Muscles

of the Foot

First & second layers of

muscles of the sole

INTRODUCTION
The muscles acting on the foot can be divided
into two distinct groups; extrinsic and
intrinsic muscles.

The extrinsic muscles

arise fromthe anterior,
posterior and lateral
compartments of the
leg. They are mainly
responsible for actions
such as eversion,
inversion,
plantarflexionand
dorsiflexion of the foot.

The intrinsic muscles are located within the

foot and are responsible for the more fine
motor actions of the foot, for example
movement of individual digits.

FIRST LAYER

Abductor Hallucis :
-Origin: Originates from
the medial tubercle of the
calcaneus,
-Insertion: It attaches to
the medial base of the
proximal phalanx of the
great toe.
-Actions: Abducts the
great toe.
-Innervation: Medial

FIRST LAYER

Abductor Digiti Minimi :

-Origin: Originates from the

medial and lateral tubercles of

the calcaneus.

-Insertion: It attaches to the

lateral base of the proximal
phalanx of the 5th digit (little
toe).
-Actions: Abducts the 5th digit.
-Innervation: Lateral plantar
nerve.

FIRST LAYER

Flexor Digitorum
Brevis :
-Origin: Originates from the
medial tubercle of the
calcaneus.
-Insertion: It attaches to
the middle phalanges of the
lateral four digits. It is
perforated by the tendons of
flexor digitorum longus.
-Actions: Flexes thelateral

medial and lateral plantar

surface of the calcaneus.

SECOND LAYER

-Insertion: It attaches to the

tendons of flexor digitorum
longus.
-Actions: Assists flexor
digitorum longus by bringing
the tendon more in line with
toes, thus helps in flexing of the
interphalangeal and
metatarsophalangeal joints of
the lateral four digits.
-Innervation: Lateral plantar
nerve.

Lumbricals :

SECOND LAYER

-Origin: Originates from the tendons

of flexor digitorum longus.
-Insertion: Attaches partly to the
extensor expansion and partly into the
base of proximal phalanx of the lateral
four digits.
-Actions: Flexes at the
metatarsophalangeal joints, while
extending the interphalangeal joints of
the lateral four toes.
-Innervation: The most medial
lumbricalis innervated by the medial
plantar nerve. The remaining three are
innervated by the deep division of
lateral plantar nerve.

SECOND LAYER

Tendon of flexor
digitorum longus :
The tendon splits into four
tendons for the lateral four toes.
The tendon receives the insertion
of the flexor digitorum
accessorius and its slips give
origin to the lumbrical muscles.
Each slip perforate the tendons
of the flexor digitorum brevis to
reach its insertion into the
terminal phalanx.

SECOND LAYER

Tendon of Flexor
hallucis longus :
This tendon passes
forward and medially
and crosses deep to the
tendon of the flexor
digitorum longus to be
inserted into the base of
the terminal phalanx of
the big toe.

THIRD LAYER

1- Flexor hallucis brevis.

2-adductor hallucis.
3-flexor digiti minimi brevis.

Flexor hallucis brevis

*origin: Cuboid and lateral cuniform.

*Insertion: Base of proximal phalanx of
the big toe.

*Nerve supply: medial plantar nerve.

*Action: Flexion.

Flexor digiti minimi brevis

*Origin: Base of 5 metatarsal and cuboid bone.

*Insertion: Base of proximal phalanx of the little
toe.

*Nerve supply: Superficial division of lateral

plantar nerve.

*Action: Flexion.

Adductor hallucis

*Origin:
a- Transverse Head: Plantar ligaments of
metatarso phalangeal joint of lateral four toes.

b- Oblique head: Base of 2 3 4 metatarsal bone.

*Insertion: Lateral side of the base of proximal
phalanx of the big toe.

*Nerve supply: Deep division of lateral

plantar nerve.

*Action:
a- Transverse Head: Maintain the transverse arch
of the foot.

b- Oblique Head: Adduction and Flexion

FOURTH LAYER
1- tendon of peroneus longus.
2-tendon of tibialis posterior.
3- plantar interossei muscle.
4- dorsal interossi muscle.

Tendon of peroneus longus

it runs in a groove on the plantar surface of the
cuboid bone.
it is inserted into the base of 1 metatarsal bone
and the adjoining part of the medial cuneiform
bone.

Tendon of tibialis posterior

It divides into medial and lateral part.
The medial part is inserted into the tuberosity of
navicular bone and medial cuneiform bone.
The lateral part is inserted into the other
metatarsal bone except the talus and to the
bases of 2 3 4 metatarsal bones.

Plantar interossei (pad)

Origin: Lateral 3 metatarsal bones.

Insertion: The base of proximal phalanx and extensor expansion.

Action: They adduct the lateral toes.
they extend the interphalangeal joint and flex the metatarsophalangeal joint.

Nerve Supply: the first and second muscles are supplied by

deep division of lateral plantar nerve. The third muscle is
supplied by the superficial division of lateral plantar nerve.

Dorsal interossei (dab)

Origin: Adjoining sides of two metatarsal bones.
Insertion: Base of proximal phalanx and extensor expansion.
Action: They abduct the 2 3 4 toes.
They extend the interphalangeal joint and flex the metatarsophalangeal joint.

Nerve Supply:The first three muscle are supplied by deep

division of lateral plantar nerve. The fourth muscle is supplied by
superficial division of lateral plantar nerve.

Plantar aponeurosis

Plantar aponeurosis

It is a dense sheet of fibrous tissue.

Posteriorly, it is attached to medial and lateral

tubercles of the calcaneus.
Anteriorly, it divides into five slips.
Two intermuscular septa pass from the edges of
the aponeurosis.

 The lumbrical muscles, plantar digital arteries and

nerve can be seen between the slips of the
plantar aponeurosis.
It protects the underlying vessels and nerves.
It maintains the longitudinal arch.

t
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the
bones of
the foot

tarsus

metatars
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phalange
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The muscles of the dorsum of the foot:

*Extensor digitorum
brevis:
_has 4 tendons inserted
into the medial 4 toes.
*The medial slip passes
to the proximal phalanx
of the big toe and known
as (Extensor hallucis
brevis)
*The lateral 3 slips join
the extensor expansions
of the corresponding
toes.

Dorsal interossei:
_inerted
*partly into the base of the proximal phalanx.
*partly into the extensor expansion.

_ The action:
*Abduction of the 2nd, 3rd and 4th toes.
*Extension of the interphalangeal joints
*Flexion of the metatarso-phalangeal joints.

_Anterior compartments
of the leg:
*Tendon of Tibialis
anterior.
*Tendon of Extensor
hallucis longus.
*tendon of Extensor
digitorum longus.
*Tendon of Peroneus
tertius.

Nerve supply
muscular
Cutaneous:

articular

Cutaneo
us

*muscular:
_lateral terminal branch of the
anterior tibial nerve supplies the
extensor digitorum brevis.
_the deep division of the lateral
plantar nerve supplies the 1st
three muscles of the dorsal
interossei.
_the superficial division of the
lateral plantar nerve supplies
the 4th muscle of the dorsal
interossei.

*articular:
_medial terminal branch of the anterior tibial
nerve gives twigs to the tarsometatarsal and
metatarso-phalangeal joints of the big toe.
_lateral terminal branch of the anterior tibial
nerve supplies the intertarsal and
tarsometatarsal joints.

Blood supply:
*veins:
Great saphenous vein: It
starts at the medial side of
the dorsal venous arch.
Small saphenous vein: it
Starts at the lateral
side
of the
dorsal venous arch
and the lateral margin of
the foot.

*Arteries

Dorsalis pedis artery

is the continuation of anterior tibial
artery in front of ankle joint.
* at the proximal part of the first
interosseous space it passes to the
sole of the foot by piercing the first
dorsal interosseous muscle.
*It ends by anastomosis with the
end of the plantar arch.
Branches:
_lateral tarsal artery
_medial tarsal arteries
_arcuate artery
_first dorsal metatarsal artery.
_first plantar metatarsal artery

The actions

dorsiflexion by the muscles of*

the anterior compartment of the
leg that inserted in the dorsum
of the foot (tibialis anterior,
extensor hallucis longus,
extensor digitorum longus and
peroneus tertius) with the
muscle of the dorsum (extensor
.digitorum brevis)

*inversion by (tibialis anterior,

flexor digitorum longus, flexor
hallucis longus and tibialis
posterior).
*eversion by (peroneus tertius)
and the muscles of the lateral
compartment of the leg

The applied anatomy

_Foot drop
It caused by the injury of the peroneal
nerve.

Pulsation of Dorsalis Pedis

artery
its pulsecan bepalpated:
_ lateral to theextensor
hallucis longustendon(or
medially to theextensor
digitorum longustendon) on
the dorsal surface of thefoot.
_ Distal to the dorsal most
prominence of thenavicular
bone.
_ It is absent, unilaterally or
bilaterally, in 23% of young
healthy individuals.

Blood vessels and nerves

of the foot

arteries

1.The medial plantar (internal plantar )

artery
Origin :
It begins deep to the flexsor retinaculum as the
smaller branch of the postirior tibial artety midway
between the medial malleolus and the medial
tubercule of calcaneus.
Course :
It is at first situated above the abductor hallocis .
then passes between the abductor hallocis and
flexor digitorum brevis.
At the base of the firstmetatrsal bone, where it is
much diminished in size, it passes along the
medial border of the first toe.

Termination:
. it ends by anastomosing with thefirst dorsal
metatarsal artery
Branches:
1.Muscular .
2. Articular : to joints of the foot.
3. Cutaneous: plantar digital arteries to the three and
half medial toes

2. Thelateral plantar
artery(external plantar artery)
Origin :
it begins as the largest branch of the
posterior tibial artery deep to the flexor
retinaculum, midway between the medial
malleolus and the medial tubercule of
calcaneus.
Course :
It passes laterally and forward to the base
of the fifth metatarsalbone. It then turns
medially to the interval between the bases
of the first and second metatarsal bones.

Termination :
It unites with the deep plantar branch of thedorsalis
pedis artery, thus completing theplantar arch.
Branches :
Muscular .
Cutaneous : to the one and half lateral toes.
Anastomosing branches with the lateral tarsal
arcuate .arteries

The plantar arch

* Theplantar archis acirculatory anastomosisformed from:
1. deep plantar artery, from thedorsalis pedis.
2. lateral plantar artery.
Branches:
Muscular.
Articular.
Posterior perforating arteries.
Plantar metatarsal arteries.
lateral plantar digital artery of the little toe.

NERVES

1. Themedial plantar
nerve(internal plantar nerve)
Origin :
it takes origin under cover of the flexor
retinaculum midway between the medial
malleoulus and the medial tubercle of calcaneus as
the larger of the two terminal branches of the
posterior tibial nerve.
Course and termination :
it passes under cover of theabductor hallucis
muscle, and, appearing between it and theflexor
digitorum brevis, gives off a proper digital plantar
nerve and finally divides opposite the bases of the
metatarsal bonesinto three common digital plantar
nerves.

Branches :
1.Cutaneous : it supplies the skin of the medial part of
the sole
2.Muscular.

2. Thelateral plantar
nerve(external plantar nerve)
Origin :
its the smaller branch of the two terminal branches of the
posterior tibial nerve.
Course and termination :
It passes obliquely forward with thelateral plantar arteryto
the lateral side of the foot, lying between theflexor
digitorum brevisandflexor digitorum accessories , in the
interval between the former muscle and theabductor digiti
minimi, divides into a superficial and a deep branch.

Branches:
A)from the trunk of the nerve :
Muscular : to the flexor accessories and abductor digiti minimi
Cutaneous: to the skin of the lateral part of the sole .
B)superficial division: this divides into two plantar digital nerves which
supply the skin of the lateral one and half toes:
1. the lateral plantar digital branch: supplies the lateral side of the
little toe . it also gives muscular twigs:
flexor digiti minimi brevis
,third plantar interosseous, fourth dorsal interosseous.
2.the medial plantar digital branch: communicates with the most
lateral of the digital branch of the medial plantar nerve; and then
divides into two branches which supply the adjoining side of the fourth
and fifth toes.
The plantar digital branch also supplies the skin of the dorsum of the
terminal phalanges of the one and half toe .

C)Deep division: this runs medially behind the plantar arch between
the third and fourth layers of muscles. It gives the following branches:
1.muscular: to adductor hallucis, second, third, fourth lumbricals, first
and second plantar interossei, the first, second, third dorsal interossei.
2.articular:

to the intertarsal and tarsometatarsal joints.

veins

The dorsal venous arch

Thedorsal venous arch of the footis a superficial vein
that connects thesmall saphenous veinand thegreat
saphenous vein.
Anatomically, it is defined by where the dorsalveinsof the
first and fifthdigit, respectively, meet the great saphenous
vein and small saphenous vein.
It is usually fairly easy topalpateand visualize (if the
patient is barefoot). It lies superior to
themetatarsalbonesapproximately midway between
theankle jointandmetatarsal phalangeal joints.

Retinaculum

1- Superior Extensor Retinaculum

2- Inferior Extensor Retinaculum
3- Superior Peroneal Retinaculum
4-Inferior Peroneal Retinaculum
5- Flexor Retinaculum

Superior Extensor Retinaculum

Medial End : Lower part of the anterior border of

Tibia

Lateral End : Subcutaneous Triangle in the lateral

S. Of Fibula

Structures Passing By from Medial to lateral

1- Tibialis Anterior
2-Extensor Hallucis Longus
3-Anterior Tibial Vessels
4-Anterior Tibial Nerve
5-Extensor Digitorum Longus
6-Peroneus Tertius

Inferior Extensor Retinaculum

Y-Shaped band
Stem of Y lateral
Two medial Ends
Lateral End : Upper Surface of Calcaneus
Upper Band : Anterior Margin of Medial Malleolus
Lower Band : Deep plantar Fascia on the medial side of foot

Stem Tunnel : Extensor Digitorum longos and peroneus tertius

First Tunnel : Extensor Hallucis Longus
Second Tunnel : Tibialis Anterior

Peroneal Retinacula
Superior Peroneal Retinaculum :

One End : Tip of lateral Malleolus

Other End : Calcaneus
Inferior Peroneal Retinaculum :

Upper End : Stem of Y

Lower End : Calcaneus

Middle Part attached to ( Peroneal Trochlea )

which

divides it to upper and lower compartment

Upper : Peroneus brevis tendon
Lower : Peroneus longus tendon

Felxor Retinaculum
Upper End : medial malleolus
Lower End : medial tubercle of calcaneus

Pierced by medial calcanean vessels and

nerves
Structures Passing by according to medial
malleolus :
1- Tibialis posterior
2- Flexor digitorum longus
3- posterior tibial vessels
4- posterior tibial nerves
5-flexor hallucis longus

Applied Anatomy
1 - Peroneal Tendonitis :
Cause : Simple ankle sprain in athletes
Symptoms : Pain and Inflammation Sometimes
inability for eversion
2 -Injury in Superior extensor retinaculum will cause
injury in tibialis anterior tendon
Leading to pain while inversion

Synovial
sheaths
obejectives

Definit
ion
Functi
on

Injury
Types

Definitio
n

A synovial sheath is one of the two

membranes of a tendon sheath which
covers a tendon. The other
membrane is the outer fibrous
tendon sheath

Function

it surround the tendons of muscles

to facilitate their movements during
action of these muscles and prevent
their friction with surrounding
.structures

Sheaths of extensor
:-tendons

( ---<tibialis anterior-)1
the sheath extends
from the
upper border of
superior

extensor retinaculum to

extensor hallicus- )2
(:-longus
the sheath extends from
the lower
border of superior
extensor

extensor digitorum- 3
longus & peroneus
tertius) --->
the sheath extends from the
lower
border of (superior extensor

Synovial sheaths of
:peroneal tendons
A single sheath surroundsthe tendons of (peroneus
longus and brevis.)
-It begins alittle above the
lateral malleolus
-It passes with the tendons
under cover of the (superior
. peroneal retinaculum)

then it divides into twosheaths, one for

each tendon which passes
separately
under the( inferior peroneal
retinaculum)
and runs to the insertion

Synovial sheaths of
:-flexor tendons
the (---<tibialis posterior- )1
sheath begins one inch
above the flexor
retinaculum and ends at
the navicular bone

(flexor digitorum longus- )2

---<
the sheath begins one inch
above the
flexor retinaculum and
ends about
the middle of the foot

(---flexor hallicus longus- )3

<
the sheath begins one
inch above
the flexor retinaculum and
ends at
the insertion of the tendon

Tenosynovi)
(tis

It means that the sheath may fail to

make synovial fluid or may not make
enough fluid due to malfunction of
the synovium because of injury of
the sheah.
This can cause inflammation or
swelling of the synovium

Causes:Tenosynovitis is typically caused

by injury to the tendon or
surrounding muscle or bone.
Injury can result from:-repetitive activities
-prolonged activities
-standing in the same position for
long periods of time
-injury
-strain

Effect
s
Include
:-

Joints
Actions
of the
muscle
Surrounding

Depend
:-on

structures

Degree of the
inflammation
Size of the

symptoms:-stiffness in the joint making it

difficult to move
-swelling in the joint
-pain and tenderness in the joint
-redness on the skin where the
tendon is located
-Some people may develop a fever.

Joints of the
foot

Movement:
(1) Inversion . (2)Eversion.

2- The talo-calcaneo-navicular
joint.
Type: Synovial, Ball and socket .
Articular surfaces: Head of talus (ball),calcaneus,and
navicular (socket).
N.B : The sockets moves and not the ball.
Ligament:
1. Spring(plantar calcaneo-navicular) ligament.
2. Deltoid ligament .
3. Medial limb of bifurcate ligament.
Movement: Sliding , inversion ,and eversion .

3- The calcaneo-cuboid joint

Type : Synovial , plane.
Articular surfaces : Anterior end of
calcaneus and posterior surface of
cuboid .
Ligament : 1- bifurcate ligament .
2- The short plantar ligament.
3- The long plantar ligament.
Movement : Inversion and eversion .

Movement
Little

Type
Synovial,
plane
Sliding
Synovial ,
plane
Little
Synovial ,
plane
Flexion,Extensio Synovial,
n,
condylar
abduction,addu
ction and
circumduction

Name of joint
Cuneonavicular

Flexion,and
extension

Interphalangeal

Synovial,
hinge

Tarsometatar
sal
Intermetatarsal
Metatarsophalangeal

Arches of the
Foot

 The bones of the foot are arranged in such a

way to form two longitudinal arches and one
transverse arch.
The arches of the foot are the bony part that
dont come in contact with the ground during
standing.
Falling of these arches lead to Flat foot

Functions :

a spring.
distribution.
protection.
Shock absorbtion.

The medial longitudinal arch:

Posterior pillar: calcaneous
Top: talus
Anterior pillar: navicular,
3cunifoerm bone, med 3
metatarsals.

 Factors keeping the medial longitudinal arch:

Ligament: Medial part of planer
aponeurosis,Spring lig,deltoid lig,long and
short plantar ligament.
Muscles: Tibialis pos,tibialis ant,flexor
halllucis longus ,flexor digitorm longus ,short
muscles of the sole
Bony factor: the shape and conistitution of
the bone keep the foot in the arching
position

The lateral longitudinal arch:

Posterior pillar: calcaneous
Top: cuboid at the high point
Anterior pillar: Lateral two
metatarsal

 Factors keeping the lateral longitudinal arch:

Ligament: lateral part of plantar aponeurosis,
long and short plantar ligament.
Muscles: peroneous longus, flexor digitorm
longus and short muscles of the little toe.
Bony factors: the shape and conistitution of
the bone keep the foot in the arching position.

The transverse arch:

It is formed by: Bases of the
metatarsal bones, cuboid and the
three cuniforms (incomplete arch).
Factors keeping the transverse arch:
Bony Factor: Intermediate and lateral
cuniforms are wedge-shaped.
Ligament: Deep transverse lig. and
interosseous ligs.
Muscles: peroneus longus, tranverse
head of adductor halluces ,slips of
tibialis posterior.

Anomalies of the foot

Flat foot (pes planus): Rotation of the
calcaneous ,eversion of the plantar surface,
slipping down of the talus and navicular,
lengthening of the medial longitudinal arch and
abduction of the forefoot.

Talipes equinovarus: plantar

flexion,inversion and adduction o the
forefoot.

Talipes calcaneovulgus:
Dorsiflexion, eversion and
abduction.