drop" is often noticeable during gait when the patient struggles to clear their foot during the swing phase.
The tibialis anterior tendon (TAT) can become irritated and inflamed, a condition known as tibialis anterior tendinitis. Tendinitis is caused by excessive tension on the tendon, often due to repetitive, high-force activities such as hill running or direct contact with equipment, such as a shoe that is too tight around the ankle. Patients with tibialis anterior tendinitis typically complain of pain at the front of the ankle or the medial midfoot.
The tibialis anterior is an important muscle for various activities such as standing, walking, running, and jumping. It works together with the fibularis longus to form the stirrup of the foot, managing the balance between eversion and inversion. When the foot is in a fixed position, the tibialis anterior helps to pull our body over our foot.
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Extensors
Extensor tendons are like strong, flexible ropes. They run along the top of the foot, inserting into different areas in the foot. The extensor digitorum longus (EDL) is one of four muscles in the anterior compartment of the lower leg. The EDL passes under the superior and inferior extensor retinaculum at the anterior surface of the ankle joint before reaching its distal insertion. It divides into four slips that insert into the proximal and distal phalanges of the lateral four digits of the foot. The EDL is the most lateral muscle in the anterior compartment.
Extensor tendinopathy is a condition that can affect the tendons that run along the top of the foot. It can be caused by overuse or repetitive motions, such as typing on a keyboard, or wearing poorly fitting shoes. Symptoms include pain and swelling, and it can be treated with at-home remedies, over-the-counter medications, and exercises.
To prevent extensor tendinopathy, it is important to avoid wearing hard, flat, or unsupportive footwear. Flat shoes may aggravate symptoms, especially with tight calf muscles. Shoes with shoelaces should be tied correctly, and care should be taken not to tie them too tightly.
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Posterior muscles
The foot is a complex structure consisting of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. The posterior muscles are located in the back of the lower leg and help with various movements and functions.
Posterior Tibialis
The posterior tibialis is one of the main muscles of the foot. It supports the arch of the foot and allows for inward turning of the foot. This muscle attaches to the posterior tibia, fibula, and interosseous membrane, connecting to the navicular tuberosity and medial cuneiform. It is an important ankle inverter and helps with plantar flexion (downward movement of the foot).
Calf Muscles
The calf muscles play a crucial role in lower leg function. They are involved in running, jumping, and standing on the toes. The gastrocnemius and soleus muscles are the two main calf muscles. These muscles work together to provide strength and stability during various movements.
Other Posterior Muscles
In addition to the posterior tibialis and calf muscles, there are other posterior muscles in the lower leg that contribute to foot movement and stability. These muscles may be superficial (close to the skin surface) or located deeper within the leg. They assist in flexing and pointing the toes, jumping, sprinting, locking and unlocking the knee, and maintaining proper posture.
The foot also relies on a series of pulley systems to lift the arches and stabilize the foot. The tendon stirrup, formed by tendons like the anterior tibial and fibularis longus, supports and elevates the transverse and longitudinal arches of the foot.
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Frequently asked questions
The main muscles of the foot include the posterior tibialis, the anterior tibialis, the peroneal tibialis, extensors, and flexors.
The arches of the feet are lifted by the muscles of the lower leg, which lift the bones of the foot into their functional positions. The ankle bone acts as a pulley, and the calf muscles provide the force needed to lift the arches.
The tendon stirrup is formed by the anterior tibial and fibularis longus muscles, which have adjacent inserts on two bones. The tendon stirrup supports and elevates the posterior transverse arch of the foot.
Foot drop is a condition that makes it difficult or impossible to lift the foot towards the knee. It is caused by health conditions such as stroke or nerve injury.
