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The muscles that extend the toes are the extensor digitorum longus and the tibialis anterior. The extensor digitorum longus is a deep-lying extrinsic muscle that runs down the length of the tibia. It passes under the superior and inferior extensor retinaculum of the foot and divides into four slips, which attach to the second, third, and fourth toes. The tibialis anterior is located at the front of the leg, near the shin, and is responsible for controlling the dorsiflexion of the foot (lifting the foot upward) and extending the toes.
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What You'll Learn
Tibialis Anterior
The tibialis anterior is a muscle that extends the toes, dorsiflexes the foot (lifts the foot upwards), and tautens the plantar aponeurosis (thick connective tissue that spans the sole of the foot). It is located at the front of the leg, along the lateral surface of the tibia, and is responsible for controlling the dorsiflexion of the foot and toe extension, making it crucial for walking, running, and maintaining balance.
The tibialis anterior muscle arises from the upper two-thirds of the lateral surface of the tibia and the adjoining part of the interosseous membrane and deep fascia overlying it. It is inserted into the medial and inferior surface of the medial cuneiform bone and the adjacent portion of the first metatarsal bone. The muscle is innervated by the deep fibular nerve and recurrent genicular nerve (L4).
The tibialis anterior plays a vital role in various activities and is essential for proper foot function and overall balance. It helps maintain the medial longitudinal arch of the foot and contributes to foot movement and stability in daily activities. For example, when walking, the tibialis anterior helps lift the front of the foot to avoid tripping over obstacles. It also aids in maintaining balance when standing on one foot by ensuring the foot is properly positioned.
The tibialis anterior is the primary dorsiflexor of the ankle and also inverses the foot at the subtalar joint. It acts to stabilise the ankle as the foot hits the ground during the contact phase of walking (eccentric contraction) and then pulls the foot clear of the ground during the swing phase (concentric contraction). This muscle is also important in activities such as hiking and kicking a ball, where it helps to stabilise the ankle joint.
Excessive physical activity, especially in runners and military personnel, can result in repetitive microtrauma of the tibialis anterior, causing a pain called anterior shin splints or anterior tibial stress syndrome along the anterior edge of the tibia. This condition typically resolves with rest, but nonsteroidal anti-inflammatory drugs (NSAIDs) and ice can also be used to relieve symptoms.
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Extensor Digitorum Longus
The extensor digitorum longus is a 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 extensor digitorum longus is the most lateral muscle in the anterior compartment.
The extensor digitorum longus is a pennate muscle, situated at the lateral part of the front of the leg. It 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 passes under the superior and inferior extensor retinaculum of the foot, dividing into four slips that run forward on the dorsum of the foot and are inserted into the second and third phalanges of the four lesser toes.
The extensor digitorum longus 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 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, eversion of the foot, and extension of the toes. It works alongside the tibialis anterior, which is also responsible for extending the toes, to control foot movement and maintain balance.
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Extensor Digitorum Brevis
The EDB arises from the forepart of the upper and lateral surface of the calcaneus (in front of the groove for the peroneus brevis tendon), from the interosseous talocalcaneal ligament, and the stem of the inferior extensor retinaculum. The fibres pass obliquely forwards and medially across the dorsum of the foot and end in four tendons. The EDB is richly vascularized, with its proximal blood supply originating from the anterior perforating branch of the fibular artery and the anterior lateral malleolar artery, a branch of the anterior tibial artery. More distally, the muscle receives blood supply from the dorsalis pedis artery and its branches, such as the lateral tarsal arteries, arcuate artery, and dorsal metatarsal arteries.
The EDB is innervated by the lateral terminal branch of the deep fibular nerve (also known as the deep peroneal nerve or peroneal nerve), which arises from the L5 and S1 spinal nerves. The EDB works in conjunction with other muscles to lift the toes off the ground during walking or running. The EDB tendon, along with a dorsal foot flap, can be used to repair soft tissue and tendon defects on the dorsum of the hand, allowing for simultaneous repair and restoration of finger extension functions.
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Extensor Hallucis Longus
The Extensor Hallucis Longus (EHL) is a thin skeletal muscle that is responsible for extending the big toe. It is a key muscle located in the anterior compartment of the lower leg, alongside three other muscles: the extensor digitorum longus, tibialis anterior, and fibularis tertius muscles. The EHL is situated between the tibialis anterior and the extensor digitorum longus muscles.
The EHL originates from the anteromedial aspect of the fibula, extending to the anterior aspect of the interosseous membrane of the leg, which is located between the fibula and tibia. From here, the muscle runs inferomedially towards the foot, ending in a tendon. The tendon passes through a distinct compartment in the inferior extensor retinaculum of the foot and crosses the anterior tibial vessels near the ankle. In the foot, the tendon is situated along the medial side of the dorsum of the foot.
The main function of the EHL is to extend the big toe, specifically at the metatarsophalangeal and interphalangeal joints. This extension is crucial for walking and running. In addition to extending the big toe, the EHL also has accessory actions in other joints, such as assisting with foot eversion, inversion, and dorsiflexion of the ankle.
Weakness of the EHL can cause issues with balance and movement. Patients with EHL weakness report that their toe tends to fold under the foot when pulling on socks or shoes, which can lead to tripping. Hyperextension of the EHL can also cause pain and calluses on the dorsal surface of the interphalangeal joint.
To target and strengthen the EHL, specific exercises such as big toe lifts, big toe extension with heel raises, short foot exercises, and towel curls can be performed. These exercises help improve isolation, range of motion, and strength in the EHL and other muscles of the foot.
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Flexor Digitorum Brevis
The flexor digitorum brevis is a broad muscle found deep in the sole of the foot. It is also referred to as the flexor digitorum communis brevis. This muscle is responsible for toe flexion at the metatarsophalangeal joints of the lateral four digits. It also supports the longitudinal arch of the foot while propelling the body forward during gait.
The flexor digitorum brevis is situated lateral to the abductor digiti minimi and medial to the abductor hallucis muscles. It runs deep to the thick layer of the plantar aponeurosis. Its tendons run medially to the common plantar digital nerves and vessels. The innervation for the flexor digitorum brevis comes from the medial plantar nerve (S1-S3), the larger of the two terminal branches of the tibial nerve. The muscle is vascularized by the branches of the posterior tibial artery, namely the medial and lateral plantar arteries.
The flexor digitorum brevis originates from three sites: the medial process of the calcaneal tuberosity, the plantar aponeurosis, and the intermuscular septum. Its large muscle belly spans across the medial side of the plantar aspect of the foot. Approximately halfway across the sole of the foot, the muscle fibres divide into four slits, each giving off a tendon for one of the lateral four toes. At the level of the corresponding proximal phalanx, each tendon divides into two terminal slits that insert into the base of the middle phalanx.
The main action of the flexor digitorum brevis is the flexion of the second to the fifth digits at the metatarsophalangeal and proximal interphalangeal joints. This muscle also supports the longitudinal arch of the foot and stabilizes the foot while walking or running. The coordination between the flexor digitorum brevis and the flexor digitorum longus muscle is crucial for the gait cycle, as they work together to maintain balance by keeping the toes in firm contact with the ground.
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Frequently asked questions
The muscles that extend the toes are the tibialis anterior, extensor digitorum longus, and extensor digitorum brevis.
The tibialis anterior is a muscle that lies near the shin and controls foot movement and balance.
The extensor digitorum longus is a deep-lying extrinsic muscle that runs down the length of the tibia and attaches to the toes.
