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functional anatomy of the foot and ankle ©
functional anatomy of the foot and ankle ©
functional anatomy of the foot and ankle ©

functional anatomy of the

foot and ankle

functional anatomy of the foot and ankle ©
functional anatomy of the foot and ankle ©
functional anatomy of the foot and ankle ©

©

functional anatomy of the foot and ankle Edward P. Mulligan, MS, PT, SCS, ATC VP,
functional anatomy of the foot and ankle Edward P. Mulligan, MS, PT, SCS, ATC VP,
functional anatomy of the foot and ankle Edward P. Mulligan, MS, PT, SCS, ATC VP,
functional anatomy of the foot and ankle Edward P. Mulligan, MS, PT, SCS, ATC VP,

functional anatomy of the

foot and ankle

functional anatomy of the foot and ankle Edward P. Mulligan, MS, PT, SCS, ATC VP, National

Edward P. Mulligan, MS, PT, SCS, ATC

VP, National Director of Clinical Education – HealthSouth Corporation Clinical Instructor – UT Southwestern Physical Therapy Department Grapevine, TX

The contents of this presentation are copyrighted © 2002 by continuing ED. They may not be utilized, reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, or by any information storage or retrieval system, without permission in writing from Edward P. Mulligan.

mechanical, or by any information storage or retrieval system, without permission in writing from Edward P.

©

Objectives Following completion of this study, the participant will be able to: © identify the
Objectives Following completion of this study, the participant will be able to: © identify the
Objectives Following completion of this study, the participant will be able to: © identify the

Objectives

Objectives Following completion of this study, the participant will be able to: © identify the bony

Following completion of this study, the participant will be able to:

completion of this study, the participant will be able to: © identify the bony anatomy of
completion of this study, the participant will be able to: © identify the bony anatomy of

©

identify the bony anatomy of the leg, foot, and ankle identify the axis of motion and accessory motions of the joints of the leg, foot, and ankle identify the ligamentous, vascular, and nervous anatomy of the leg, foot, and ankle identify the muscular anatomy of the leg, foot, and ankle explain the muscular function of the leg, foot, and ankle during gait palpate the bony and soft tissue structures of the leg, foot, and ankle

anterior view © leg anatomy Tibia – triangular shape with medial, lateral and posterior surfaces
anterior view © leg anatomy Tibia – triangular shape with medial, lateral and posterior surfaces
anterior view
anterior view
anterior view © leg anatomy Tibia – triangular shape with medial, lateral and posterior surfaces –
anterior view © leg anatomy Tibia – triangular shape with medial, lateral and posterior surfaces –

©

leg anatomy

anterior view © leg anatomy Tibia – triangular shape with medial, lateral and posterior surfaces –

Tibia

triangular shape with medial, lateral and posterior surfaces

interosseus membrane connects the tibia to the fibula

distally, articulates with the talus

This is an anterior view

Distinct medial, lateral, and posterior surfaces with anterior tibial crest representing the apex of the triangle

Strong, tough, interosseus membrane connects the tibia to the fibula

distally, the tibia articulates with the talus

posterior view leg anatomy Fibula – long, thin bone located posterolateral to the tibia –
posterior view leg anatomy Fibula – long, thin bone located posterolateral to the tibia –
posterior view
posterior view
posterior view leg anatomy Fibula – long, thin bone located posterolateral to the tibia – little

leg anatomy

posterior view leg anatomy Fibula – long, thin bone located posterolateral to the tibia – little

Fibula

long, thin bone located posterolateral to the tibia

little weight bearing function; mainly for muscle attachment

distally, the medial surface articulates with the tibia and talus

the medial surface articulates with the tibia and talus © This is a posterior view: Fibula

©

This is a posterior view:

Fibula is a long, thin bone positioned at about a 45 degree angle posterolateral to the tibia

little weight bearing function; mainly for muscle attachment

distally, the medial surface articulates with the tibia and talus

foot anatomy Superior (dorsal) Posterior Antetior (proximal) (distal) rearfoot midfoot Inferior (plantar)
foot anatomy Superior (dorsal) Posterior Antetior (proximal) (distal) rearfoot midfoot Inferior (plantar)
foot anatomy Superior (dorsal) Posterior Antetior (proximal) (distal) rearfoot midfoot Inferior (plantar)

foot anatomy

foot anatomy Superior (dorsal) Posterior Antetior (proximal) (distal) rearfoot midfoot Inferior (plantar)

Superior

(dorsal) Posterior Antetior (proximal) (distal) rearfoot midfoot Inferior (plantar) forefoot
(dorsal)
Posterior
Antetior
(proximal)
(distal)
rearfoot
midfoot
Inferior
(plantar)
forefoot
Phalanges Metatarsals C1 C2 C3 N Cu T C
Phalanges
Metatarsals
C1
C2 C3
N Cu
T
C
C
C

©

Directional terminology Superior = dorsal Inferior = plantar Posterior = proximal Anterior = distal

The foot can be divided into three sections Rearfoot = hindfoot Midfoot Forefoot

foot-ankle articulations C = Calcaneus C1-2-3 = Cuneiforms T = Talus Cu = Cuboid N
foot-ankle articulations
C
= Calcaneus
C1-2-3
= Cuneiforms
T
= Talus
Cu
= Cuboid
N
= Navicular
Mt
= Metatarsal
Talocrural (ankle) joint
Talonavicular (midtarsal) joint
2
1
4 3
5
Tarsometatarsal joint
T
N
C1
C3-2-1
1 st Mt
C
N
Cu
1 st PP
Talocalcaneal (subtalar) joint
T
1 st Metatarsophalangeal joint
C
©

Talocrural (ankle) joint

Talocalcaneal (subtalar) joint

Talonavicular (midtarsal) joint – calcaneocuboid joint not pictured but is on the lateral side of the jont

Tarsometatarsal (LisFranc) joint - Cuneiforms articulate with mets 1- 3 and cuboid articulates with mets 4-5

1 st metatarsophalangeal joint

Sustaniculum tali on medial calcaneus and is origin of calcaneonavicular (spring ligament)

Lateral pillar Medial pillar TBTB FF TT TT NN MCMC MtMt CC CuCu CC MtMt
Lateral pillar Medial pillar TBTB FF TT TT NN MCMC MtMt CC CuCu CC MtMt
Lateral pillar Medial pillar TBTB FF TT TT NN MCMC MtMt CC CuCu CC MtMt

Lateral pillar

Medial pillar

Lateral pillar Medial pillar TBTB FF TT TT NN MCMC MtMt CC CuCu CC MtMt Feiss
TBTB FF TT TT NN MCMC MtMt CC CuCu CC MtMt Feiss Line
TBTB
FF
TT
TT
NN
MCMC
MtMt
CC
CuCu
CC
MtMt
Feiss Line
FF TT TT NN MCMC MtMt CC CuCu CC MtMt Feiss Line © F – Fibula

©

F

– Fibula

T

– Talus

Cu – Cuboid

C – Calcaneus

Mt – Metatarsal

TB –Tibia

N – Navicular

MC – Medial Cuneiform

Navicular Tuberosity should lie on the line that connects the medial malleolus and medial 1 st metatarsal head in both WBing and NWBing

postures.

This line is called the Feiss line

Note that the lateral longitudinal arch is lower than the medial longitudinal arch

tibiofibular joint Superior – plane synovial joint – fibular head articulating with posterolateral aspect of
tibiofibular joint Superior – plane synovial joint – fibular head articulating with posterolateral aspect of
tibiofibular joint Superior – plane synovial joint – fibular head articulating with posterolateral aspect of

tibiofibular joint

tibiofibular joint Superior – plane synovial joint – fibular head articulating with posterolateral aspect of tibial

Superior

plane synovial joint

fibular head articulating with posterolateral aspect of tibial condyle

Inferior

syndesmosis with fibroadipose tissue connecting tibia and fibula

reinforced by anterior and posterior tibiofibular ligaments

reinforced by anterior and posterior tibiofibular ligaments © While geographically closer to the kn ee, the
reinforced by anterior and posterior tibiofibular ligaments © While geographically closer to the kn ee, the

©

While geographically closer to the knee, the tibfib joint is functionally associated with the foot and ankle

Interosseous membrane binds tibia an fibula together and is the origin for many of the muscles that effect the foot and ankle

tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing
tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing
tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing

tibiofibular accessory motions

tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing

Plantarflexion

tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing
tibiofibular accessory motions Plantarflexion © fibula slides caudally and lateral malleolus rotates medially causing

©

fibula slides caudally and lateral malleolus rotates medially causing approximation of TCJ

Dorsiflexion

fibula slides cephalically and lateral malleolus rotates laterally to spread the mortise and accommodate the wider portion of the anterior talus

and accommodate the wider portion of the anterior talus Accessory motions are defined as involuntary arthrokinematic

Accessory motions are defined as involuntary arthrokinematic spin, glide, or roll at the joint surfaces that must accompany full, pain-free osteokinematic motion.

Clinically, lack of dorsiflexion range may be partially associated with tibiofibular hypomobility

tibiofibular accessory motions Supination fibula slides distally and posteriorly Pronation fibula slides proximally and
tibiofibular accessory motions Supination fibula slides distally and posteriorly Pronation fibula slides proximally and
tibiofibular accessory motions Supination fibula slides distally and posteriorly Pronation fibula slides proximally and

tibiofibular accessory motions

tibiofibular accessory motions Supination fibula slides distally and posteriorly Pronation fibula slides proximally and

Supination

fibula slides distally and posteriorly

Pronation

fibula slides proximally and anteriorly

Pronation fibula slides proximally and anteriorly © Distal tibfib accessory motions Supination – fibula
Pronation fibula slides proximally and anteriorly © Distal tibfib accessory motions Supination – fibula

©

Distal tibfib accessory motions

Supination – fibula slides distally and posteriorly with external rotation of the lower leg

Pronation – fibula slides proximally and anteriorly with internal rotation of the lower leg

Part 2 – Talocrural Joint ©
Part 2 – Talocrural Joint ©
Part 2 – Talocrural Joint ©

Part 2 – Talocrural Joint

Part 2 – Talocrural Joint ©
Part 2 – Talocrural Joint ©
Part 2 – Talocrural Joint ©

©

talocrural joint • synovial mortise joint • concave tibial plafond and convex talar dome •
talocrural joint • synovial mortise joint • concave tibial plafond and convex talar dome •
talocrural joint • synovial mortise joint • concave tibial plafond and convex talar dome •

talocrural joint

talocrural joint • synovial mortise joint • concave tibial plafond and convex talar dome • supported

• synovial mortise joint

• concave tibial plafond and convex talar dome

• supported by:

• Anterior talofibular ligaments

• Posterior talofibular ligaments

• Calcaneofibular ligament

• Deltoid ligament

ligaments • Calcaneofibular ligament • Deltoid ligament © Referred to as a mortise joint beca use
ligaments • Calcaneofibular ligament • Deltoid ligament © Referred to as a mortise joint beca use

©

Referred to as a mortise joint because of its resemblance to a wood joint used by carpenters

talocrural joint ligaments lateral view 3 calcaneofibular anterior tibiofibular 1 anterior talofibular 2 © 1
talocrural joint ligaments lateral view 3 calcaneofibular anterior tibiofibular 1 anterior talofibular 2 © 1
talocrural joint ligaments lateral view 3 calcaneofibular anterior tibiofibular 1 anterior talofibular 2 © 1

talocrural joint ligaments

lateral view

talocrural joint ligaments lateral view 3 calcaneofibular anterior tibiofibular 1 anterior talofibular 2 © 1 -
3
3

calcaneofibular

anterior tibiofibular

1

anterior talofibular

2

anterior tibiofibular 1 anterior talofibular 2 © 1 - Ant TibFib ligament injured in “high” ankle

©

1 - Ant TibFib ligament injured in “high” ankle sprain. The

mechanism of injury is typically a rotational injury when tibia IR and

foot abducts. Evaluated by Kleiger test

2 - ATFL lies in the hollow depression just superior to EHB (called the

sinus tarsi) and resists anterior anterior talar translation when plantarflexed; resists calcaneal inversion when ankle is plantarflexed

2 - ATF is most commonly injured ankle ligament and evaluated by the anterior drawer test

3 - CFL is typically about 100 degrees inferior and resists calcaneal inversion with the ankle dorsiflexed

talocrural joint ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are
talocrural joint ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are
talocrural joint ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are

talocrural joint ligaments

posterior view

talocrural joint ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are

posterior talofibular

joint ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are

posterior tibiofibular

ligaments posterior view posterior talofibular posterior tibiofibular © Posterolateral lignaments are rarely injured

©

Posterolateral lignaments are rarely injured

talocrural joint ligaments medial view Fan shaped medial “deltoid” ligament Anterior tibiotalar Tibionavicular
talocrural joint ligaments medial view Fan shaped medial “deltoid” ligament Anterior tibiotalar Tibionavicular
talocrural joint ligaments medial view Fan shaped medial “deltoid” ligament Anterior tibiotalar Tibionavicular

talocrural joint ligaments

medial view

talocrural joint ligaments medial view Fan shaped medial “deltoid” ligament Anterior tibiotalar Tibionavicular

Fan shaped medial “deltoid” ligament

medial view Fan shaped medial “deltoid” ligament Anterior tibiotalar Tibionavicular Posterior tibiotalar T

Anterior tibiotalar Tibionavicular

Posterior tibiotalar

Tibiocalcaneal

tibiotalar T i b i o c a l c a n e a l ©

©

Delotid resists ankle eversion and is typically injured with a hyperpronation mechanism (calcaneal eversion)

Medial sprains are unusual because the lateral malleolous provides a bony block to extreme eversion and the strength of the deltoid ligament

talocrural joint axis posterolateral inferior to anteromedial superior approximately 10-15° off the frontal and
talocrural joint axis posterolateral inferior to anteromedial superior approximately 10-15° off the frontal and
talocrural joint axis posterolateral inferior to anteromedial superior approximately 10-15° off the frontal and

talocrural joint axis

talocrural joint axis posterolateral inferior to anteromedial superior approximately 10-15° off the frontal and

posterolateral inferior to anteromedial superior approximately 10-15° off the frontal and transverse plane

TRIPLANAR MOTION

PF Add – Inv DF Abd - Ever

TRIPLANAR MOTION PF – Add – Inv DF – Abd - Ever © Posterior View: axis

©

Posterior View: axis is lateral and inferior to medial superior

Dorsal view: axis is posteior to anterior

Motion always occurs perfectly perpendicular to the axis

Sagittal plane plantar-dorsiflexion are primary motions because the axis is nearly parallel to both the frontal and transverse planes

talocrural joint motion analogy PLANTAR-DORSIFLEXION Texas Arkansas NJ ©© Abduction - Adduction Inversion-eversion
talocrural joint motion analogy PLANTAR-DORSIFLEXION Texas Arkansas NJ ©© Abduction - Adduction Inversion-eversion
talocrural joint motion analogy PLANTAR-DORSIFLEXION Texas Arkansas NJ ©© Abduction - Adduction Inversion-eversion

talocrural joint motion analogy

talocrural joint motion analogy PLANTAR-DORSIFLEXION Texas Arkansas NJ ©© Abduction - Adduction Inversion-eversion

PLANTAR-DORSIFLEXION

Texastalocrural joint motion analogy PLANTAR-DORSIFLEXION Arkansas NJ ©© Abduction - Adduction Inversion-eversion Sagittal

Arkansas NJ
Arkansas
NJ

©©joint motion analogy PLANTAR-DORSIFLEXION Texas Arkansas NJ Abduction - Adduction Inversion-eversion Sagittal plane

Abduction - Adduction

Inversion-eversion

Sagittal plane plantar-dorsiflexion are primary motions because the axis is nearly parallel to both the frontal and transverse planes

A lot (Texas size) of PF-DF motion

Some (Arkansas size) Ab-Add motion

A little (New Jersey size) Inv-Eversion motion

fluoroscopic talocrural sagittal plane motion Fluoroscopic motion movie clip of the talocrural joint available for
fluoroscopic talocrural sagittal plane motion Fluoroscopic motion movie clip of the talocrural joint available for
fluoroscopic talocrural sagittal plane motion Fluoroscopic motion movie clip of the talocrural joint available for

fluoroscopic talocrural

sagittal plane motion

fluoroscopic talocrural sagittal plane motion Fluoroscopic motion movie clip of the talocrural joint available for

Fluoroscopic motion movie clip of the talocrural joint available for download

Sagittal plane plantar-dorsiflexion on talocrural joint axis

PLANTAR-DORSIFLEXION

Abduction-Adduction

Inversion-Eversion

plane plantar-dorsiflexion on talocrural joint axis PLANTAR-DORSIFLEXION Abduction-Adduction Inversion-Eversion ©

©

talocrural joint range of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees
talocrural joint range of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees
talocrural joint range of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees

talocrural joint range of motion

talocrural joint range of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees 20

20-0-50° sagittal plane plantar-dorsiflexion

of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees 20 degrees dorsiflexion
of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees 20 degrees dorsiflexion
of motion 20-0-50° sagittal plane plantar-dorsiflexion © AAOS standard – 20-0-50 degrees 20 degrees dorsiflexion

©

AAOS standard – 20-0-50 degrees

20 degrees dorsiflexion is with knee flexed to put gastroc on slack

talocrural joint Resting Position slight plantarflexion 10-15 ° Closed Pack Position maximal dorsiflexion © Resting
talocrural joint Resting Position slight plantarflexion 10-15 ° Closed Pack Position maximal dorsiflexion © Resting
talocrural joint Resting Position slight plantarflexion 10-15 ° Closed Pack Position maximal dorsiflexion © Resting

talocrural joint

talocrural joint Resting Position slight plantarflexion 10-15 ° Closed Pack Position maximal dorsiflexion © Resting

Resting Position

slight plantarflexion

10-15°

Closed Pack Position

maximal dorsiflexion

10-15 ° Closed Pack Position maximal dorsiflexion © Resting position – ligaments on slac k; maximal
10-15 ° Closed Pack Position maximal dorsiflexion © Resting position – ligaments on slac k; maximal

©

Resting position – ligaments on slack; maximal joint space; treatment position

Closed Pack Position – ligaments taught; talus engaged in mortise; dynamically stable; testing position

Talus wider anteriorly than posteriorly and fully engages the mortise in extreme dorsiflexion

talocrural accessory motion anterior talar glide with plantarflexion posterior talar glide with dorsiflexion dorsiflexion
talocrural accessory motion anterior talar glide with plantarflexion posterior talar glide with dorsiflexion dorsiflexion
talocrural accessory motion anterior talar glide with plantarflexion posterior talar glide with dorsiflexion dorsiflexion

talocrural accessory motion

talocrural accessory motion anterior talar glide with plantarflexion posterior talar glide with dorsiflexion dorsiflexion

anterior talar glide with plantarflexion posterior talar glide with dorsiflexion

dorsiflexion

plantarflexion
plantarflexion
talar glide with dorsiflexion dorsiflexion plantarflexion © Talus moves in NWB – convex talus glides and

©

Talus moves in NWB – convex talus glides and rolls in opposite directions

ConcaveTibia moves in WB - anterior with dorsiflexion

- posterior with dorsiflexion

Part 3 – Subtalar Joint ©
Part 3 – Subtalar Joint ©
Part 3 – Subtalar Joint ©

Part 3 – Subtalar Joint

Part 3 – Subtalar Joint ©
Part 3 – Subtalar Joint ©
Part 3 – Subtalar Joint ©

©

subtalar joint • talocalcaneal synovial articulation with uniaxial oblique hinge • couples function of foot
subtalar joint • talocalcaneal synovial articulation with uniaxial oblique hinge • couples function of foot
subtalar joint • talocalcaneal synovial articulation with uniaxial oblique hinge • couples function of foot

subtalar joint

subtalar joint • talocalcaneal synovial articulation with uniaxial oblique hinge • couples function of foot with

• talocalcaneal synovial articulation with uniaxial oblique hinge

• couples function of foot with rest of kinetic chain

• talus has no muscular attachments

ER- IR- supination
ER- IR-
supination

pronation

has no muscular attachments ER- IR- supination pronation © Talus articulates with thre e facets on

©

Talus articulates with three facets on the calcaneus

Smaller, relatively flat anterior and middle facets and the larger, concave talar posterior facet

Stand up and rotate – feel the subtalar motion that accompanies lower extremity rotation

subtalar joint ligaments Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal
subtalar joint ligaments Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal
subtalar joint ligaments Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal

subtalar joint ligaments

subtalar joint ligaments Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal
subtalar joint ligaments Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal

Posterior talocalcaneal ligament

Lateral talocalcaneal ligament

Interosseus talocalcaneal ligament

Posterior talocalcaneal ligament Lateral talocalcaneal ligament Interosseus talocalcaneal ligament © Exploded View

©

Exploded View

subtalar joint axis orientation 16º 42º © 16° off the sagittal plane 42°off the frontal
subtalar joint axis orientation 16º 42º © 16° off the sagittal plane 42°off the frontal
subtalar joint axis orientation 16º 42º © 16° off the sagittal plane 42°off the frontal

subtalar joint axis orientation

subtalar joint axis orientation 16º 42º © 16° off the sagittal plane 42°off the frontal plane
16º 42º
16º
42º
subtalar joint axis orientation 16º 42º © 16° off the sagittal plane 42°off the frontal plane

©

16° off the sagittal plane 42°off the frontal plane

To understand subtalar joint motion you must define the axis about which motion will take place

Average of 16 degrees medial to sagittal plane and up 42 degrees from the frontal plane

Frontal plane orientation varies from 20-60 degrees

subtalar joint axis of motion Axis runs from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same
subtalar joint axis of motion Axis runs from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same
subtalar joint axis of motion Axis runs from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same

subtalar joint axis of motion

subtalar joint axis of motion Axis runs from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same orientation

Axis runs from

dorsal-medial-distal

to

plantar-lateral-proximal

runs from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same orientation as TCJ – anteromedial superior

DMD

from dorsal-medial-distal to plantar-lateral-proximal DMD © PLP Same orientation as TCJ – anteromedial superior to

©

PLP

Same orientation as TCJ – anteromedial superior to posterolateral inferior; only in different proportions

Dorsal (superior) – Medial – Distal (anterior)

Plantar (inferior – Lateral – Proximal (posterior)

Primary motion is frontal plane inversion-eversion

subtalar joint motion analogy INVERSION-EVERSION Texas Arkansas NJ © Abduction-Adduction plantar-dorsiflexion A lot of
subtalar joint motion analogy INVERSION-EVERSION Texas Arkansas NJ © Abduction-Adduction plantar-dorsiflexion A lot of
subtalar joint motion analogy INVERSION-EVERSION Texas Arkansas NJ © Abduction-Adduction plantar-dorsiflexion A lot of

subtalar joint motion analogy

subtalar joint motion analogy INVERSION-EVERSION Texas Arkansas NJ © Abduction-Adduction plantar-dorsiflexion A lot of

INVERSION-EVERSION

Texassubtalar joint motion analogy INVERSION-EVERSION Arkansas NJ © Abduction-Adduction plantar-dorsiflexion A lot of (Texas

Arkansas NJ
Arkansas
NJ

©

Abduction-Adduction

plantar-dorsiflexion

A lot of (Texas size) Inverison-Eversion

Some (Arkansas size) Ab-Adduction

Little (New Jersey size) pf-df because axis is so close to sagittal plane

subtalar joint motion approximate one to one rela tionship with calcaneal inversion/eversion and tibial
subtalar joint motion approximate one to one rela tionship with calcaneal inversion/eversion and tibial
subtalar joint motion approximate one to one rela tionship with calcaneal inversion/eversion and tibial

subtalar joint motion

subtalar joint motion approximate one to one rela tionship with calcaneal inversion/eversion and tibial

approximate one to one relationship with calcaneal inversion/eversion and tibial internal-external rotation

inversion/eversion and tibial internal-external rotation With low level of inclination increased calcaneal mobility

With low level of inclination

increased calcaneal mobility
increased calcaneal mobility

With high level of inclination

decreased calcaneal mobility

high level of inclination decreased calcaneal mobility © Clinical Consideration: If the STJ axis is at
high level of inclination decreased calcaneal mobility © Clinical Consideration: If the STJ axis is at

©

Clinical Consideration:

If the STJ axis is at the typical 40-45° pitch then there is appoximatley

a one-to-one relationship between calcaneal inversion-eversion and

tibial internal-external rotation

Meaning that for every degree of IR there is one degree of calcaneal eversion as a component of STJ pronation

As the axis moves toward the transverse plane – Lower Level

greater risk for hypermobility, overuse injures – tendinitis, fasciitis; pf syndrom

As the axis moves more parallel to the long axis of the tibia - High level – greater risk for hypombobility injuries – poor shock absorption and prxomail injuries – stress fractures; LBP

STJ range of motion 20 ° – 0 – 10 ° Inversion Eversion at least
STJ range of motion 20 ° – 0 – 10 ° Inversion Eversion at least
STJ range of motion 20 ° – 0 – 10 ° Inversion Eversion at least
STJ range of motion 20 ° – 0 – 10 ° Inversion Eversion at least

STJ range of motion

STJ range of motion 20 ° – 0 – 10 ° Inversion Eversion at least 8-12°

20° – 0 – 10°

Inversion

Eversion

at least 8-12° of supination and 4-6° of pronation required for normal gait

supination and 4-6° of pronation required for normal gait 20º 10º inv ever © 20-0-10 degree
20º 10º inv ever
20º
10º
inv
ever

©

20-0-10 degree is normal STJ motion

at least 8-12° of supination and 4-6° of pronation required for normal gait

Rule of 1/3rds

Podiatrists use this mathematical model to determine STJN position.

1. Determine the total STJ ROM and divide by 3

2. Move this amount from end range eversion to locate the STJ neutral position

3. Example: 6° eversion + 30° = 36° of total motion/3 = 12°

4. 6° eversion - 12° = 6° inverted as STJ neutral

Works well as an average of the entire population but lacks individual validity. Subsequently, recommend palpaltion method for determining individual STJ neutral position.

subtalar joint Closed Pack Position full supination Open Pack Position subtalar joint neutral © Full
subtalar joint Closed Pack Position full supination Open Pack Position subtalar joint neutral © Full
subtalar joint Closed Pack Position full supination Open Pack Position subtalar joint neutral © Full

subtalar joint

subtalar joint Closed Pack Position full supination Open Pack Position subtalar joint neutral © Full supination

Closed Pack Position

full supination

Open Pack Position

subtalar joint neutral

full supination Open Pack Position subtalar joint neutral © Full supination offers maximaly st ability as
full supination Open Pack Position subtalar joint neutral © Full supination offers maximaly st ability as

©

Full supination offers maximaly stability as during propulsion

STJ neutral provides maximal mobility as at heel strike into forefootl loading where terrain adaptation must occur

STJ neutral - 1/3 of the distance from full eversion of total STJ range

subtalar joint accessory motions EVER I N V convex portion of calcaneus slides laterally with
subtalar joint accessory motions EVER I N V convex portion of calcaneus slides laterally with
subtalar joint accessory motions EVER I N V convex portion of calcaneus slides laterally with

subtalar joint accessory motions

EVER
EVER

INV

subtalar joint accessory motions EVER I N V convex portion of calcaneus slides laterally with inversion

convex portion of calcaneus slides laterally with inversion

convex portion of calcaneus

slides medially with

eversion

of calcaneus s l i d e s medially w ith eversion © Convex posterior facet

©

Convex posterior facet on calcaneus is up to 70% of the surface area of the STJ) articulation

Part 4 – Midtarsal Joints ©
Part 4 – Midtarsal Joints ©
Part 4 – Midtarsal Joints ©

Part 4 – Midtarsal Joints

Part 4 – Midtarsal Joints ©
Part 4 – Midtarsal Joints ©
Part 4 – Midtarsal Joints ©

©

midtarsal joint (transverse tarsal joint) two joints functioning together ( talonavicular and calcaneocuboid a r
midtarsal joint (transverse tarsal joint) two joints functioning together ( talonavicular and calcaneocuboid a r
midtarsal joint (transverse tarsal joint) two joints functioning together ( talonavicular and calcaneocuboid a r

midtarsal joint

(transverse tarsal joint)

midtarsal joint (transverse tarsal joint) two joints functioning together ( talonavicular and calcaneocuboid a r t

two joints functioning together

(talonavicular and calcaneocuboid

articulations) about two common axes

of motion (longitudinal and oblique)

ligamentous support from calcaneo- navicular (spring), deltoid, dorsal talonavicular, and calcaneocuboid ligaments (long and short plantar) ligaments

ligaments (long and short plantar) ligaments © Also called Chopart’s (sho-par) Jo int after the French
ligaments (long and short plantar) ligaments © Also called Chopart’s (sho-par) Jo int after the French

©

Also called Chopart’s (sho-par) Joint after the French surgeon who first described an amputation at this level of the foot

calcaneonavicular ligament Spring Ligament © Spring ligament runs from the sustanaculum tali to the navicular
calcaneonavicular ligament Spring Ligament © Spring ligament runs from the sustanaculum tali to the navicular
calcaneonavicular ligament Spring Ligament © Spring ligament runs from the sustanaculum tali to the navicular

calcaneonavicular ligament

calcaneonavicular ligament Spring Ligament © Spring ligament runs from the sustanaculum tali to the navicular
Spring Ligament
Spring Ligament
calcaneonavicular ligament Spring Ligament © Spring ligament runs from the sustanaculum tali to the navicular

©

Spring ligament runs from the sustanaculum tali to the navicular tuberosity and supports medial longitudinal arch by cradling or supporting the talus and navicular

dorsal-plantar ligamentous support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar
dorsal-plantar ligamentous support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar
dorsal-plantar ligamentous support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar

dorsal-plantar ligamentous support

dorsal-plantar ligamentous support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar

Superior View

Dorsal talonavicular ligament

support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar ligaments © Long –
support Superior View Dorsal talonavicular ligament Inferior View Long and short plantar ligaments © Long –

Inferior View

Long and short plantar ligaments

ligament Inferior View Long and short plantar ligaments © Long – calcanenus to base of lateral

©

Long – calcanenus to base of lateral metatarsals Short - calcaneocuobid

plantar fascia • Dense multilayered fibrous connective tissue • Originates at the medial calcaneal tuberosity
plantar fascia • Dense multilayered fibrous connective tissue • Originates at the medial calcaneal tuberosity
plantar fascia • Dense multilayered fibrous connective tissue • Originates at the medial calcaneal tuberosity

plantar fascia

plantar fascia • Dense multilayered fibrous connective tissue • Originates at the medial calcaneal tuberosity •

Dense multilayered fibrous connective tissue

Originates at the medial calcaneal tuberosity

Inserts into the plantar plates of the MTP joints and bases of the proximal phalanges

of the MTP joints and bases of the proximal phalanges © Dense multilayered fibrous connective tissue
of the MTP joints and bases of the proximal phalanges © Dense multilayered fibrous connective tissue

©

Dense multilayered fibrous connective tissue

Originates at the medial calcaneal tuberosity

Inserts into the plantar plates of the MTP joints and bases of the proximal phalanges

Provides truss support and assists with propulsion through windlass mechanism in the late stance phase of gait.

midtarsal joint oblique axis of motion Equally angulated from transverse and sagittal planes allowing coupled
midtarsal joint oblique axis of motion Equally angulated from transverse and sagittal planes allowing coupled
midtarsal joint oblique axis of motion Equally angulated from transverse and sagittal planes allowing coupled

midtarsal joint oblique axis of motion

midtarsal joint oblique axis of motion Equally angulated from transverse and sagittal planes allowing coupled motions

Equally angulated from transverse and sagittal planes allowing coupled motions of plantarflexion-adduction and dorsiflexion-abduction

52° off transverse plane and 57° off sagittal plane

52º
52º

57º

off transverse plane and 57° off sagittal plane 52º 57º © Ab-Adduction of foot occurs on
off transverse plane and 57° off sagittal plane 52º 57º © Ab-Adduction of foot occurs on
off transverse plane and 57° off sagittal plane 52º 57º © Ab-Adduction of foot occurs on

©

Ab-Adduction of foot occurs on the 52 degree axis Plantar-dorsiflexion of mid-foot occurs on the 57 degree axis

midtarsal joint longitudinal axis of motion 15º 9º 15° off transverse plane and 9° off
midtarsal joint longitudinal axis of motion 15º 9º 15° off transverse plane and 9° off
midtarsal joint longitudinal axis of motion 15º 9º 15° off transverse plane and 9° off

midtarsal joint longitudinal axis of motion

15º 9º
15º
midtarsal joint longitudinal axis of motion 15º 9º 15° off transverse plane and 9° off sagittal

15° off transverse plane and 9° off sagittal plane

Parallel to the transverse and sagittal planes allowing only frontal plane motion of inversion and eversion

only frontal plane motion of inversion and eversion © Inversion-Eversion motion of mid-foot occurs on the

©

Inversion-Eversion motion of mid-foot occurs on the longitudinal axis

midtarsal joint motion vs. position No clinically reliable method of quantifying the amount of midtarsal
midtarsal joint motion vs. position No clinically reliable method of quantifying the amount of midtarsal
midtarsal joint motion vs. position No clinically reliable method of quantifying the amount of midtarsal

midtarsal joint motion vs. position

midtarsal joint motion vs. position No clinically reliable method of quantifying the amount of midtarsal ROM.

No clinically reliable method of quantifying the amount of midtarsal ROM. Midtarsal joint motion is dictated by the position of the subtalar joint.

The position of the midtarsal joint is dictated by ground reaction forces and muscular forces, motion of the joint is determined by the position of the subtalar joint.

joint is determined by the position of the subtalar joint. © Rhetorical question – “How do
joint is determined by the position of the subtalar joint. © Rhetorical question – “How do

©

Rhetorical question – “How do you measure midtarsal joint motion?” – obviously we can’t

We tend to subjectively qualify mobility instead of trying to quantify the amount of angular motion at the midtarsal joints

midtarsal joint axes relationship When the STJ is pronated the two axes of the MTJ
midtarsal joint axes relationship When the STJ is pronated the two axes of the MTJ
midtarsal joint axes relationship When the STJ is pronated the two axes of the MTJ

midtarsal joint axes relationship

midtarsal joint axes relationship When the STJ is pronated the two axes of the MTJ diverge

When the STJ is pronated the two axes of the MTJ diverge (become more parallel and allow motion)

of the MTJ diverge (become more parallel and allow motion) When the axes converge during supination,

When the axes converge during supination, the MTJ locks, allowing little motion

during supination, the MTJ locks, allowing little motion © Root’s and Weed’s classic explanat ion of

©

Root’s and Weed’s classic explanation of how midtarsal joint axe’s relationship can be both a flexible adaptor to terrain and a rigid lever for propulsion

midtarsal joint “locking” Root and Weeds contention of converging axis may be challenged by the
midtarsal joint “locking” Root and Weeds contention of converging axis may be challenged by the
midtarsal joint “locking” Root and Weeds contention of converging axis may be challenged by the

midtarsal joint “locking”

midtarsal joint “locking” Root and Weeds contention of converging axis may be challenged by the fact

Root and Weeds contention of converging axis may be challenged by the fact that:

talonavicular joint is a ball and socket joint with an infinite number of axes

consequently, at any one time an axis is both parallel and askew to the calcaneocuboid joint

is both parallel and askew to the calcaneocuboid joint © If both parallel and askwed simu
is both parallel and askew to the calcaneocuboid joint © If both parallel and askwed simu

©

If both parallel and askwed simultaneously, the axes can never converge or diverge

midtarsal joint “locking” Anterior facet of the talus articulates with the cuboid in supination talus
midtarsal joint “locking” Anterior facet of the talus articulates with the cuboid in supination talus
midtarsal joint “locking” Anterior facet of the talus articulates with the cuboid in supination talus

midtarsal joint “locking”

midtarsal joint “locking” Anterior facet of the talus articulates with the cuboid in supination talus acts
midtarsal joint “locking” Anterior facet of the talus articulates with the cuboid in supination talus acts

Anterior facet of the talus articulates with the cuboid in supination

talus acts as a bony block to cuboid motion

Glasser, 1999

talus acts as a bony block to cuboid motion Glasser, 1999 © Anterior facet of the

©

Anterior facet of the talus articulates with the cuboid in supination as evidenced by presence of hyaline cartilage at the talocuboid interface

talus acts as a bony block to cuboid motion when the STJ is supinated

Clinically, it is simply important to assess if midtarsal mobility is increased with pronation and decreased (stiffened) with supination

midtarsal joint Closed Pack Position Subtalar joint supination Resting Position Subtalar joint neutral © Rember
midtarsal joint Closed Pack Position Subtalar joint supination Resting Position Subtalar joint neutral © Rember
midtarsal joint Closed Pack Position Subtalar joint supination Resting Position Subtalar joint neutral © Rember

midtarsal joint

midtarsal joint Closed Pack Position Subtalar joint supination Resting Position Subtalar joint neutral © Rember that

Closed Pack Position

Subtalar joint supination

Resting Position

Subtalar joint neutral

joint supination Resting Position Subtalar joint neutral © Rember that motion availability is de pendent upon
joint supination Resting Position Subtalar joint neutral © Rember that motion availability is de pendent upon

©

Rember that motion availability is dependent upon the position of the STJ

midtarsal joint accessory motion SUPINATION dorsal glide of the navicular on the talus PRONATION plantar
midtarsal joint accessory motion SUPINATION dorsal glide of the navicular on the talus PRONATION plantar
midtarsal joint accessory motion SUPINATION dorsal glide of the navicular on the talus PRONATION plantar

midtarsal joint accessory motion

midtarsal joint accessory motion SUPINATION dorsal glide of the navicular on the talus PRONATION plantar glide

SUPINATION

dorsal glide of the navicular on the talus

PRONATION

plantar glide of the navicular on the talus

supination pronation
supination
pronation
glide of the navicular on the talus supination pronation © Functionally, supination is assist ed by

©

Functionally, supination is assisted by posterior tib pulling the navicular up and by the peroneals pulling the navicular down with the eversion component of STJ pronation

Part 5 – First Ray - 1 s t MTP Joint ©
Part 5 – First Ray - 1 s t MTP Joint ©
Part 5 – First Ray - 1 s t MTP Joint ©

Part 5 – First Ray - 1 st MTP Joint

Part 5 – First Ray - 1 s t MTP Joint ©
Part 5 – First Ray - 1 s t MTP Joint ©
Part 5 – First Ray - 1 s t MTP Joint ©

©

first ray functional articulation consisting of the 1 s t metatarsal, medial cuneiform, and navicular
first ray functional articulation consisting of the 1 s t metatarsal, medial cuneiform, and navicular

first ray

first ray functional articulation consisting of the 1 s t metatarsal, medial cuneiform, and navicular DL
first ray functional articulation consisting of the 1 s t metatarsal, medial cuneiform, and navicular DL
first ray functional articulation consisting of the 1 s t metatarsal, medial cuneiform, and navicular DL

functional articulation consisting of the 1 st metatarsal, medial cuneiform, and navicular

DL

axis angulated 45° from the frontal and sagittal planes and parallel to transverse plane

and sagittal planes and parallel to transverse plane distal-lateral to proximal-medial PM © Scapulohumeral

distal-lateral to proximal-medial

to transverse plane distal-lateral to proximal-medial PM © Scapulohumeral analogy – like the sc apula gliding
to transverse plane distal-lateral to proximal-medial PM © Scapulohumeral analogy – like the sc apula gliding

PM

to transverse plane distal-lateral to proximal-medial PM © Scapulohumeral analogy – like the sc apula gliding

©

Scapulohumeral analogy – like the scapula gliding across the thorax, the first ray is not a typical diarthrodial joint but has important functional contribution

Distal lateral (instead of distal-medial) to Proximal medial (instead of proximal-lateral)

first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©
first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©
first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©

first ray motion

first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©
first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©

coupled motion of plantarflexion and eversion

dorsiflexion and inversion

first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©
first ray motion coupled motion of plantarflexion and eversion dorsiflexion and inversion ©

©

Subtalar Joint Effect on 1st Ray PRONATION – medial longitudinal arch lowers – increased 1
Subtalar Joint Effect on 1st Ray PRONATION – medial longitudinal arch lowers – increased 1
Subtalar Joint Effect on 1st Ray PRONATION – medial longitudinal arch lowers – increased 1

Subtalar Joint Effect on 1st Ray

Subtalar Joint Effect on 1st Ray PRONATION – medial longitudinal arch lowers – increased 1 s

PRONATION

medial longitudinal arch lowers

increased 1 st ray mobility

peroneus longus important stabilizer

SUPINATION

medial longitudinal arch elevation

increased 1st ray stability

longus important stabilizer SUPINATION – medial longitudinal arch elevation – increased 1st ray stability ©
longus important stabilizer SUPINATION – medial longitudinal arch elevation – increased 1st ray stability ©

©

1 s t ray accessory motion 1st ray motion of plantar-dorsiflexion is influenced by the
1 s t ray accessory motion 1st ray motion of plantar-dorsiflexion is influenced by the
1 s t ray accessory motion 1st ray motion of plantar-dorsiflexion is influenced by the

1 st ray accessory motion

1 s t ray accessory motion 1st ray motion of plantar-dorsiflexion is influenced by the subtalar

1st ray motion of plantar-dorsiflexion is influenced by the subtalar joint’s position

1st ray motion is increased with pronation and decreased with supination

Normal mobility is .5 to 1 cm (thumb's width) in plantar and dorsal directions

1 cm (thumb's width) in plantar and dorsal directions © Method by which to determine mobi
1 cm (thumb's width) in plantar and dorsal directions © Method by which to determine mobi
1 cm (thumb's width) in plantar and dorsal directions © Method by which to determine mobi

©

Method by which to determine mobility of first ray (hypo or hyper)

1 s t metatarsophalangeal joint articulation between 1st metatarsal and the 1 s t proximal
1 s t metatarsophalangeal joint articulation between 1st metatarsal and the 1 s t proximal
1 s t metatarsophalangeal joint articulation between 1st metatarsal and the 1 s t proximal

1 st metatarsophalangeal joint

1 s t metatarsophalangeal joint articulation between 1st metatarsal and the 1 s t proximal phalanx

articulation between 1st metatarsal and the 1 st proximal phalanx

between 1st metatarsal and the 1 s t proximal phalanx sesamoids articulate with plantar metatarsal head

sesamoids articulate with plantar

metatarsal head

between 1st metatarsal and the 1 s t proximal phalanx sesamoids articulate with plantar metatarsal head
between 1st metatarsal and the 1 s t proximal phalanx sesamoids articulate with plantar metatarsal head

©

1 s t MTP joint axis of motion horizontal axis allowing sagittal plane motion of
1 s t MTP joint axis of motion horizontal axis allowing sagittal plane motion of
1 s t MTP joint axis of motion horizontal axis allowing sagittal plane motion of

1 st MTP joint axis of motion

1 s t MTP joint axis of motion horizontal axis allowing sagittal plane motion of plantar-dorsiflexion

horizontal axis allowing sagittal plane motion of plantar-dorsiflexion vertical axis allowing abduction- adduction

20-30° with 1st ray stabilized 60-70° when 1st ray allowed to plantarflex

stabilized 60-70° when 1st ray allowed to plantarflex © horizontal (medial to lateral) axis allowing the
stabilized 60-70° when 1st ray allowed to plantarflex © horizontal (medial to lateral) axis allowing the

©

horizontal (medial to lateral) axis allowing the sagittal plane motion of plantar-dorsiflexion

vertical (superior to inferior) axis allowing abduction-adduction

20-30° with 1st ray stabilized 60-70° when 1st ray allowed to plantarflex

Common to have less 1 st MTP dorsiflexion range – implications to many pathologies.

1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©
1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©
1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©

1 st MTP joint

1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©
1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©

Closed Pack Position

full dorsiflexion

Resting Position

slight plantarflexion

1 s t MTP joint Closed Pack Position full dorsiflexion Resting Position slight plantarflexion ©

©

1 s t MTP joint accessory motion PLANTARFLEXION Plantar glide of proximal phalanx DORSIFLEXION (extension)
1 s t MTP joint accessory motion PLANTARFLEXION Plantar glide of proximal phalanx DORSIFLEXION (extension)
1 s t MTP joint accessory motion PLANTARFLEXION Plantar glide of proximal phalanx DORSIFLEXION (extension)

1 st MTP joint accessory motion

1 s t MTP joint accessory motion PLANTARFLEXION Plantar glide of proximal phalanx DORSIFLEXION (extension) ©

PLANTARFLEXION

Plantar glide of proximal phalanx

DORSIFLEXION (extension)

Plantar glide of proximal phalanx DORSIFLEXION (extension) © Dorsal glide of proximal phalanx PF – plantar
Plantar glide of proximal phalanx DORSIFLEXION (extension) © Dorsal glide of proximal phalanx PF – plantar

©

Dorsal glide of proximal phalanx

PF – plantar glide of proximal phalanx or dorsal glide of metatarsal

DF – dorsal glide of proximal phalanx or plantar glide of metatarsal

Bony palpation landmarks 1st Met Head 1 s t Metatarsal 1st Cunieform 2nd Cuneiform 3rd
Bony palpation landmarks 1st Met Head 1 s t Metatarsal 1st Cunieform 2nd Cuneiform 3rd
Bony palpation landmarks 1st Met Head 1 s t Metatarsal 1st Cunieform 2nd Cuneiform 3rd

Bony palpation landmarks

Bony palpation landmarks 1st Met Head 1 s t Metatarsal 1st Cunieform 2nd Cuneiform 3rd Cuneiform

1st Met Head 1 st Metatarsal 1st Cunieform 2nd Cuneiform 3rd Cuneiform Navicular Tuberosity Talar Head Medial Malleolus Sustentaculum Tali Calcaneus

5th Metatarsal Styloid Process Cuboid Sinus Tarsi Talar Dome Calcaneus Lat. Malleolus Medial Calcaneal Tuberosity

Calcaneus Lat. Malleolus Medial Calcaneal Tuberosity © 1st Met Head – bunions, gout, sesamoids First
Calcaneus Lat. Malleolus Medial Calcaneal Tuberosity © 1st Met Head – bunions, gout, sesamoids First

©

1st Met Head – bunions, gout, sesamoids First Metatarsal Medial Cunieform – articulates with 1st met 2nd Cuneiform – articulates with 2nd met 3rd Cuneiform – articulates with 3rd met Navicular Tuberosity – landmark of feiss line Talar Head – palpated for STJ neutral (no muscle attachments) – more prominent with pronation Sustentaculum Tali – large medial extension of calcaneus; fingers width below medial malleolus; origin of spring ligament Medial Malleolus - Calcaenus 5th Metatarsal Styloid Process at Base of 5th – insertion of peroneus brevis Cuboid – notch for peroneus longus Sinus Tarsi – EHB origin; area of ATF ligament Calcaneus Lateral Malleolus Tibiofibular Synostosis Talar Dome – can palpate anterior talus in the sinus tarsi with plantarflexion/inversion Medial Calcaneal Tuberosity – origin of plantar fascia Met Heads

Lower Leg Muscles ©
Lower Leg Muscles ©
Lower Leg Muscles ©

Lower Leg Muscles

Lower Leg Muscles ©
Lower Leg Muscles ©
Lower Leg Muscles ©

©

© muscular anatomy
© muscular anatomy
© muscular anatomy
© muscular anatomy
© muscular anatomy

©

muscular anatomy

© muscular anatomy
anterior compartment Muscles – TA, EHL, ED, PT General Function – Ankle df; toe extension
anterior compartment Muscles – TA, EHL, ED, PT General Function – Ankle df; toe extension
anterior compartment Muscles – TA, EHL, ED, PT General Function – Ankle df; toe extension

anterior compartment

anterior compartment Muscles – TA, EHL, ED, PT General Function – Ankle df; toe extension Innervation

Muscles

TA, EHL, ED, PT

General Function

Ankle df; toe extension

Innervation

Deep peroneal nerve

L4,5 S1

Blood Supply

Anterior Tibial Artery

– Ankle df; toe extension Innervation – Deep peroneal nerve – L4,5 S1 Blood Supply –

©

anterior compartment muscle function TCJ STJ STJ Axis Mm anterior Axis Axis AT Dorsiflex Med
anterior compartment muscle function TCJ STJ STJ Axis Mm anterior Axis Axis AT Dorsiflex Med
anterior compartment muscle function TCJ STJ STJ Axis Mm anterior Axis Axis AT Dorsiflex Med

anterior compartment muscle function

anterior compartment muscle function TCJ STJ STJ Axis Mm anterior Axis Axis AT Dorsiflex Med Inv
TCJ STJ STJ Axis Mm anterior Axis Axis AT Dorsiflex Med Inv EHL EDL AT
TCJ
STJ
STJ Axis
Mm
anterior
Axis
Axis
AT
Dorsiflex
Med
Inv
EHL
EDL
AT
medial
EHL
Anterior
Extend
PT
ED
Extend
Lat
Ever
PT
Dorsiflex
Lat
Ever
TCJ Axis
lateral
posterior
x-section of left lower leg
©
Anterior Tibialis Origin – lateral tibial condyle; proximal 2/3 of anterolateral surface of tibia; interosseous
Anterior Tibialis Origin – lateral tibial condyle; proximal 2/3 of anterolateral surface of tibia; interosseous
Anterior Tibialis Origin – lateral tibial condyle; proximal 2/3 of anterolateral surface of tibia; interosseous

Anterior Tibialis

Anterior Tibialis Origin – lateral tibial condyle; proximal 2/3 of anterolateral surface of tibia; interosseous

Origin

lateral tibial condyle; proximal 2/3 of anterolateral surface of tibia; interosseous membrane

Insertion

medial & plantar surface of base of 1st metatarsal

medial & plantar surface of the cuneiform

Action

strongest dorsiflexor; inverts & adducts the foot

– strongest dorsiflexor; inverts & adducts the foot © Origin is on the laterallateral tibia l

©

Origin is on the laterallateral tibial condyle; upper 2/3 of anterolateral surface of tibia; interosseous membrane

Anterior tib wraps around the foot to insert on the medial & plantar surface of base of 1st metatarsal and medial cuneiform

Anterior tibi is the strongest dorsiflexor; inverts & adducts the foot

© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane
© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane
© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane
© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane
© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane

©

Extensor Hallicus Longus

© Extensor Hallicus Longus Origin – middle half of anterior shaft of fibula; interosseous membrane Insertion

Origin

middle half of anterior shaft of fibula; interosseous membrane

Insertion

dorsal surface of base of proximal and distal phalanx of hallux

Action

extends distal phalanx of big toe; weak dorsiflexor; weak inversion & adduction

Lateral to the Anterior tib

Questionable inversion/eversion effect as tendon is on the STJ axis

Extensor Digitorum Origin – lateral condyle of the tibia; upper ant. surface of fibula; interosseous
Extensor Digitorum Origin – lateral condyle of the tibia; upper ant. surface of fibula; interosseous
Extensor Digitorum Origin – lateral condyle of the tibia; upper ant. surface of fibula; interosseous

Extensor Digitorum

Extensor Digitorum Origin – lateral condyle of the tibia; upper ant. surface of fibula; interosseous membrane

Origin

lateral condyle of the tibia; upper ant. surface of fibula; interosseous membrane

Insertion

dorsal surface of the bases of the middle & distal phalanxes of the 2nd-5th rays

via 4 tendons creating a fibrous expansion

Action

extends the lateral 4 toes; weak dorsiflexor & evertor of foot

4 tendons creating a fibrous expansion Action – extends the lateral 4 toes; weak dorsiflexor &

©

© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of
© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of
© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of
© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of
© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of

©

Peroneus Tertius

© Peroneus Tertius Origin – distal 1/3 of anterior fibula; distal & lateral aspect of extensor

Origin

distal 1/3 of anterior fibula; distal & lateral aspect of extensor digitorum

Insertion

dorsal surface of base of 5th metatarsal

Action

extends the 5th toe; weak dorsiflexor & evertor of foot

Origin is on lower 1/3 of anterior fibula; distal & lateral aspect of extensor digitorum and inserts on top of the dorsal surface of base of 5th metatarsal

Action - extends the 5th toe; weak dorsiflexor & evertor of foot

lateral compartment Muscles – Peroneus Longus and Brevis General Function – © Ankle pf; STJ
lateral compartment Muscles – Peroneus Longus and Brevis General Function – © Ankle pf; STJ
lateral compartment Muscles – Peroneus Longus and Brevis General Function – © Ankle pf; STJ

lateral compartment

lateral compartment Muscles – Peroneus Longus and Brevis General Function – © Ankle pf; STJ eversion;

Muscles

Peroneus Longus and Brevis

General Function

©
©

Ankle pf; STJ eversion; plantarflexion of 1 st ray

Innervation

Blood Supply

Superficial peroneal nerve

L4,5 S1

Peroneal branch from posterior tib artery

no arteries in lateral compartment apart from a muscular branch to the peroneal muscles from the peroneal artery, a branch of the posterior tibial artery

lateral compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PB Posterior Plantarflex Lat
lateral compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PB Posterior Plantarflex Lat
lateral compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PB Posterior Plantarflex Lat

lateral compartment muscular function

lateral compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PB Posterior Plantarflex Lat Ever
TCJ STJ STJ Axis Mm Axis Axis PB Posterior Plantarflex Lat Ever PL TCJ Axis
TCJ
STJ
STJ Axis
Mm
Axis
Axis
PB
Posterior
Plantarflex
Lat
Ever
PL
TCJ Axis
Posterolateral quadrant
©
© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion
© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion
© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion
© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion
© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion

©

Peroneus Longus

© Peroneus Longus Origin – head of the fibula; proximal 2/3 of lateral fibula Insertion –

Origin

head of the fibula; proximal 2/3 of lateral fibula

Insertion

plantar surface of cuboid; base of 1st & 2nd metatarsal; plantar surface of medial cuneiform

Action

eversion & abduction of the foot; plantarflexion of the 1 st ray

Originates from the head head and the upper 2/3 of lateral fibula

Passes through the cuboid notch or pulley on its way to it’s insertion at the base of 1st & 2nd metatarsal; plantar surface of medial cuneiform

Action - eversion & abduction of the foot; plantarflexion of the 1 st ray

© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at
© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at
© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at
© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at
© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at

©

Peroneus Brevis

© Peroneus Brevis Origin – distal 2/3 of lateral fibula Insertion – styloid process at base

Origin

distal 2/3 of lateral fibula

Insertion

styloid process at base of 5th metatarsal

Action

eversion & abduction of the foot; weak plantarflexion of foot

superficial posterior compartment Muscles – Gastroc, soleus, and plantaris General Function – Ankle pf; STJ
superficial posterior compartment Muscles – Gastroc, soleus, and plantaris General Function – Ankle pf; STJ
superficial posterior compartment Muscles – Gastroc, soleus, and plantaris General Function – Ankle pf; STJ

superficial posterior compartment

superficial posterior compartment Muscles – Gastroc, soleus, and plantaris General Function – Ankle pf; STJ

Muscles

Gastroc, soleus, and plantaris

General Function

Ankle pf; STJ supination

Innervation

Function – Ankle pf; STJ supination Innervation – © Tibial nerve which is derived from L5-S1
Function – Ankle pf; STJ supination Innervation – © Tibial nerve which is derived from L5-S1
Function – Ankle pf; STJ supination Innervation – © Tibial nerve which is derived from L5-S1

©

Tibial nerve which is derived from L5-S1 nerve roots

Blood Supply

Posterior Tibial Artery

superficial posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis Gastroc Posterior Plantarflex
superficial posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis Gastroc Posterior Plantarflex
superficial posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis Gastroc Posterior Plantarflex

superficial posterior compartment muscular function

superficial posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis Gastroc Posterior Plantarflex
TCJ STJ STJ Axis Mm Axis Axis Gastroc Posterior Plantarflex Med Inv Soleus TCJ Axis
TCJ
STJ
STJ Axis
Mm
Axis
Axis
Gastroc
Posterior
Plantarflex
Med
Inv
Soleus
TCJ Axis
Posteromedial
quadrant
©
Gastrocnemius Origin – medial head: just above medial condyle of femur – lateral head: just
Gastrocnemius Origin – medial head: just above medial condyle of femur – lateral head: just
Gastrocnemius Origin – medial head: just above medial condyle of femur – lateral head: just

Gastrocnemius

Gastrocnemius Origin – medial head: just above medial condyle of femur – lateral head: just above

Origin

medial head: just above medial condyle of femur

lateral head: just above lateral condyle of femur

Insertion

calcaneus via achilles tendon

Action

plantarflex the ankle

knee flexion (when not weight bearing)

the ankle – knee flexion (when not weight bearing) © Gastroc is a phasic (fast twitch)

©

Gastroc is a phasic (fast twitch) muscle that is better recruited with high intensity activity

© Soleus Origin – upper fibula – soleal line of tibia (upper 1/3 of posterior
© Soleus Origin – upper fibula – soleal line of tibia (upper 1/3 of posterior
© Soleus Origin – upper fibula – soleal line of tibia (upper 1/3 of posterior
© Soleus Origin – upper fibula – soleal line of tibia (upper 1/3 of posterior

©

Soleus

© Soleus Origin – upper fibula – soleal line of tibia (upper 1/3 of posterior tibia

Origin

upper fibula

soleal line of tibia (upper 1/3 of posterior tibia

Insertion

calcaneus via achilles tendon

Action

plantarflex the ankle

Soleus is a tonic or slow twitch predominant muscle

Soleal line located on upper 1/3 of posterior tibia

deep posterior compartment Muscles – PT, FDL, FHL General Function – FDL PT FHL ©
deep posterior compartment Muscles – PT, FDL, FHL General Function – FDL PT FHL ©
deep posterior compartment Muscles – PT, FDL, FHL General Function – FDL PT FHL ©

deep posterior compartment

deep posterior compartment Muscles – PT, FDL, FHL General Function – FDL PT FHL © Ankle

Muscles

PT, FDL, FHL

General Function

FDL PT FHL ©
FDL
PT
FHL
©

Ankle pf; STJ inversion; toe flexion

Innervation

Tibial nerve

L5-S1

Blood Supply

Posterior Tibial Artery

deep posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PT Plantarflex Inv
deep posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PT Plantarflex Inv
deep posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PT Plantarflex Inv

deep posterior compartment muscular function

deep posterior compartment muscular function TCJ STJ STJ Axis Mm Axis Axis PT Plantarflex Inv FHL
TCJ STJ STJ Axis Mm Axis Axis PT Plantarflex Inv FHL Posterior Plantarflex Med Inv
TCJ
STJ
STJ Axis
Mm
Axis
Axis
PT
Plantarflex
Inv
FHL
Posterior
Plantarflex
Med
Inv
FDL
Plantarflex
Inv
FDL
PT
FHL
TCJ Axis
©
Posterior Tibialis Origin – Postermedial portion of the proximal tibia; interosseous membrane; medial surface of
Posterior Tibialis Origin – Postermedial portion of the proximal tibia; interosseous membrane; medial surface of
Posterior Tibialis Origin – Postermedial portion of the proximal tibia; interosseous membrane; medial surface of

Posterior Tibialis

Posterior Tibialis Origin – Postermedial portion of the proximal tibia; interosseous membrane; medial surface of

Origin

Postermedial portion of the proximal tibia; interosseous membrane; medial surface of fibula

Insertion (broad expansive insertional area)

navicular tuberosity (principle); all three cuneiforms (plantar surface); bases of 2nd-4th metatarsals; cuboid; sustentaculum tali of calcaneus

Action

stabilizes ankle; inverts and adducts the foot; weak ankle plantarflexor; control and reverse pronation

weak ankle plantarflexor; control and reverse pronation © Posterior tib origin palpable a hand’s width superior

©

Posterior tib origin palpable a hand’s width superior to medial malleolus; tendon palpable just posterior to medial malleolus with resistance plantarflexion and inversion

Flexor Digitorum Longus Origin: – posterior surface of tibia and crural fascia Insertion – plantar
Flexor Digitorum Longus Origin: – posterior surface of tibia and crural fascia Insertion – plantar
Flexor Digitorum Longus Origin: – posterior surface of tibia and crural fascia Insertion – plantar

Flexor Digitorum Longus

Flexor Digitorum Longus Origin: – posterior surface of tibia and crural fascia Insertion – plantar surface

Origin:

posterior surface of tibia and crural fascia

Insertion

plantar surface of bases of the 2-5th distal phalanges

Action:

primarily flexes 2nd - 5th toes

weak ankle plantarflexor and inversion & adduction of foot

– weak ankle plantarflexor and inversion & adduction of foot © Crural fascia also known as

©

Crural fascia also known as interosseous membrane

© Flexor Hallicus Longus Origin: – posterior, inferior 2/3 of fibula; interosseous membrane; – crural
© Flexor Hallicus Longus Origin: – posterior, inferior 2/3 of fibula; interosseous membrane; – crural
© Flexor Hallicus Longus Origin: – posterior, inferior 2/3 of fibula; interosseous membrane; – crural
© Flexor Hallicus Longus Origin: – posterior, inferior 2/3 of fibula; interosseous membrane; – crural

©

Flexor Hallicus Longus

© Flexor Hallicus Longus Origin: – posterior, inferior 2/3 of fibula; interosseous membrane; – crural fascia

Origin:

posterior, inferior 2/3 of fibula; interosseous membrane;

crural fascia & posterior intermuscular septum

Insertion

plantar surface of distal phalanx of hallux

Action:

flexes big toe (hallux); weak plantarflexion of the foot; weak inversion & adduction of foot

of the foot; weak inversion & adduction of foot Origin is from posterior, lower 2/ 3

Origin is from posterior, lower 2/3 of fibula; interosseous membrane; crural fascia & posterior intermuscular septum

Inserts onto the plantar surface of the big toe

Action: flexes big toe (hallux); weak plantarflexion of the foot; weak inversion & adduction of foot

Trivia Question: What kind of athlete is susceptible to FHL tendinitis?

Commonly injured in ballet dancers

Foot Intrinsic Muscles ©
Foot Intrinsic Muscles ©
Foot Intrinsic Muscles ©

Foot Intrinsic Muscles

Foot Intrinsic Muscles ©
Foot Intrinsic Muscles ©
Foot Intrinsic Muscles ©

©

Intrinsic Muscles of the Foot Superficial First Layer ADMADM AHAH FDBFDB © •Muscles that originate
Intrinsic Muscles of the Foot Superficial First Layer ADMADM AHAH FDBFDB © •Muscles that originate
Intrinsic Muscles of the Foot Superficial First Layer ADMADM AHAH FDBFDB © •Muscles that originate

Intrinsic Muscles of the Foot

Intrinsic Muscles of the Foot Superficial First Layer ADMADM AHAH FDBFDB © •Muscles that originate and

Superficial First Layer

ADMADM AHAH FDBFDB
ADMADM
AHAH
FDBFDB
of the Foot Superficial First Layer ADMADM AHAH FDBFDB © •Muscles that originate and insert within

©

•Muscles that originate and insert within the foot

•foot muscles have gross rather than precise functions compared to the hand

•many muscles in the foot have names that imply a function they rarely perform, or, for some individuals, are unable to perform

•however, and somewhat ironically, loss of function or surgical alteration of these muscles can result in the development of a foot deformity

© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of
© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of
© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of
© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of

©

Abductor Hallicus

© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of base

Origin

© Abductor Hallicus Origin – medial process of calcaneal tuberosity; Insertion – medial aspect of base

medial process of calcaneal tuberosity;

Insertion

medial aspect of base of proximal phalanx of hallux

Action

flexes the big toe (primary action); may assist in abduction of big toe

Blood Supply

medial plantar artery

Innervation

medial plantar nerve, L5,S1

plantar artery Innervation – medial plantar nerve, L5,S1 •Muscles which produce transverse plane motion

•Muscles which produce transverse plane motion (ab/adduction) in the foot are named relative to the midline of THE FOOT, not the midline of the body

•The ‘midline’ of the foot is a line passing through the heel and the 2 nd toe

•Abduction of the big toe is a medial motion while abduction of the little toe is a lateral motion

•Weakness of AH may contribute to hallux valgus

© Flexor Digitorum Brevis Origin – medial and lateral process of calcaneal tuberosity; plantar aponeurosis
© Flexor Digitorum Brevis Origin – medial and lateral process of calcaneal tuberosity; plantar aponeurosis
© Flexor Digitorum Brevis Origin – medial and lateral process of calcaneal tuberosity; plantar aponeurosis
© Flexor Digitorum Brevis Origin – medial and lateral process of calcaneal tuberosity; plantar aponeurosis

©

Flexor Digitorum Brevis

© Flexor Digitorum Brevis Origin – medial and lateral process of calcaneal tuberosity; plantar aponeurosis Insertion

Origin

medial and lateral process of calcaneal tuberosity; plantar aponeurosis

Insertion

both sides of the bases of the middle phalanx of rays 2-5 with each of the 4 tendons splitting to form tunnel for FDL

Action

flexes toes 2-5

Blood Supply

medial plantar artery

Innervation

medial plantar nerve, L5,S1

plantar artery Innervation – medial plantar nerve, L5,S1 Originates from the medial and late ral process

Originates from the medial and lateral process of calcaneal tuberosity and plantar fascia

Insertion is from both sides of the bases of the middle phalanx of rays 2-5 with each of the 4 tendons splitting to form tunnel for FDL

Action – flexes the less four toes

Blood Supply is from medial plantar artery

Innervated by the medial plantar nerve, L5,S1

Origin is the site of calcaneal spurs typically associated with plantar fascitis

© Abductor Digiti Minimi Origin – lateral & medial processes of the calcaneal tuberosity and
© Abductor Digiti Minimi Origin – lateral & medial processes of the calcaneal tuberosity and
© Abductor Digiti Minimi Origin – lateral & medial processes of the calcaneal tuberosity and
© Abductor Digiti Minimi Origin – lateral & medial processes of the calcaneal tuberosity and

©

Abductor Digiti Minimi

© Abductor Digiti Minimi Origin – lateral & medial processes of the calcaneal tuberosity and plantar

Origin

lateral & medial processes of the calcaneal tuberosity and plantar aponeurosis

Insertion

lateral aspect of base of proximal phalanx of 5th ray

Action

abducts and assist in flexing the 5th toe

Blood Supply

lateral plantar artery

Innervation

lateral plantar nerve, S1,2

plantar artery Innervation – lateral plantar nerve, S1,2 Most lateral of the three musc les in

Most lateral of the three muscles in the superficial layer

Intrinsics Muscles of the Foot Second Layer – FHL – FDL – Quadratus Plantae –
Intrinsics Muscles of the Foot Second Layer – FHL – FDL – Quadratus Plantae –
Intrinsics Muscles of the Foot Second Layer – FHL – FDL – Quadratus Plantae –

Intrinsics Muscles of the Foot

Intrinsics Muscles of the Foot Second Layer – FHL – FDL – Quadratus Plantae – Lumbricales

Second Layer

FHL

FDL

Quadratus Plantae

Lumbricales

– FHL – FDL – Quadratus Plantae – Lumbricales © Both intrinisc muscles (quadratus plantae and
– FHL – FDL – Quadratus Plantae – Lumbricales © Both intrinisc muscles (quadratus plantae and

©

Both intrinisc muscles (quadratus plantae and the lumbricales) are functionally related to the FDL

FHL - FDL Flexor Hallicus Longus Flexor Digitorum Longus © From posterior deep compartment
FHL - FDL Flexor Hallicus Longus Flexor Digitorum Longus © From posterior deep compartment
FHL - FDL Flexor Hallicus Longus Flexor Digitorum Longus © From posterior deep compartment

FHL - FDL

FHL - FDL Flexor Hallicus Longus Flexor Digitorum Longus © From posterior deep compartment

Flexor Hallicus Longus Flexor Digitorum Longus

FHL - FDL Flexor Hallicus Longus Flexor Digitorum Longus © From posterior deep compartment

©

From posterior deep compartment

Quadratus Plantae Origin – medial head: medial calcaneus – lateral head: lateral calcaneus & long
Quadratus Plantae Origin – medial head: medial calcaneus – lateral head: lateral calcaneus & long
Quadratus Plantae Origin – medial head: medial calcaneus – lateral head: lateral calcaneus & long

Quadratus Plantae

Quadratus Plantae Origin – medial head: medial calcaneus – lateral head: lateral calcaneus & long plantar
Origin – medial head: medial calcaneus – lateral head: lateral calcaneus & long plantar ligament
Origin
– medial head: medial calcaneus
– lateral head: lateral calcaneus & long plantar
ligament
Insertion
lateral margin of tendon of FDL and may send
slips into the distal tendons
Action
assists FDL in flexing the distal phalanges of toes
2-5; corrects FDL from pulling toes medially
Blood Supply
lateral plantar artery
Innervation

lateral plantar nerve, S1,2

plantar artery Innervation – lateral plantar nerve, S1,2 © The action or line of pull corrects

©

The action or line of pull corrects the natural medial vector that the FDL would create if acting alone

Lumbricales Origin   – from tendons of FDL:   1st: medial aspect of tendon to
Lumbricales Origin   – from tendons of FDL:   1st: medial aspect of tendon to
Lumbricales Origin   – from tendons of FDL:   1st: medial aspect of tendon to

Lumbricales

Lumbricales Origin   – from tendons of FDL:   1st: medial aspect of tendon to 2nd

Origin

 

from tendons of FDL:

 

1st: medial aspect of tendon to 2nd ray

2nd-4th: two heads between the tendons in which they lie

Insertion

extensor tendons of EDL on dorsal foot

Action

 

flex proximal phalanges at 2-5 MTP; extend middle & distal 2-5 phalanges at IP

Blood Supply

1st: medial plantar artery; 2nd-4th: lateral plantar artery

Innervation

1st: medial plantar nerve, L5,S1; 2nd-4th: lateral plantar nerve, S1,2

medial plantar nerve, L5,S1; 2nd-4th: lateral plantar nerve, S1,2 © Lumbricale flex the MTPs and extend
medial plantar nerve, L5,S1; 2nd-4th: lateral plantar nerve, S1,2 © Lumbricale flex the MTPs and extend

©

Lumbricale flex the MTPs and extend the PIP and DIPs

Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi
Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi
Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi

Intrinsics Muscles of the Foot

Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi Brevis

Third Layer

Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi Brevis

Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi Brevis
Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi Brevis
Intrinsics Muscles of the Foot Third Layer Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi Brevis

©

Flexor Hallicus Brevis Origin – plantar aspect of the cuboid and lateral cuneiform Insertion –
Flexor Hallicus Brevis Origin – plantar aspect of the cuboid and lateral cuneiform Insertion –
Flexor Hallicus Brevis Origin – plantar aspect of the cuboid and lateral cuneiform Insertion –

Flexor Hallicus Brevis

Flexor Hallicus Brevis Origin – plantar aspect of the cuboid and lateral cuneiform Insertion – medial

Origin

plantar aspect of the cuboid and lateral cuneiform

Insertion

medial and lateral aspect of base of proximal phalanx of hallux

Action

flexes hallux at MTP

Blood Supply

medial plantar artery

Innervation

medial plantar nerve, L5,S1

plantar artery Innervation – medial plantar nerve, L5,S1 © Insertion is on both sides of the
plantar artery Innervation – medial plantar nerve, L5,S1 © Insertion is on both sides of the
plantar artery Innervation – medial plantar nerve, L5,S1 © Insertion is on both sides of the

©

Insertion is on both sides of the base of the 1 st proximal phalanx

Adductor Hallicus Origin – oblique head: base of 2nd-4th metatarsals & long plantar ligament –
Adductor Hallicus Origin – oblique head: base of 2nd-4th metatarsals & long plantar ligament –
Adductor Hallicus Origin – oblique head: base of 2nd-4th metatarsals & long plantar ligament –

Adductor Hallicus

Adductor Hallicus Origin – oblique head: base of 2nd-4th metatarsals & long plantar ligament – transverse

Origin

oblique head: base of 2nd-4th metatarsals & long plantar ligament

transverse head: deep transverse metatarsal ligament & plantar ligaments at MTP joints

Insertion

lateral aspect of base of proximal phalanx of hallux

Action

adduction and flexion of hallux at MTP

Blood Supply

lateral plantar artery

Innervation

lateral plantar nerve, S1,2

plantar artery Innervation – lateral plantar nerve, S1,2 © Often become contracted with hallux valugus and
plantar artery Innervation – lateral plantar nerve, S1,2 © Often become contracted with hallux valugus and
plantar artery Innervation – lateral plantar nerve, S1,2 © Often become contracted with hallux valugus and

©

Often become contracted with hallux valugus and is released as a part of soft tissue realingment procedures with bunions

Flexor Digiti Minimi Brevis Origin – base of 5th metatarsal – digital sheath of peroneus
Flexor Digiti Minimi Brevis Origin – base of 5th metatarsal – digital sheath of peroneus
Flexor Digiti Minimi Brevis Origin – base of 5th metatarsal – digital sheath of peroneus

Flexor Digiti Minimi Brevis

Flexor Digiti Minimi Brevis Origin – base of 5th metatarsal – digital sheath of peroneus longus

Origin

base of 5th metatarsal

digital sheath of peroneus longus

Insertion

lateral aspect of base of 5 th proximal phalanx

Action

flexes the 5th toe at MTP

Blood Supply

lateral plantar artery

Innervation

lateral plantar nerve, S1,2

– flexes the 5th toe at MTP Blood Supply – lateral plantar artery Innervation – lateral
– flexes the 5th toe at MTP Blood Supply – lateral plantar artery Innervation – lateral
– flexes the 5th toe at MTP Blood Supply – lateral plantar artery Innervation – lateral

©

Intrinsics Muscles of the Foot Deepest Fourth Layer Plantar Interossei Dorsal Interossei © Deepest fourth
Intrinsics Muscles of the Foot Deepest Fourth Layer Plantar Interossei Dorsal Interossei © Deepest fourth
Intrinsics Muscles of the Foot Deepest Fourth Layer Plantar Interossei Dorsal Interossei © Deepest fourth

Intrinsics Muscles of the Foot

Intrinsics Muscles of the Foot Deepest Fourth Layer Plantar Interossei Dorsal Interossei © Deepest fourth layer
Deepest Fourth Layer Plantar Interossei Dorsal Interossei
Deepest Fourth Layer
Plantar Interossei
Dorsal Interossei

©

Deepest fourth layer contains the plantar and dorsal interossei

Similar function as in hand except the reference digit is the 2 nd digit instead of the 3 rd in the hand

Plantar Interossei – 3 muscles Origin – medial aspect of 3rd-5th metatarsals (each muscle has
Plantar Interossei – 3 muscles Origin – medial aspect of 3rd-5th metatarsals (each muscle has
Plantar Interossei – 3 muscles Origin – medial aspect of 3rd-5th metatarsals (each muscle has

Plantar Interossei – 3 muscles

Plantar Interossei – 3 muscles Origin – medial aspect of 3rd-5th metatarsals (each muscle has a

Origin

medial aspect of 3rd-5th metatarsals (each muscle has a single head)

Insertion

medial aspect of base of proximal phalanx of the same ray (3rd-5th rays)

Action

adduct toes 3-5 and flex toes 3-5 at MTP

Blood Supply

lateral plantar artery

Innervation

lateral plantar nerve (deep branch), S1,2

toes 3-5 at MTP Blood Supply – lateral plantar artery Innervation – lateral plantar nerve (deep
toes 3-5 at MTP Blood Supply – lateral plantar artery Innervation – lateral plantar nerve (deep

©

Dorsal Interossei – 4 muscles Origin – from both metatarsals between which they lie Insertion
Dorsal Interossei – 4 muscles Origin – from both metatarsals between which they lie Insertion
Dorsal Interossei – 4 muscles Origin – from both metatarsals between which they lie Insertion

Dorsal Interossei – 4 muscles

Dorsal Interossei – 4 muscles Origin – from both metatarsals between which they lie Insertion –

Origin

from both metatarsals between which they lie

Insertion

base of proximal phalanx closest to the axis of the foot (2nd ray)

Action

abduct toes 2-4

flexes toes 2-4 at MTP

Blood Supply

lateral plantar artery

Innervation

lateral plantar nerve (deep branch), S1,2

toes 2-4 at MTP Blood Supply – lateral plantar artery Innervation – lateral plantar nerve (deep
toes 2-4 at MTP Blood Supply – lateral plantar artery Innervation – lateral plantar nerve (deep

©

Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei
Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei
Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei

Interossei Function Pneumonic

Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei AB

PAD

Plantar Interossei ADduct

DAB

Dorsal Interossei ABduct

Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei AB
Interossei Function Pneumonic PAD – P lantar Interossei AD duct DAB – D orsal Interossei AB

©

Extensor Hallicus Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion – base
Extensor Hallicus Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion – base
Extensor Hallicus Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion – base

Extensor Hallicus Brevis

Extensor Hallicus Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion – base

Origin

upper anterolateral calcaneus and inferior extensor retinaculum

Insertion

base of proximal phalanx of hallux

Action

extends hallux

Blood Supply

dorsalis pedis artery

Innervation

deep peroneal nerve, L4,5

pedis artery Innervation – deep peroneal nerve, L4,5 © Some consider this muscle to anatom ically
pedis artery Innervation – deep peroneal nerve, L4,5 © Some consider this muscle to anatom ically

©

Some consider this muscle to anatomically be a part of the Extensor Digitorum brevis

Extensor Digitorum Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion –
Extensor Digitorum Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion –
Extensor Digitorum Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion –

Extensor Digitorum Brevis

Extensor Digitorum Brevis Origin – upper anterolateral calcaneus and inferior extensor retinaculum Insertion –

Origin

upper anterolateral calcaneus and inferior extensor retinaculum

Insertion

middle & distal phalanges of 2nd-4th rays (via EDL)

Action

extends 2nd-4th rays

Blood Supply

dorsalis pedis artery

Innervation

deep peroneal nerve, L4,5

Supply – dorsalis pedis artery Innervation – deep peroneal nerve, L4,5 © Same origin as extensor
Supply – dorsalis pedis artery Innervation – deep peroneal nerve, L4,5 © Same origin as extensor

©

Same origin as extensor hallicus brevis

Muscle Action in Gait ©
Muscle Action in Gait ©
Muscle Action in Gait ©

Muscle Action in Gait

Muscle Action in Gait ©
Muscle Action in Gait ©
Muscle Action in Gait ©

©

muscular function in gait © Contrast the open kinetic chain musc ular function as dictated
muscular function in gait © Contrast the open kinetic chain musc ular function as dictated
muscular function in gait © Contrast the open kinetic chain musc ular function as dictated

muscular function in gait

muscular function in gait © Contrast the open kinetic chain musc ular function as dictated by
muscular function in gait © Contrast the open kinetic chain musc ular function as dictated by
muscular function in gait © Contrast the open kinetic chain musc ular function as dictated by

©

Contrast the open kinetic chain muscular function as dictated by the tendon’s location relative to axes with their functional responsibilities in gait

© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase
© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase
© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase
© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase
© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase
© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase

©

Muscular Function in Gait

Anterior Group

© Muscular Function in Gait Anterior Group Tibialis Anterior: – concentric function in swing phase and

Tibialis Anterior:

concentric function in swing phase and eccentric function in stance

assist in ground clearance, controls forefoot loading and midstance pronation

Long Extensors:

hold the oblique axis of the MTJ in a pronated position at heel strike and assist controlled deceleration of forefoot loading and midstance pronation

Long Extensors = EHL and EDL

© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at
© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at
© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at
© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at
© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at
© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at

©

Muscular Function in Gait

Posterior Deep Group

© Muscular Function in Gait Posterior Deep Group Posterior Tibialis: – controls STJ pronation at heel

Posterior Tibialis:

controls STJ pronation at heel strike and reverses it through midstance

maintains stability of the MTJ in the direction of supination around the oblique axis during stance phase

Flexor Digitorum Longus:

stabilizes the foot as a weight bearing platform for propulsion.

Works antagonistically with the intrinsics.

supports the medial arch

Flexor Hallicus Longus:

functions in concert with the other posterior deep muscles, specifically stabilizing the 1st ray during propulsion and supporting the medial arch.

© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of
© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of
© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of
© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of
© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of
© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of

©

Muscular Function in Gait

Posterior Superficial Group

© Muscular Function in Gait Posterior Superficial Group Gastroc-Soleus: active throughout the stance phase of gait

Gastroc-Soleus: