LOWER LEG, ANKLE, &

FOOT
Gross Anatomy
Bones
• Tibia
• Fibula
• Tarsals
• Metatarsals
• Phalanges
Tibia
• Osseous features
• Medial and Lateral Tibial Plateaus
• Intercondylar eminence
• Anterior and Posterior condylar fossa
• Tibial tuberosity
Tibia
• Osseous features
• Tibial tuberosity
• Tibial crest
• Soleal line
Fibula
• Osseous features
• Upper end
• Head
• Neck
• Styloid process
• Shaft
• Lower end
• Lateral malleolus
Tarsals
• Tall = Talus
• Centers = Calcaneus
• Never = Navicular
• Take = Third (Lateral) Cuneiform
• Shots = Second (Intermediate) Cuneiform
• From = First (Medial) Cuneiform
• Corners = Cuboid
Talus
• Osseous Features
• Head
• Neck
• Sulcus tali
• Body
• Articular Facets
• Tubercles
Calcaneous
• Osseous Features
• Anterior Surface
• Posterior Surface
• Superior Surface
• Facets for Talus
• Sulcus Calcanei
• Inferior Surface
• Anterior Tubercle
• Medial Tubercle
• Lateral Tubercle
Calcaneous
• Osseous Features
• Medial Surface
• Sustentaculum tali
• Lateral Surface
• Peroneal tubercle
Navicular
• Osseous Features
• Navicular tuberosity
Third (Lateral), Second (Intermediate),
First (Medial) Cuneiform
• Maintains the Transverse arc of the foot

3rd
2nd
1st
Cuboid
• Osseous Features
• Cuboidal groove
Metatarsals (5)
• All Metatarsals have:
• Head
• Shaft
• Base 5
5 4
4 3 3
• First metatarsal 2
1
• Fifth metatarsal
• Tubercle
Phalanges (Proximal, Middle, & Distal)
• All metatarsals have 3 phalanges
• The 1st metatarsal have 2 phalanges
• All phalanges have:
• Head
• Shaft
• Base
RETINACULA OF THE
ANKLE
Extensor Retinaculum
• There is a superior extensor retinaculum &
Inferior superior retinaculum
• The superior extensor retinaculum is attached to
the distal ends of the anterior borders of the
fibula and the tibia
• The inferior extensor retinaculum is a Y-shaped
band located in front of the ankle joint. Fibrous
bands separate the tendons into compartments
each of which is lined by a synovial sheath.
Extensor retinaculum
• Contents in front of the retinaculum from Medial to lateral:
• Saphenous nerve and great saphenous vein (in front of the medial malleolus) →
Superficial peroneal nerve (medial and lateral branches)

• Contents in beneath the retinaculum from Medial to lateral:

• Tibialis anterior tendon → Extensor hallucis longus tendon → Anterior tibial artery with
venae comitantes → Deep peroneal nerve → Extensor digitorum longus tendons →
Peroneus tertius.

• Structures That Pass in Front of the Medial Malleolus

• Great saphenous vein
• Saphenous nerve
Flexor Retinaculum
• Flexor retinaculum extends from
the medial malleolus downward
and backward to be attached to
the medial surface of the
calcaneum
Flexor Retinaculum
• Structures That Pass behind the Medial
Malleolus beneath the Flexor
Retinaculum From medial to lateral:
• Tibialis posterior tendon → Flexor
digitorum longus → Posterior tibial artery
with venae comitantes → Tibial nerve →
Flexor hallucis longus
Superior Peroneal Retinaculum
• Connects the lateral malleolus to the
lateral surface of the calcaneum
• Binds the tendons of the peroneus
longus and brevis to the back of the
lateral malleolus
Superior Peroneal Retinaculum
• Structures that pass behind the
lateral malleolus superficial to the
superior peroneal retinaculum:
• The sural nerve
• Small saphenous vein

• Structures That Pass behind the

Lateral Malleolus beneath the
Superior Peroneal Retinaculum
• Peroneus longus tendons
• Peroneus brevis tendons
Plantar Aponeurosis

• Triangular thickening of the deep fascia that

protects the underlying nerves, blood
vessels, and muscles
• Attachments: medial and lateral tubercles
of the calcaneum ↔ divides into five slips
that pass into the toes.
JOINTS & LIGAMENTS
Proximal Tibiofibular joints
• Articulation: lateral condyle of the
tibia ↔ the head of the fibula
• Type: Synovial plane joint
• Passive stabilizers:
• Anterior and Posterior ligaments
• Interosseous membrane
Distal Tibiofibular joints
• Articulation: fibular notch of the tibia ↔
the lower end of the fibula
• Type: Syndesmosis
• Passive stabilizers:
• Anterior and Posterior ligaments
• Interosseous membrane
• Inferior transverse ligament
Talocrural Joint
• Articulation: the lower end of the tibia,
the two malleoli, ↔ the body of the
talus
• Type: Synovial hinge joint
Talocrural Joint
• Passive Stabilizers:
• Medial (Deltoid) Ligament
• Anterior & Posterior Talotibial ligament
• Calcaneotibial ligament
• Tibionavicular ligament
• Function:
• Stabilizes during eversion to protect
against valgus stresses to the
talocrural, subtalar, and talonavicular
joints.
Talocrural Joint
• Passive Stabilizers:
• Lateral collateral ligament
• Anterior Talofibular ligament
• Function: Restricts combined motion of
plantarflexion with inversion or
adduction
• Posterior Talofibular ligament
• Function: Provides stability to the talus
within the joint and restrict abduction
during dorsiflexion.
• Calcaneofibular ligament
• Function: Restricts inversion or varus
stress of the talocrural and subtalar
joints.
Talocrural Joint
• Movements
• Plantarflexion - Dorsiflexion
Subtalar joint
• Articulation: inferior surface of the body
of the talus ↔ the facet on the middle
of the upper surface of the calcaneum
• Type: Synovial plane joint
Subtalar joint
• Passive Stabilizers
• Medial Collateral (Deltoid) Ligament
• Lateral Collateral Ligament
Subtalar joint
• Passive Stabilizers
• Lateral, posterior, and medial
talocalcaneal ligament
• Function: Assists in providing
some support to the subtalar
joint.
• Interosseous (talocalcaneal)
ligament
• Function: Restricts end-range
eversion motion
Subtalar joint
• Passive Stabilizers
• Cervical ligament
• Function: Restricts end-range
inversion motion
Transverse tarsal: Talocalcaneonavicular joint

• Articulations: head of the talus, the

upper surface of the Sustentaculum
tali, and the posterior surface of the
navicular bone
• Type: Synovial joint
Transverse tarsal: Talocalcaneonavicular joint

• Passive Stabilizers
• Talonavicular ligament
• Function: Restricts movement of
talus on navicular. Allows
rotation.
• Plantar Calcaneonavicular
ligament (aka Spring ligament)
• Function: Maintains the Medial
Longitudinal arch, especially during
weight-bearing
• Lateral Calcaneonavicular
ligament
• Function: Maintains the Medial
Longitudinal arch, especially during
weight-bearing
Transverse Tarsal: Calcaneocuboid joint

• Articulations: anterior end of the

calcaneum ↔ the posterior surface of
the cuboid
• Type: Synovial plane joint
Transverse Tarsal: Calcaneocuboid joint

• Passive Stabilizers:
• Bifurcated ligament
• Function: Supports Transverse tarsal joint.
Permits Rotation (inversion/eversion of
foot)
Transverse Tarsal: Calcaneocuboid joint

• Passive Stabilizers:
• Long Plantar Ligament
• Function: Limits depression of
the lateral Longitudinal arch.
Transverse Tarsal: Calcaneocuboid joint

• Passive Stabilizers:
• Short plantar Ligament
(Plantar calcaneocuboid
ligament)
• Function: Maintains the Lateral
Longitudinal arch.
Transverse Tarsal: Calcaneocuboid joint
• Passive Stabilizers:
• Dorsal ligaments
• Function: Protect and support
the tarsometatarsal joints.
Permit gliding between tarsals
and metatarsals.
Subtalar & Transverse Tarsal joints
• Motions
• Inversion - Eversion
Tarsometatarsal joints
• Type: Synovial plane joint
• Passive Stabilizers:
• Plantar ligaments
• Function: Protect and support
the tarsometatarsal joints.
Permit gliding between tarsals
and metatarsals
Tarsometatarsal joints
• Passive Stabilizers:
• Interosseous Cuneometatarsal
ligaments
• Function: Protect and support
the Tarsometatarsal joints.
Permit gliding between tarsals
and metatarsals
Intermetatarsal joint
• Type: Synovial plane joint
• Passive Stabilizers:
• Dorsal, plantar, and Interosseous
ligaments
• Function: Protect and support the
Intermetatarsal joints. Permit slight
gliding between the metatarsals.
Metatarsophalangeal joints
• Type: Synovial condyloid joints
• Movements:
• Abduction-Adduction
• Flexion-Extension
Metatarsophalangeal joints
• Passive Stabilizers
• Collateral ligaments
• Function: Support capsule
and restrict lateral motion of
the respective joint. Allow
flexion and extension.
Metatarsophalangeal joints
• Passive Stabilizers
• Plantar ligaments
• Function: Assist Collateral
ligaments with which they
blend.
Metatarsophalangeal joints
• Passive Stabilizers
• Plantar ligaments
• Function: Assist Collateral
ligaments with which they
blend.
Metatarsophalangeal joints
• Passive Stabilizers
• Deep Transverse metatarsal
ligament
• Function: Supports the joint
capsule and MTP joint.
Interphalangeal joints
• Type: Synovial hinge joint
• Motions:
• Flexion-Extension
Interphalangeal joints
• Passive Stabilizers
• Collateral ligaments
• Function: Support capsule
and restrict lateral motion of
the respective joint. Allow
flexion and extension.
Interphalangeal joints
• Passive Stabilizers
• Plantar ligaments
• Function: Assist Collateral
ligaments with which they
blend.
MUSCLES
 ANTERIOR
COMPARTMENT OF THE
LOWER LEG
Tibialis anterior
• Origin: Lateral surface of shaft of tibia and
Interosseous membrane
• Insertion: Medial cuneiform and base of 1st
metatarsal bone
• Action: Extends foot at ankle joint; inverts
foot at subtalar and transverse tarsal joints;
holds up medial longitudinal arch of foot
• Innervation: Deep peroneal nerve
Extensor digitorum longus
• Origin: Anterior surface of shaft of
fibula
• Insertion: Extensor expansion of
lateral four toes
• Action: Extends toes; extends foot
at ankle joint
• Innervation: Deep peroneal nerve
Peroneus tertius
• Origin: Anterior surface of shaft of
fibula
• Insertion: Base of 5th metatarsal
bone
• Action: Extends foot at ankle
joint; everts foot at subtalar and
transverse tarsal joints
• Innervation: Deep peroneal nerve
Extensor hallucis longus
• Origin: Anterior surface of shaft of fibula
• Insertion: Base of distal phalanx of great
toe
• Action: Extends big toe; extends foot at
ankle joint; inverts foot at subtalar and
transverse tarsal joints
• Innervation: Deep peroneal nerve
Extensor digitorum brevis
• Origin: Calcaneum
• Insertion: By four tendons into the
proximal phalanx of big toe and
long extensor tendons to second,
third, and fourth toes
• Action: Extends toes
• Innervation: Deep peroneal nerve
 LATERAL
COMPARTMENT OF THE
LEG
Peroneus longus
• Origin: Lateral surface of shaft of
fibula
• Insertion: Base of 1st Metatarsal and
the medial cuneiform
• Action: Plantar flexes foot at ankle
joint; everts foot at subtalar and
transverse tarsal joints; supports
lateral longitudinal and transverse
arches of foot
• Innervation: Superficial peroneal
nerve
Peroneus brevis
• Origin: Lateral surface of shaft of
fibula
• Insertion: Base of 5th metatarsal
bone
• Action: Plantar flexes foot at ankle
joint; everts foot at subtalar and
transverse tarsal joint; supports
lateral longitudinal arch of foot
• Innervation: Superficial peroneal
nerve
 POSTERIOR
COMPARTMENT OF THE
LEG
Gastrocnemius
• Origin: Lateral head from lateral condyle of
femur and medial head from above medial
condyle
• Insertion: Via tendo calcaneus into posterior
surface of calcaneum
• Action: Plantar flexes foot at ankle joint;
flexes knee joint
• Innervation: Tibial nerve
Soleus
• Origin: Shafts of tibia and fibula
• Insertion: Via tendo calcaneus into
posterior surface of calcaneum
• Action: Together with gastrocnemius
and plantaris is powerful plantar flexor
of ankle joint; provides main propulsive
force in walking and running
• Innervation: Tibial nerve
Plantaris
• Origin: Lateral Supracondylar ridge of
femur
• Insertion: Posterior surface of calcaneum
• Action: Plantar flexes foot at ankle joint;
flexes knee joint
• Innervation: Tibial nerve
Popliteus
• Origin: Lateral surface of lateral
condyle of femur
• Insertion: Posterior surface of shaft
of tibia above soleal line
• Action: Flexes leg at knee joint;
unlocks knee joint by lateral
rotation of femur on tibia and
slackens ligaments of joint
• Innervation: Tibial nerve
Flexor digitorum longus
• Origin: Posterior surface of shaft of tibia
• Insertion:Bases of distal phalanges of
lateral four toes
• Action: Flexes distal phalanges of lateral
four toes; plantar flexes foot at ankle
joint; supports medial and lateral
longitudinal arches of foot
• Innervation: Tibial nerve
Flexor hallucis longus
• Origin: Posterior surface of shaft of
fibula
• Insertion: Base of distal phalanx of big
toe
• Action: Flexes distal phalanx of big toe;
plantar flexes foot at ankle joint;
supports medial longitudinal arch of foot
• Innervation: Tibial nerve
Tibialis posterior
• Origin: Posterior surface of shafts of
tibia and fibula, and Interosseous
membrane
• Insertion: Tuberosity of navicular bone
and other Neighboring bones
• Action: Plantar flexes foot at ankle
joint; inverts foot at subtalar and
transverse tarsal joints; supports
medial longitudinal arch of foot
• Innervation: Tibial nerve
MUSCLES OF THE FOOT
First layer of the foot
• The following muscles are a part of the first
layer of the foot:
• Abductor hallucis
• Flexor digitorum brevis
• Abductor digiti minimi
Second layer of the foot
• The following muscles are a part of the
second layer of the foot:
• Quadratus plantae
• Lumbricals (4)
• Flexor digitorum longus tendon
• Flexor hallucis longus tendon
Third layer of the foot
• The following muscles are a part
of the third layer of the foot:
• Flexor hallucis brevis
• Adductor hallucis
• Flexor digiti minimi brevis
Fourth layer of the foot
• The following muscles are a part of the
fourth layer of the foot:
• Dorsal Interossei (4)
• Plantar Interossei (3)
• Peroneus longus tendon
• Tibialis posterior tendon
ARCHES OF THE FOOT
Arches of the foot
• Medial Longitudinal Arch
• Lateral Longitudinal Arch
• Transverse Arch
Medial Longitudinal Arch
• Consists of the calcaneum, the talus, the navicular bone, the three cuneiform
bones, and the first three metatarsal bones
• Support systems
• Keystone: Round Head of Talus
• Staples: Plantar Ligaments, Plantar Calcaneonavicular Ligament, Tendinous Extensions
of the Insertion of the Tibialis Posterior
• Tie Beam: Plantar Aponeurosis, Medial aspect of the Flexor Digitorum Longus + Brevis,
Flexor Hallucis Longus + Brevis, Abductor Hallucis
• Suspension bridge: Tibialis Anterior, Tibialis Posterior
Lateral Longitudinal Arch
• Consists of the calcaneum, the cuboid, and the 4th and 5th metatarsal bones
• Support systems
• Keystone: Cuboid
• Staples: Long and Short Plantar Ligaments, Origins of the Short Muscles
• Tie Beam: Plantar Aponeurosis, Lateral aspect of the Flexor Digitorum + Brevis,
Abductor Digiti Minimi
• Suspension bridge: Peroneus Longus, Peroneus Brevis
Transverse Arch
• Consists of the bases of the metatarsal bones and the cuboid and the three
cuneiform
• Support systems
• Keystone: middle cuneiform and 2nd metatarsal
• Staples: deep transverse ligaments, plantar ligaments, origins of the plantar muscles
from the forefoot (e.g. flexor hallucis brevis) the dorsal interossei and transverse head of
the adductor hallucis
• Tie Beam: Peroneus Longus
• Suspension bridge: Peroneus Longus, Peroneus Brevis