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Phasic Activity of Intrinsic Muscles of the Foot

ROGER MANN and VERNE T. INMAN J Bone Joint Surg Am. 1964;46:469-481.

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The Bone and

Journal Joint

of Surgery

American
VOLUME 46-A, No. 3

Volume
APRIL

1964

Phasic
BY

Activity
1IO(ER MANN,

of Intrinsic
M.I)4, SAN
AND VERNE

Muscles
T. INMAN,

of the
MI)., PH.D4,

Foot

FRANCISCO,

CALIFORNIA of California, San Iranci.sco and Her/c/eq

lroiuu

the

Bionuechanic

Laboratory,

University

An muscles

electi-omyogi-aphic of the foot: digitoi-um the up quiet and standing. third down the

study extensor bi-evis, and

was digitorum abductor

done digiti toe. slope,

of brevis,

the

phasic abductor and

activity hallucis, the

of dorsal were: stairs;

six flexot-

intrinsic hallucis on on

bi-evis,
muscle level toes; and

flexotbetween gi-ound,

minimi, and up and

inteiosseus walking standing

fourth

Experimental

conditions down

a 10-degree

Sites

of eliot

1o(l(

I)Ia(-enwnt

: .1,

aI nlw-tor

digiti Fto.

minirm 1

B,

eXt

(11501

(ligit

oritns

1 irevis

: (

iii ursa

mit (ti)55(tis

1),

tI )(Iti(tOI

Irailtu-is

; E,

flexor

digitorum

brevis

I, flexor

lIallu(-is

1 revis.

Methods
Twelve

subjects

whose

ages

i-anged examined
in all

fi-om
which

fifteen
could

to twenty-five
pi-oduce over

yeats aix altet-ed of

pat-ticiwalking

pated.
pattet-it. recoided. placement pi-oduced electi-ode
*

None
1acls

had
foot i-ight

aisy
was
foot

gioss was and the of by P.

of the

abisoi-malities studied a stet-ilized 36-gauge, its

(

caiefully

and
cases.

the

clsaractei-istics
the (1ig.

the
fot

The
was through was

Ihie skiii subcutaneous were

site 1).

at-eli were elect i-ode

wheal wire. was The

cleaned

one-centimeter electrodes

lidocaine stainless-steel

which
coissisted

placed

F;lecti-odes

enamel-coated, tip of enamel,

piepared
tIl(
four

cleaning
Fltompsun

sti-inging
Program

it tlii-oiigls
awarul-wintnimnig

a 26-gauge
l)aI)ers. Septem-

( )nn at ltlG3.

of

\ernon Meeting

Resident-framnitsg

IeL(l

the Annual
Sttl(IV

Western b
\eterans

)rthopedie

Assouiatioti, rations
Iniversity

Seattlu,

Washington,

ber

25,

t This
(alifornia.

was

supported

Biomeelsanies

Lahoratorv,

School

of

Adniinist Medi(-ine,

Contra(-t \-l($)oM-203). of California, Sari

Franu-iw-o

22,

41i9

470 disposable meter was into hai-b. then hypodermic The needle, withdrawn,

ROGER

MANN

AND

V. T. INMAN

needle, with leaving the the

and

then

bending was in place.

the placed Two

wire into such Each

to each

produce muscle electrodes muscle from the was

a one-milli; the were needle placed

electrode, electrode was verified

each muscle studied. Placerneiit of the electrodes each and individual If adequate a new
of the

as follows:

stimulated S-4E was

before

through stimulator. removed

contraction

electrode muscle one inserted.

was

with a square contraction was In addition, the

an on

wave current not obtained, signal produced

and

a Grass electrode

by a voluntary
loudspeaker

muscle

monitored

oscilloscope

and behind right

after
rfhe

each experiment. electrode sites were covered with a bandage and the wires wei-e brought up the malleoli to a junction box, which was taped to the lateral aspect of the The subject wore a sock and soft, boot a rubber boot on each foot. The boot was the foi skin diving ; it was to the foot. The right cases the direct subject current distensible, had no heel or arch, was equipped with a metal strip on to eight a carbon-particle volts) was passed. or copper It was and readily on its heel mat thus through possible

leg.

type used conformed and which toe. In all

walked (four

a small

to record heel and toe strike from the metal strips on the boot. In order to ensure the gi-eatest possible accuracy in relating the activity of each foot muscle studied to the whole walking cycle, electrodes were also placed in the tibialis anterior and
gastrodnemius muscles.

Each supervised and

plete

subject for

was splinting was

be

instructed of the No difficulties performed

the

to walk experimental

at his natural foot,

speed.

Every arm

run was or leg

carefully foot. corn-

abnormal

movements,

gait peculiarities. Level walking

steps could

arose because on a forty-foot 10-degree stairs slope consisted

of pain in the mat on which was twelve feet of six standard

experimental five to seven

taken;

two

or

three

complete tread) place

steps;

the

long, pei-mitting steps (six-inch by eight

rise and nine-inch having the subject

with a platform on top. Quiet the feet a comfortable distance

standing was performed apart (approximately

to twelve inches) and bear equal was cairied out for approximately The electrical activity from
on plifier the subjects had a band right width leg through of twenty

weight on each foot. Electromyographic fifteen seconds. each muscle was relayed from the
an to overhead thirty boom thousand into the cycles amplifier. per

recording junction
The and second

box
aman

equivalent The recordings

cles, step

peak-to-peak noise level of five microvolts. signal was recorded on an eight-channel Offner were were
for

Dynagraph. and

Simultaneous musavei-age from this

made
the subject

each
heel

time
and

from
toe

the
contacts.

tibialis each

anterior experimental as the extent

gastrocnemius the

as well

as from the

Data length

reduced

as

follows: was

For

condition, of variation

computed,

as well

mean for each individual step. The enlarged or reduced proportionately mental condition and for each superimposed, and a composite
thus obtained. (It

electromyographic by means

record for each step was then of a pantograph. For each experiof the activity individual of each steps muscle were was by this scale
walking

muscle, record

the records of the phasic

method; The
so that all

however, composite
the results

is obvious that the amplitudes of the records were altered only the phasic activity was considered in this study.) was then mathematically expanded to a teix-centimeter
could was be compared and expressed as per cent of the full

cycle. 1rom herein.

THE JOURNAL OF B0NF: AN1) JOINT SURGERY

this

scale

obtained

the

ideal

or average

activity

which

is reported

PHASIC

ACTIViTY

OF

INTRINSIC

MUSCLES

OF

THE

FOOT

471

Results All or parts enough many was of the records obtained from eight of twelve subjects were accurate

to warrant reduction. technical problems that accii tate and voluntary not be recorded. cases, an electrical

The discarded records were inadequate because of the arose. In several cases, although electrode placement contractions Sometimes artefact produced normal electromyograms, device did probably flat-foot. phasic the heel-toe was produced, bilateral not record propby movement of Theiipatterns

activity could erly ; in othei the

electiodes, either within or outside the muscle. Thee of the eight subjects had asymptornatic

for level walking differed from the patterns of subjects was essentially no difference in electrical activity between subjects staiiding L(P(l (lxiling on the lVaII1iiig The the stance 11w electrical phase abductor activity of the six intrinsic and extensor muscles stair toes.
-

with normal feet. There normal and flat-footed down and up slopes, or

climbing

or

descending,

walking

studied

occuired brevis muscles

only

during became

(ligs. 2 and 3). digiti minimi

20

digitorum

active at approximately hallucis, flexor digitorum at 3S, 40, aisd 28 per cent these both and pcitibiahis the

per cent of the cycle. brevis, and flexor hallucis of the cycle, respectively.

In normal feet, the abductoibrevis muscles showed activity In subjects with pronated feet, cycle. The activity was cent at in 35

muscles showed activity at 0, 26, and 14 per cent of the the noi-mal aisd pronated feet ceased ixear toe-off. [lie onset of activity in the interosseus and gastrocuemius 1. per cent of the cycle, cent and thei-e was rio
,

muscles

respectively. difference just before

Activity ceased at (iS per between normal and pronated toe-off, for and activity muscles continued except

and 56 feet. The

anterior

became

active

throughout foi the tihialis

swing The

phase until early stance. amplitude was nearly constant which

lie/king

all the just

antei-ioi, LpsIope The at about digitorum activity the the the the Down

displayed

decreased

activity

before

heel-strike.

onset :30 per brevis

began

of electrical

activity

of four

of the

intrinsic

muscles digiti 10 per anterior phase All the

(Fig.

4) occurred

cent of the cycle, while the abductor began to show activity at 18 and at 25 pei cent of the cycle; the tibialis study until remained of the which that 34 per was cent active of the during
new

minimi and extensor cent. Gastrocnemius was the only one of (from intrinsic 60 per muscles cent of and of

muscles previous

under cycle

swing cycle).

gastiocnemius The amplitude tibiahis anterior,

slope

active until just before toe-off, at 70 per cent. electromyogram was nearly constant, except foi that had two peaks of activity.

II a/king of the intriiisic muscles digitorum cent just cent became brevis and active the in the interosseus first 7 per muscles cent did of the not cycle

lour (Iig.

5). The

extensor

become

active until 42 and 16 per cles ceased activity until showed activity by 7 per
anterior was

of the cycle, respectively. None of the inti-insic musl)efore toe-off, at 67 per cent. The gastrocnemius of the cycle and ceased at 57 per cent. The tihialis

active from 52 per cent of the previous cycle until 18 pci- cent of the The amplitude was neai-ly constant throughout stance phase foi the inti-insic muscles and the gasti-ocnemius; the til)iahs anterior again showed two peaks of activity. new cycle.
VOL. 46-A, Ni). 3, APRIL 1964

472

ROGER

MANN

AND

V.

T.

INMAN

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MUSCLES

OF

THE

FOOT

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MANN

AND

V. T. INMAN

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IHASIC

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OF INTRINSIC

MUSCLES

OF TIlE

FOOT

473

lie/king
Foutand became ceased during stopped

(p

Stairs
intrinsic before at 33 per at toe-off. condition, muscles toe-off cent of the

of the just active

showed
at 66 per cycle

cent

activity (Fig. the extensor

in the fit-st 4 pet- cent of the cycle 6). The dorsal interosseus muscle
gastrocnemius at

and the

21 pet- cent. became each

Both active at

activity

Under
swiIsg
36

this
per

experimental phase, cent along of the of

digitorum Activity 7 per cent,

for each

brevis for

61 and The
was

with the tibialis anterior. cycle and ceased at 3 and

electromyographic record

stat-ted
muscle

respectively.

amplitude

the

individual

constant
a/king

in all cases.
1)own

11

Stairs hallucis, became flexotactive digitorum in the first brevis, 9 per flexotcent hallucis of the cycle, bi-evis, cent cent aiid inthe of the of the

The tetosseus abductotpi-evious

abductor muscles digiti cycle

whereas

minimi became active (Fig. 7). All continued

in late swing their activity

phase, at 90 per until 60 to 70 per

FIG.
Axis

8
joint.

of

subtalar

cycle, except for the pet- cent of the cycle. Under muscles per cent, There this both were respectively,

abductor the

digiti extensor

minimi

muscle, digitorum

whose
brevis

activity and the began

declined
gastt-ocnetnius

at

46

condition, active and

during ceased muscle record,

swing phase; their activity at 38 and 55 per cent.

at

39

and

63

The til)iahs anterior was no peak in the

did not evidence any consistent except in that of the gastrocnemius

phasic activity. muscle, near

heel-sti-ike. Sta nding on Toes insti-insic muscles were active when the subject was standing on his toes.

All the

476 The
mius onset of activity was

ROGER

MANN

AND

V. T. INMAN

coincided silent.

with

that

the same for all the muscles. The activity of the gastrocneof the intrinsic muscles. The tibialis anterior muscle was

electrically

Quiet

Standing There was no electrical of activity activity recorded from the intrinsic seconds muscles, in some except subjects.

for

spot-adic

bursts

at intervals Discussion

of five

to ten

Before expet-imental regarding them. The medial axis the

discussing condition, axes of the

the different electromyographic it is appropriate to summarize of the joint has foot been and the muscles

patterns obtained the investigations that control and axis Hicks rotation

in each of others about ft-orn 8) and

of motion subtalar

shown

by Manter

to pass (Fig.

to lateral

at an angle

of 16 degrees

to the

longitudinal

of the foot

Arrows

represent

resultant

axes

of

rotation

of

the

calcaneocuboid

and

talotsavicular

joints:

A,

pronated foot. When and calcaneocuhoid motion is restricted axis of rotation.

the resultant axes are parallel joints is possible. B, supinated in the transverse tarsal articulation

to each other, free motion foot. When the resultant since each individual

of the talotsavicular axes are divergent, joint has a different

from joint

superior was subjects

to

inferior

at

42 degrees

to the

vertical.

The

motion

at the

subtalar gi-eater compared.

the stance

studied and with associates

by

when Wright
phase downslope

Close normal studied

found with transverse

and Inman and feet, pronated

the an motion at increase

shown to be progressively feet, and flat-foot wei-e

the subtalar joint during

of walking; and axes The

they in subjects of the

in motion

at the
joint

joint
as

in subjects
by

walking
Elftman

pronated
tarsal

feet.
or mid-tarsal described

consist joint.
about (Fig. joint

of two axes for the calcaneocuboid From the two calcaneocuboid

which

axes,

joint and Elftman

two axes calculated

for

the talonavicular the resultant axis joint must transverse

a single

9).
are

In

the combined the pronated

to each

movements of the foot, the resultants

other, allowing free

transverse of the axes

motion to

tarsal of the
occur

occur tarsal
axis.

parallel

about

In the supinated foot, tarsal joint is restricted,

the resultants are divergent, since the component joints

THE

and motion (talonavicular

OF BONE

in the transverse and calcaneocuAND JOINT SURGERY

JOURNAL

PHASIC

ACTIVITY

OF

INTRINSIC

MUSCLES

OF

THE

FOOT

477 longer coincide. with the

boid) are attempting to rotate through their own axes which it is obvious that the latter system is more stable mechanically. Since the transvei-se tarsal joint has the head of the talus subtalar tt-ansvet-se applied In supinator The hallucis in the it can fore support
transverse

no

in common

joint, supination tat-sal joint to the Figure pull

of the subtalar This foot stability that the muscles,

joint produces is necessary the fore triceps part that

increased stability of the when excessive forces are surae foot muscle is fixed is a powerful on the hallucis, floor. flexor

foot just before toe-off. 10-A, it can be seen subtalar main joint when of the intrinsic

at the brevis, long axis be stated

of the is, the

abductor

flexor digitorum brevis, and of the foot and perpendicular that the intrinsic muscles foot
joint; arch

abductor digiti minimi, lies essentially to the transverse tarsal joints. Thus, exert considerable flexion force on the role the in the main muscle contributors stabilization to the of the
muscle

part

of the
tarsal

and

play

the

principal thet-efore,

of the

they are, (Fig. 10-B).

OF SURAE

PULL TRICEPS

Fm.
Approximate
direction

10-A
of force

FIG.

10-B (Fig. 10-A) and the intrinsic muscles

exerted

by

the

triceps

surae

of the

foot

(Fig.

10-B).

It should muscle, at the joint tion of the foi-ce power

consider

be kept

in mind

that

control

of the

transverse
each

tarsal

joint

is provided
participates

by

ligament, and hone. Exactly to what extent during locomotion is not known. It should tibia causes movement of the talus, which transvet-se these facts tarsal in mind joint to raise the
obtained

of these

be noted in turn without axes

that external rotatransmits sufficient direct

use of muscle

to the
.

the

arch

With
the

t-egarding
pattettss

various
he seen

of the present
for the

foot, study.
most

we
part,

cati
the

now in-

electromyographic

in the
that,

In each trinsic digiti muscles

experimental acted

condition, as a gi-oup. This

it can

is especially

true

with

regard

to the

abductor

minimi, flexor hallucis brevis, abductor hallucis, and In level walking, the ititi-insic muscles in subjects with oiiset of activity in the main intrinsic mass at approximately as contrasted
ceased fi-om just

flexor digitorum brevis. normal feet showed the :35 per cent of the cycle, In all cases,
activity

with
before

0 to 26 per
toe-off.

cent

for the
downslope

flat-footed
walking,

subjects.
however,

activity
occurred

During

0 to 7 pet cent of the The electromyographic of Wright and

cycle, again with findings in this of onset and

cessation
study are

just

before

in accord

toe-off. with the rotation subject,

observaduring supina-

tiotis statice

associates

degree

of subtalar tiormal

in a normal and a flat-footed subject (Fig. 11). In level walking, pronation occui-t-ed early and, in the
46-A. NO 3. APRIL 1964

VOl..

478

ROGER

MANN

ANI)

V.

T.

IXMAN

Lii -J U
>-

00
(C%J

z
-J

<0
U.

00
i0

zo
0

I-

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a.

UJC%J

0 0

Li -J

00 >U 0

z
B 00 z
Li

I.)

Li

Cl

THE

JOURNAL

OF

BONE

ANI)

JOINT

SURGERY

PHASIC

ACTIVITY

OF

INTRINSIC

MUSCLES

OF

THE

FOOT

479 at appi-oximately t-otatioii at at the cent 57 pet

tion suhtalai of the foot . tt-insic

l)egan cent joint cycle This

at

33 to of the w-as

40 per cycle one

cent

of the sul)ject

cycle, with supination,

whet-eas pronated reaching

it began feet. The a peak

10 pet

in the

of ptogressive

fot- the sul)ject with ptogiesSive supination

not-mal feet and 67 pet- cent can be linked to the pet-iod delayed
electt-ical

for the one of activity subtalar same study

with flatin the injoint of the as he t-elated

nmscles recorded in this study. 1)ui-iiig upslope valking, thete -as subject,
walking.

i-otation neat-ly
activity

in the the
in this

flat-footed did in level to the

but
Once

the

normal
again, the

subject

showed

pattern cati be

pattetiis

of subtalat-

t-otation.
PER 0 CENT OF 50 WALKING 00 CYCLE

LEVEL

UPSLOPE

DOW

NSLOPE

40

UPSTAIRS
-40
-

40

DOWN

STAIRS

40L
FIG.

13 Positive indicates
fore and negative indicates
aft.

lore-and-aft

Modified

from

shear on Cunningham

the

foot
2

during

walking.

from Sul)ject aisd triiLsic

In the downslope pattern, one heel-strike on and, concomitantly, with If these transverse In level
IflltScles

can

ohsei-ve activity rapid supination in the light one

in the intrinsic muscles in the subtalatjoint of the with normal about feet. the subtalar in the
.Just before

flat-foot changes tai-sal walking, from

there

and are

to a lessetconsidered

degt-ee in the

of out knowledge can there of the

cent

axes, the following in a subject with heel-strike

is tio activity

obsetvations normal feet, 40 per

fit-st

be made. is no activity
cycle. of the

inwith

until

cent

In

a subject

ptonated toe-off

feet,

fot- the

10 pet-

cycle.

in level walking, when the foi-ces (Fig. 12) at-c greatest, maximum (Fig. 11) occurs and thete is optimum transverse tat-sal stabilization. subject, this stabilization begins at appi-oximately 40 per cent of by
N(
)

supiiiation In a notmal
the cycle as

demonstt-ated
Vol.
46-A,

the
1(11. 1164

degtee

aisd

rapidity

of

subtalat-

motion

and

confirmed

by

3, Al

480 electrical activity in the

ROGER

MANN

AND

V. T.

INMAN

intrinsic

muscles.

In

a subject

with

pronated

feet, progresses by activity

this to in

stabilization starts in the first 10 per cent of the cycle and gradually toe-off. Again, this greatest period of subtalar rotation is paralleled the intrinsic muscles. In upslope walking, the degree of supination and transverse tion
Of

tarsal flexible

stabilizafore part

is delayed

until

the

center

of gravity 30 per transverse cent

passes

over

the

relatively

the foot at approximately place and there is optimum created delayed In by the activity walking

of the cycle ; rapid supination then takes tarsal stabilization for the forces (Fig. 13) delay requires in foot the stabilization foot to is paralleled be a rigid lever by arm

propulsion of toe-off. The in the intrinsic muscles. down a slope, the body

early in the cycle to counteract the moment magnitudes of the vertical and fore-and-aft downslope walking than for any of the other 13). Early supination 8 and transverse tarsal activity The closely
stairs,

created by the accelerating body. The shear floor reactions at-c greater for experimental conditions (Figs. 12 and stabilization occur together with eatly and descent of stairs ascent or descent of

in the intrinsic electromyographic resemble those

muscles. recordings made during

made during the ascent downslope walking. In

the subject strikes each step with his toes and metatarsal heads first and the heel does not as a rule come into contact with the tread. Thus the foot is loaded very rapidly after initial contact. If one considers the excessive and rapidly applied load upon extent, would the fore part of the foot (Figs. 12 and 13) while ascending stairs 2, it is obvious that be essential to stabilize the body by no later is also during required during this experimental while descending and, to a lesser complete stabilization of the foot than 5 to 10 per cent of the cycle.

Rigidity of the foot in the recordings made

standing on the toes. It can be seen condition that all the intrinsic in the evidence intrinsic muscles of postural adactivity is not

muscles were active. When a person is standing quietly, there is no activity (except for short bursts of activity, which presumably are justments).
necessary

This electrical to maintain the

silence supports the concept arch of the loaded foot when Summary and Conclusions

that muscle it is at rest.

1. The 2. The the progressive walking. 3. Since axes the the foot of the principal 4. The transverse 5. Muscle at rest.

intrinsic electrical

muscles activity

of the foot act of the intrinsic at the subtalar joint exists tarsal

as a functional unit. muscles of the foot during between joints, they level, the upslope, intrinsic may

closely and muscles

pat-alleled dowaslope and the

supination such subtalar active pronated a close and role

relationship transverse

be considered propulsion. activity foot. of the to fully

to play stabilize loaded

in the stabilization foot requires greater

of the foot during intrinsic muscle than does to support the normal the arches

tarsal and subtalar joints activity is not necessary

References
1.

2.

3.
4.

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