Maximus Gage
The ankle joint is a hinged joint that permits several types of movements, including inversion, eversion, plantar flexion, and dorsiflexion. Inversion of the foot is a movement where the plantar surface of the foot tilts medially towards the body's midline, with the lateral border of the foot pointing inferiorly. This movement is primarily produced by the tibialis anterior and tibialis posterior muscles. The tibialis anterior muscle is located alongside the lateral surface of the tibia and is the strongest dorsiflexor of the foot. The tibialis posterior muscle, on the other hand, is the deepest-lying muscle in the posterior compartment, originating from the tibia and fibula and attaching to the plantar surfaces of the toes.
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Tibialis Anterior
The tibialis anterior muscle is a fusiform muscle found in the anterior part of the leg. It is easily palpable lateral to the anterior border of the tibia. The muscle is innervated by the deep fibular nerve, and recurrent genicular nerve (L4). The body of the tibialis anterior is entirely supplied by the branches of the anterior tibial artery.
The tibialis anterior is situated on the lateral side of the tibia. It is thick and fleshy above, and tendinous below. The fibres run vertically downward, ending in a tendon at the lower third of the leg. This muscle overlaps the anterior tibial vessels and the deep peroneal nerve in the upper part of the leg.
The tibialis anterior is the primary dorsiflexor of the ankle. It acts to dorsiflex and invert the foot. It is also one of the muscles that tend to be inhibited and underactive. This can lead to an abnormality in the anticipatory postural adjustment (APA) phase during gait initiation of the affected limb.
The tibialis anterior helps maintain the medial longitudinal arch of the foot. It draws up and holds the toe in a locked position. The muscle 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 acts later to pull the foot clear of the ground during the swing phase (concentric contraction).
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Tibialis Posterior
The tibialis posterior muscle is a key stabilising muscle of the lower leg and is the most central of all the leg muscles. It is located in the deep posterior compartment of the lower leg, situated between the flexor digitorum longus and the flexor hallucis longus. The muscle belly arises from the posterior aspect of the interosseous membrane and superior two-thirds of the posterior and medial surface of the fibula, and the superior aspect of the proximal tibia.
The tibialis posterior is a primary inverter of the foot, along with the tibialis anterior. This inversion happens at two synovial joints of the foot: the midtarsal joint and the subtalar joint. The tibialis posterior is also a secondary plantar flexor of the foot. The muscle is responsible for plantar flexion and inversion of the foot, and it receives its arterial blood supply from the posterior tibial artery and innervation from the tibial nerve.
The tibialis posterior tendon (TPT) travels distally, then posterior to the medial malleolus, along with the FDL tendons, posterior tibial artery, tibial nerve, and FHL. The TPT then splits into three components: primary, plantar, and recurrent. This split allows for the broad attachment site of the tibialis posterior tendon. The main portion inserts primarily onto the navicular bone tubercle, while the plantar portion inserts onto the base of the second, third, and fourth metatarsals, along with the second and third cuneiform and the cuboid.
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Gastrocnemius
The gastrocnemius muscle is a complex muscle located in the posterior compartment of the leg. It is considered a superficial muscle as it is directly under the skin, and its shape can often be seen through the skin. The gastrocnemius forms half of the calf muscle, with the other half being the soleus muscle. The two muscles share a common insertion via the Achilles tendon, which then inserts into the middle part of the posterior surface of the calcaneus.
The gastrocnemius is involved in plantar flexion of the foot at the ankle joint and flexion of the leg at the knee joint. It is particularly active during running, jumping, and other fast movements of the leg. The muscle provides a significant amount of propulsive force during these activities. The gastrocnemius also plays a role in walking and posture, although to a lesser degree.
The medial head of the gastrocnemius originates from the posterior surface of the medial condyle of the femur, while the lateral head originates from the lateral surfaces of the epicondyle. The medial head is generally thicker and wider than the lateral head. The two heads unite at the level of the middle third of the leg and insert into the Achilles tendon.
The gastrocnemius muscle is prone to spasms and may become inflamed due to overuse. A severe ankle dorsiflexion force can result in a medial gastrocnemius strain (MGS) injury, commonly known as a "torn" or "strained" calf muscle. This injury is acutely painful and disabling. To treat gastrocnemius injuries and inflammation, anti-inflammatory medications and physical therapy, including stretching and weight-bearing exercises, may be recommended.
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Plantaris
Inversion of the foot is primarily produced by the tibialis anterior and tibialis posterior muscles. The deep posterior compartment is composed of three muscles: the tibialis posterior, the flexor digitorum longus, and the flexor hallucis longus, which produce plantar flexion and inversion of the foot. The anterior compartment consists of four muscles: the tibialis anterior, the extensor digitorum longus, the extensor hallucis longus, and the peroneus tertius. The tibialis anterior and the extensor hallucis longus produce dorsiflexion and inversion of the foot.
The plantaris muscle is located in the posterior compartment of the leg, along with the gastrocnemius and soleus muscles. These muscles contribute to plantar flexion of the foot, which is the movement that occurs when the foot is lowered towards the ground. During plantar flexion, the foot is moved towards the body, reducing the angle between the foot and the leg. This is the opposite of dorsiflexion, where the foot is moved away from the body, increasing the angle between the foot and the leg.
While the plantaris muscle is involved in plantar flexion, it does not directly invert the ankle. Inversion of the ankle is a movement in which the plantar surface of the foot tilts medially towards the midline of the body, with the lateral border of the foot pointing inferiorly. This movement is primarily produced by the tibialis muscles, as mentioned earlier.
However, the plantaris muscle can still play an important role in ankle stability and function. It is connected to other muscles and tendons in the posterior compartment, such as the gastrocnemius and the Achilles tendon. Through these connections, the plantaris muscle can contribute to overall ankle strength and movement, indirectly influencing the inversion and eversion of the ankle.
In terms of clinical relevance, the plantaris muscle is rarely involved in ankle injuries or pathologies. It is not commonly associated with ankle sprains or tears during inversion or eversion movements. Instead, other muscles, ligaments, and tendons are typically affected in such injuries, as they play a more direct role in ankle inversion and eversion.
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Fibularis Longus
The fibularis longus (also known as peroneus longus) is a muscle in the lateral compartment of the leg. It is the longest and most superficial of the three fibularis muscles. The fibularis longus arises from the head and upper two-thirds of the lateral, or outward, surface of the fibula, as well as from the deep surface of the fascia and the connective tissue between it and the muscles on the front and back of the leg.
The fibularis longus muscle ends in a long tendon that wraps around and behind the lateral malleolus of the ankle. This tendon then continues under the foot to attach to the medial cuneiform and first metatarsal. The fibularis longus muscle is supplied by the superficial fibular nerve, which arises from the fifth lumbar and first sacral roots of the spinal cord.
The main function of the fibularis longus is to produce plantar flexion and eversion of the foot on the ankle joint. In other words, it acts to tilt the sole of the foot away from the midline of the body and to extend the foot downward away from the body at the ankle. The fibularis longus also plays an important role in maintaining the transverse arch of the foot and helps to steady the leg upon the foot, especially when standing on one leg.
Injury to the fibularis longus muscle or tendon can cause lateral ankle pain and may lead to ankle instability. Peroneal tenosynovitis, a condition affecting the common peroneal tendon, is associated with fluid accumulation within the tendon sheath and can result in localized swelling and tenderness. Acute peroneal tenosynovitis is commonly seen in athletes who resume their activity after a break.
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Frequently asked questions
Ankle inversion is the tilting of the foot so that the sole faces towards the midline of the body.
The tibialis anterior and tibialis posterior muscles are primarily responsible for ankle inversion.
The tibialis anterior muscle 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 tibialis posterior muscle inverts and plantarflexes the foot, as well as maintaining the arch of the foot. It is the deepest-lying muscle in the posterior compartment.
Preparatory co-activation of the ankle muscles may prevent ankle inversion injuries. Training interventions that focus on stiffening the ankle with muscle co-activation prior to landing can be beneficial.
