Ankle/Foot palpations

Tibialis Anterior

Palpate: Pull the foot up and in

Origin: lateral condyle and superior half of lateral tibia and interosseous membrane

Insertion: Medial and inferior surfaces of medial cuneiform

Innervation: Deep fibular nerve (L4,L5)

Action: Inversion and Dorsiflexion

Extensor Hallucis Longus

Palpate: Stabilize the MTP joint and lift the tip of the big toe up

Origin: middle part of anterior surface of the fibula and interosseous membrane

Insertion: Base of distal phalanx of great toe

Innervation: Deep fibular nerve (L4,L5)

Action: extends the great toe and dorsiflexes the ankle

Extensor Digitorum Longus

Palpate: lift your toes towards your face

Origin:

• Lateral condyle of tibia

• Superior ¾ of medial surface of fibula

• interosseous membrane

Instertion: Middle and distal phalanges of lateral 4 digits

Innervation: Deep fibular nerve (L4,L5)

Action: Extends lateral 4 digits and dorsiflexes the ankle

Fibularis Longus

Palpate: have the patient point their foot and toes down and twist the foot externally and internally

Origin: Head and superior 2/3 of lateral surface of fibula

Insertion: Base of 1st metatarsal and medial cuneiform

Innervation: Superficial fibular nerve (L5, S1, S2)

Action: everts foot and weakly plantar flexes ankle

Fibularis Brevis

Palpate: If you go to the base of the fifth (styloid process) and tell the patient to relax and twist out again, the tendon that pops up is the brevis

Origin: Inferior 2/3 of lateral surface of fibula

Insertion: Tuberosity on lateral side of base of 5th metatarsal

Innervation: superficial fibular nerve (L5, S1, S2)

Action: Everts foot and weakly plantar flexes ankle

Gastrocnemius

Palpate: Keep the knee straight and push your foot down, you can also do a standing calf raise

Origin:

• Lateral head: lateral aspect of lateral condyle of femur

• Medial head: Popliteal surface of femur, superior to medial condyle

Insertion: Posterior calcaneus via calcaneal (achilles) tendon

Innervation: Tibial nerve (S1, S2)

Action: Plantarflexes ankle joint and flexes knee joint

Soleus

Palpate: Bend the knee to shorten gastroc, place your hand on patients’ foot and ask them to push into you

Origin:

• posterior surface of head of fibula

• posterior surface of head of tibia

• Soleal line and middle 1/3 of medial border of tibia

Insertion: posterior calcaneus via calcaneal (Achilles) tendon

Innervation: Tibial Nerve (S1, S2)

Action: Plantarflexes ankle joint independent of knee position (doesn’t cross the knee)

Tibialis Posterior

Palpate: Test in long sit, tendon will run just behind the medial malleolus, point your toes down and twist your foot in

Origin:

• interosseous membrane

• posterior tibia inferior to soleal line

• Posterior fibula

Insertion:

• tuberosity of navicular, cuneiforms, and cuboid

• Sustentaculum tali of calcaneus

• Bases of 2, 3, and 4th metatarsals

Innervation: Tibial nerve (L4, L5)

Action:

• Plantarflexes ankle

• inverts foot

• supports medial longitudinal arch of foot (dynamic support)

Flexor Hallucis Longus

Palpate: Stabilize the MTP joint, bend just the tip of your big toe down

Origin: Posterior and inferior surface of fibula and inferior part of interosseous membrane

Insertion: Base of distal phalanx of great toe

Innervation: Tibial Nerve (S2, S3)

Action:

• Flexes great toe at all joints

• Weakly plantarflexes ankle

• supports medial longitudinal arch of foot (dynamic support)

Flexor Digitorum Longus

Palpate: keep your ankle still and curl all your toes down

Origin: Posterior and medial surface of tibia inferior to soleal line

Insertion: Bases of distal phalanges of lateral four digits

Innervation: Tibial Nerve (S2, S3)

Action:

• Flexes lateral 4 digits

• plantarflexes ankle

• supports longitudinal arches (dynamic support of foot)