Dominic Stone
The foot and ankle form a complex system of bones, joints, ligaments, and muscles. Inversion is a movement of the foot that causes the soles of the feet to face inwards, and this movement is primarily produced by the tibialis anterior and tibialis posterior muscles. The ankle consists of two joints that permit inversion of the foot, and the foot has eight different joints that allow for inversion.
| Characteristics | Values |
|---|---|
| Inversion of the foot | The plantar surface of the foot tilts medially towards the midline of the body, with the lateral border of the foot pointing inferiorly |
| Muscles that invert the foot | Tibialis anterior, Tibialis posterior |
| Range of motion for inversion of the foot | Subtalar joint: 25° to 30°; Transverse tarsal joint: 8° to 10° |
| Other muscles involved in foot movement | Extensor digitorum longus, Extensor hallucis longus, Gastrocnemius, Plantaris, Fibularis longus, Fibularis brevis |
| Joints involved in foot movement | Talocalcaneonavicular joint, Subtalar joint, Talocrural joint, Tarsal joint, Transverse tarsal joint, Lisfranc joint, Talocalcaneal joint |
| Ligaments involved in foot movement | Anterior tibiofibular ligament, Posterior tibiofibular ligament, Anterior talofibular ligament, Posterior talofibular ligament, Spring ligament, Deltoid ligament |
| Bones involved in foot movement | Tibia, Fibula, Talus, Calcaneus, Metatarsals, Phalanges (toes), Sesamoid |
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What You'll Learn
Tibialis anterior muscle
The tibialis anterior muscle, also known as the tibialis anticus, is the largest of the four muscles in the anterior compartment of the leg. It is a thick and fleshy muscle that arises from its proximal attachment at the upper two-thirds of the lateral tibia. The tibialis anterior tendon (TAT) inserts distally on the medial border of the foot, specifically on the medial and inferior surface of the medial cuneiform bone and the adjacent portion of the first metatarsal bone.
The tibialis anterior muscle is primarily responsible for dorsiflexion and inversion of the foot. During the contact phase of walking, it helps to stabilise the ankle as the foot hits the ground (eccentric contraction). It then acts to pull the foot clear of the ground during the swing phase (concentric contraction). The tibialis anterior also helps to maintain the medial longitudinal arch of the foot and can ''lock' the ankle, as when toe-kicking a ball, through isometric contraction.
The action of the tibialis anterior is considerably stronger than that of the other three dorsiflexor muscles of the foot. It is such a powerful inverter that the muscles of the lateral compartment must engage in eversion for the tibialis anterior to dorsiflex the foot without inversion. The tibialis anterior is innervated by the deep fibular nerve and the recurrent genicular nerve (L4).
A deep portion of the tibialis anterior muscle is rarely inserted into the talus, but a tendinous slip may pass to the head of the first metatarsal bone or the base of the first phalanx of the great toe. Pain along the path of this muscle is often referred to as "shin splints" or medial tibial stress syndrome (MTSS). A tibialis anterior hernia is a rare type of hernia where fat or other material protrudes through a defect in the muscle, often caused by trauma to the lower leg.
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Tibialis posterior muscle
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 tibialis posterior is also a secondary plantar flexor of the foot, along with the gastrocnemius, soleus, and plantaris muscles.
The muscle is primarily responsible for plantar flexion and inversion of the foot. It also plays a major role in supporting the medial arch of the foot. The medial arch in a normal person is higher than the lateral arch and is maintained by the calcaneus, talus, navicular, three cuneiforms, and the first three metatarsals. The tibialis posterior tendon descends behind the medial malleolus, and its tendon attaches to the navicular and the plantar slip attaches to the medial cuneiform bone.
Tibialis posterior dysfunction can lead to flat feet and weak arch control in adults. This dysfunction is thought to be the likely cause in most cases of adult-acquired flatfoot. In addition, injury to the distal tendon of the tibialis posterior muscle can result in posterior tibial tendonitis, a condition that predominantly affects runners and active individuals. It involves inflammation or tearing of the tendon, which can cause pain, swelling, and potentially lead to flatfoot if left untreated.
Strengthening of the tibialis posterior muscle can be done in multiple positions and will improve arch control of the foot. This can be done in functional positions, and different equipment can be used to assist in strengthening, such as therabands and weights.
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Talocalcaneonavicular joint
The talocalcaneonavicular joint is a ball-and-socket joint in the foot, formed by the convex talus bone and a socket made by the calcaneus and navicular bones. It is also known as the articulatio talocalcaneonavicularis and is one of two articulations that connect the talus and calcaneus bones, the other being the anatomical subtalar (talocalcaneal) joint. The talocalcaneonavicular joint is considered a functional unit with the subtalar joint in clinical practice.
The joint is formed by the rounded head of the talus bone, which fits into the concavity formed by the posterior surface of the navicular, the anterior articular surface of the calcaneus, and the upper surface of the plantar calcaneonavicular ligament. This ligament forms the whole floor of the talus as it extends inferiorly. The plantar calcaneonavicular ligament is also referred to as the spring ligament.
The talocalcaneonavicular joint is an arthrodial joint, permitting a considerable range of gliding movements and some rotation. Its feeble construction means that dislocation of the other bones of the tarsus from the talus can occasionally occur. The joint is lined with a synovial membrane, which helps to lubricate the joint and facilitate the movement of the bones.
The joint capsule of the talocalcaneonavicular joint is present on the dorsal and proximal aspects of the articulation. The dorsal component of the capsule extends from the neck of the talus to the dorsal margin of the proximal articular surface of the navicular bone. The proximal part of the joint capsule is better developed and found within the tarsal sinus, forming the strong talocalcaneal interosseous ligament, along with the anterior part of the talocalcaneal joint capsule.
The talocalcaneonavicular joint is associated with three principal ligaments: the dorsal talonavicular ligament, the plantar calcaneonavicular ligament, and the calcaneocuboid part of the bifurcate ligament. The bifurcate ligament is a Y-shaped structure that runs from the dorsolateral surface of the calcaneus and divides into two separate parts: the calcaneocuboid and the calcaneonavicular. The calcaneonavicular part of this ligament is significant for the talocalcaneonavicular joint as its dorsal surface participates in the formation of the middle part of the acetabulum pedis.
Inversion of the foot is a movement that causes the soles of the feet to face inwards, and it is primarily produced by the tibialis anterior and tibialis posterior muscles.
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Subtalar joint
The subtalar joint, also known as the talocalcaneal joint, is a joint in the foot that is formed by the meeting of the talus and calcaneus bones. The joint is structurally classed as a synovial joint and functionally as a plane joint or gliding joint. The talus is oriented slightly obliquely on the anterior surface of the calcaneus, with three points of articulation: two anteriorly and one posteriorly. These articulations are known as facets, with the posterior, middle, and anterior facets allowing for pronation and supination of the midfoot.
The subtalar joint is enclosed by a joint capsule, which is lined internally by a synovial membrane and strengthened externally by a fibrous layer. The capsule is supported by the interosseous talocalcaneal ligament, which binds the talus and calcaneus together and provides ligamentous stability to the joint. There are four additional ligaments that form weaker connections between the two bones: the anterior talocalcaneal ligament, the posterior talocalcaneal ligament, the lateral talocalcaneal ligament, and the medial talocalcaneal ligament.
The subtalar joint plays a role in the inversion and eversion of the foot, with a range of motion for inversion at the joint ranging from 25° to 30°. However, it has minimal involvement in dorsiflexion or plantarflexion of the foot. The joint receives its arterial supply from the posterior tibial and fibular arteries, while innervation to the plantar aspect is supplied by the medial or lateral plantar nerve, and to the dorsal aspect by the deep fibular nerve.
The subtalar joint is susceptible to arthritis, especially if it has been previously affected by sprains or fractures of the calcaneus or talus. Symptoms of subtalar joint arthritis include pain when walking, loss of motion, and difficulty walking on uneven surfaces. Treatment options include physical therapy, orthotics, and surgery.
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Ankle stability
The peroneal muscles, which include the peroneus longus and peroneus brevis, wrap around the arch of the foot and past the ankle, providing support and stability. The posterior tibialis muscle also helps to stabilise the ankle. It starts behind the shin and connects to the inside of the ankle, helping to point the foot and turn it inward. The tibialis anterior and tibialis posterior muscles are responsible for inversion of the foot, a movement where the soles of the feet tilt inwards.
To improve ankle stability, it's essential to strengthen the muscles that support the joint. This can be achieved through various exercises, such as calf raises and resistance band drills. Calf raises help target the calf muscles, including the gastrocnemius and soleus, which support the back of the ankle. Resistance band exercises can help strengthen the muscles around the ankle, reducing the risk of rolling the ankle and sprains.
In addition to muscle strength, ankle stability also relies on proprioception, which is the brain's ability to perceive and orient the body in space. By practicing specific drills, you can improve your brain's ability to stabilise the ankle joint, working in conjunction with stronger ankle muscles.
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Frequently asked questions
Inversion of the foot 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, and the soles of the feet facing inwards.
The muscles which cause inversion of the foot are the tibialis anterior and tibialis posterior muscles.
Eversion is the opposite movement of inversion, where the sole of the foot faces away from the midline.
The muscles which cause eversion of the foot are the fibularis longus and fibularis brevis.
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.
