Dominic Stone
Dorsiflexion is an essential movement of the ankle joint, allowing the mid- and forefoot to raise while the tibia and fibula remain static, causing an upward bend at the ankle joint. The muscles that facilitate dorsiflexion are located in the anterior compartment of the leg and include the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius. These muscles help lift the foot and toes during gait, preventing them from dragging on the ground. Conversely, the posterior leg muscles, along with certain ligaments, restrict the movement. Weakness in the dorsiflexor muscles can lead to a condition called foot drop, characterised by an inability to dorsiflex the foot, resulting in the foot dropping when walking.
| Characteristics | Values |
|---|---|
| Dorsiflexion | The upward movement of the mid- and forefoot while the tibia and fibula remain static, causing an upward bend at the ankle joint. |
| Muscles involved | Tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius |
| Location of muscles | Anterior compartment of the leg |
| Range of motion | 15-20° is the mean and maximum angulation an individual can reach. However, Roaas & Anderson stated that very flexible individuals can reach 40° of dorsiflexion, while less flexible individuals can reach up to 5°. |
| Function | Important during the gait cycle, lifting the foot and toes to prevent them from dragging along the ground. |
| Restrictions | Can be caused by muscular imbalance, tight muscles, weak muscles, myofascial issues, trigger points, arthrofibrosis, arthritis, and scar tissue. |
| Clinical significance | Foot drop, or the inability to dorsiflex the foot, can interfere with walking as the affected foot drags along the ground. |
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What You'll Learn
Tibialis Anterior
The tibialis anterior is a muscle in the anterior compartment of the lower leg. It is the most medial muscle in this compartment and is also the largest and most superficial. It originates from the upper portion of the tibia, arising from the lateral tibia, and inserts into the medial cuneiform and first metatarsal bones of the foot. The muscle ends in a tendon, which is apparent on the anteriomedial dorsal aspect of the foot close to the ankle.
The tibialis anterior is a primary inverter of the foot, along with the tibialis posterior. It is responsible for dorsiflexion and inversion of the foot. Dorsiflexion is the upward bending of the ankle joint, which lifts the mid- and forefoot while the tibia and fibula remain static. The tibialis anterior is a considerably strong dorsiflexor muscle, compared to the other three muscles in the foot.
The tibialis anterior aids in any activity that requires moving the leg or keeping the leg vertical. It stabilises the ankle as the foot hits the ground during the contact phase of walking (eccentric contraction) and later pulls the foot clear of the ground during the swing phase (concentric contraction). It also functions to ''lock' the ankle, as in toe-kicking a ball, when held in an isometric contraction.
The tibialis anterior is susceptible to rupture, although this is uncommon. If a rupture occurs, it can be treated with surgical repair or reconstruction, where the tendon is reattached to the bone.
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Extensor Digitorum Longus
The extensor digitorum longus (EDL) is a pennate muscle, situated at the lateral part of the front of the leg. It is one of four muscles in the anterior compartment of the lower leg, alongside 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 passes under the superior and inferior extensor retinaculum of the foot, along with the fibularis tertius, and divides into four slips, which run forward on the dorsum of the foot. These slips are inserted into the second and third phalanges of the four lesser toes. The EDL is classified as an unipennate muscle because all of its muscle fibres attach to one side of the tendon.
The EDL plays a crucial role in dorsiflexion, which is the upward bending of the ankle joint. It also helps to evert the foot and extend the toes. The anterior tibial artery and vein pass between the EDL and the tibialis anterior, and the leg portion of the muscle is supplied by these arteries. The EDL is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve.
The EDL can become overactive and tight, leading to an inhibited tibialis anterior. To regain muscle balance and improve functional ankle dorsiflexion, stretching and myofascial release of the EDL, along with activation of the tibialis anterior, may be recommended.
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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 also assists with foot eversion and inversion.
The EHL originates from the anteromedial aspect of the fibula, specifically the middle third or middle portion of the anterior surface of the fibula, and the adjacent interosseous membrane of the leg. It is situated between the tibialis anterior and the extensor digitorum longus muscles. The anterior tibial artery and vein, as well as the deep peroneal nerve, run between the EHL and the tibialis anterior.
The EHL tendon 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.
The EHL is a crucial muscle for walking and running. It works together with other muscles from the anterior compartment of the leg to dorsiflex the foot in the ankle joint. Weakness in the EHL can lead to issues such as the toe folding under the foot when putting on socks or shoes, and can cause tripping.
There are exercises that target the EHL, such as the Big Toe Lift, where you raise your big toe while keeping the other toes flat on the floor. This helps improve isolation and range of motion. Another exercise is the Big Toe Extension with Heel Raises, where you perform heel raises while keeping the big toe extended. This can be made easier by placing a towel roll under the toes.
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Fibularis Tertius
The fibularis tertius (also known as the peroneus tertius) is a muscle in the anterior compartment of the leg. It is involved in dorsiflexion, which is the upward bending of the ankle joint, and eversion, which is tilting the sole of the foot away from the body's midline. The fibularis tertius originates from the lower third of the front surface of the fibula, the interosseous membrane, and the connective tissue or septum between the fibula and the fibularis brevis. The septum is sometimes called the intermuscular septum of Otto.
The fibularis tertius is a thin, unipennate type of skeletal muscle. It passes downward and ends in a tendon that runs under the superior and inferior extensor retinaculum of the foot, alongside the extensor digitorum longus muscle. The tendon inserts into the dorsal aspect of the base of the fifth metatarsal bone. The fibularis tertius is considered a weak dorsiflexor and evertor of the foot due to its small size and poor mechanical leverage. It may be absent in humans, with its presence varying across different populations.
The fibularis tertius is supplied by the deep fibular nerve, a branch of the sciatic nerve, and in rare cases, by the common fibular nerve. It receives arterial blood from several sources, including the anterior tibial artery, the dorsalis pedis artery and its branches, and the posterior tibial artery. The muscle fibres travel in an inferolateral direction, forming a tendon that inserts into the dorsal aspect of the base of the fifth metatarsal bone.
The fibularis tertius has a role in the gait cycle, working with other foot dorsiflexors to lift the foot and toes off the ground during the swing phase. It also provides support for the ankle joint, helping to prevent excessive inversion of the foot during physical activities. However, its functions can also be performed by other, more powerful muscles, and some individuals lacking the fibularis tertius do not experience any movement impairment.
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Dorsiflexion and inversion of the foot
The ankle joint is one of the most valuable structures in the human body due to its intricate articulating surfaces and function in ambulation. Dorsiflexion is an essential movement of the ankle joint. It involves the superior raising of the mid- and forefoot while the tibia and fibula remain static, causing an upward bend at the ankle joint. The main muscles contributing to dorsiflexion are the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius. These muscles are all located in the anterior compartment of the leg.
The tibialis anterior is the strongest dorsiflexor of the foot. It originates from the lateral surface of the tibia and attaches to the base of the big toe. The extensor digitorum longus is a deep-lying extrinsic muscle that runs the length of the tibia. It originates from the tibia and transitions into a tendon, passes into the foot, splits into four, and attaches to the toes. The extensor hallucis longus is also a deep-lying extrinsic muscle, located beneath the extensor digitorum longus. It originates from the fibula and attaches to the big toe.
Dorsiflexion of the foot is facilitated by the muscles in the anterior compartment of the leg and restricted by the muscles in the posterior compartment, as well as the joint capsule and ligaments. It is particularly important during the gait cycle, lifting the foot and toes to prevent them from dragging along the ground. The range of motion for dorsiflexion varies depending on the individual's flexibility, with more flexible individuals capable of greater dorsiflexion.
Inversion of the foot refers to the tilting of the sole of the foot inwards towards the midline. It is performed by the tibialis posterior and tibialis anterior muscles. The tibialis anterior muscle is also involved in dorsiflexion, as mentioned earlier. The subtalar joint, formed between the talus and calcaneus bones of the foot, controls the inversion and eversion of the ankle and hindfoot.
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Frequently asked questions
The muscles that perform dorsiflexion are the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius.
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 tibialis anterior is the strongest dorsiflexor of the foot and is responsible for dorsiflexion and inversion of the foot.
The extensor digitorum longus is a deep-lying extrinsic muscle that runs the length of the tibia and is responsible for the extension of the toes and dorsiflexion of the foot.
The extensor hallucis longus is a deep-lying extrinsic muscle beneath the extensor digitorum longus and is responsible for the extension of the big toe and dorsiflexion of the foot.
