Lower LIMB | INCOMPLETE | GO TO SLIDES TO DOUBLE CHECK

Bones of the Foot and Ankle

Tibia

Fibula

Tarsals

Metatarsals

Phalanges

Tarsal Bones

Cuneiforms (Lateral, Intermediate, Medial)

Cuboid

Navicular

Talus

Calcaneus

What are the functional divisions of the foot?

Hindfoot (Talus and Calcaneus)

Midfoot (Navicular, cuboid and cuneiforms)

Forefoot (Metatarsals and phalanges)

Talocural Joint

- Hinge type, synovial joint

- Distal tibia, fibular form mortise for trochlea of talus

- primary motions are dorsiflexion (more stable) and plantar flexion (less stable)

- Soft tissue stability provided by capsule (weak) and collateral ligaments

Ligaments of the Talocrural Joint

Medial/Deltoid Ligament

- 4 parts, tibionavicular, anterior and posterior tibiotalar, tibiocalcaneal

Lateral Ligaments

- 3 distinct ligaments anterior and posterior talofibular, calcaneofibular

- weaker than medial

Subtalar Joint

- Gliding type, synovial joint

- Talus on calcaneus and navicular

- Gliding motions produce inversion and eversion of foot

- Stability provided by capsule and medial, lateral, posterior, talocalcaneal ligaments and interosseous (anterior) talocalcaneal

What are the three arches of the foot?

1. Medial Longitudinal (calcaneus, talus, cuneiforms , 1-3 MT)

2. Lateral Longitudinal (calcaneus, cuboid, 4-5 MT)

3. Transverse (across foot, cuneiforms, cuboid, base of metatarsals)

What are the purposes of the arches in the foot?

Mobility (shock absorption and surface adaptability) and Stability (shock absorption and propulsion)

What contributes to arch integrity?

Bony Architecture

Strong plantar ligaments

Bracing action of muscles and tendons

Muscles of the 1st Layer of the Foot

Abductor Hallucis

Flexor Digitorum Brevis

Abductor Digiti Minimi

Abductor Hallucis

First Layer

-Abducts great toe, supports medial longitudinal arch

- Attaches to calcaneus and base of proximal phalanx

Flexor Digitorum Brevis

First Layer

- Short flexor of toes 2-5, supports medial and longitudinal arches

- Attaches to middle phalanges and calcaneus

Abductor Digiti Minimi

First Layer

- Abducts 5th digit, supports lateral longitudinal arch

- attaches to calcaneus and 5th metarsal

Muscles of the Second Layer

Quadratus Plantae

Lumbricales

Tendons of the FHL and FDL

Quadratus Plantae

Second Layer

- originates by 2 heads from calcaneus and inserts on tendon of FDL

- assist by aligning pull of tendon

Lumbricales

Second Layer

- function like hand, flex of MTP's and extends IP's

- Origin: FDL tendons, insertion is extensor expansion

Muscles of the 3rd layer of the foot

Flexor Hallucis Brevis

Adductor Hallucis

Flexor Digiti Minimi

Flexor Hallucis Brevis

Third Layer

flexes 1st MTP joint.

2 heads with sesamoid bone in each tendon

Adductor Hallucis

Third Layer

2 heads.

Adducts great toe and helps flex 1sr MTP joint, supports the transverse arch of foot

Magic 7

Flexor Digiti Minimi

Flexes 5th MTP joint

base of 5th metatarsal to base of middle phalange

Musculature of the 4th Layer of the Foot

Plantar Interossei

Dorsal Interossei

Tendond of Per. Long and Post. Tib

Plantar Interossei

3 insert on base of proximal phalanges 3-5 and extensor expansion. Adduct digits 3-5 and flex MTP joints and ext. IP

Dorsal Interossei

4 insert on base of prox. Phalanges and ext. expansion of digit s 2-4. Abduct, flex MTP, ext IP, Abduction and adduction are referenced to 2nd metatarsal

Nerves of the Foot

Medial Planter

Lateral Planter

Sural Nerve

Saphaneous Nerve

Medial Plantar Nerve

Terminal branch of the tibial nerve, motor and sensory

Lateral Plantar Nerve

Terminal branch of tibial nerve, motor and sensory

Sural Nerve

Sensory fibers

Saphaneous Nerve

Cutaneous branch of femoral nerve

Arteries of the foot

Dorsalis Pedis

Posterior Tibial

Medial Planter and Lateral Plantar

Dorsalis Pedis

continuation of the anterior tibial artery, passes deep to extensor retinaculum, divides into deep plantar and arcuate arteries

psoas major origin

transverse processes, bodies and intervertebral discs of L1-L5

psoas major insertion

lesser trochanter of the femur

psoas major action

Origin fixed: hip flexion, hip external rotation
Insertion fixed: trunk flexion, anterior pelvic tilt
Unilaterally:  lateral flexion of the trunk

psoas major nerve

anterior rami of L1-L3

iliacus origin

iliac fossa

iliacus insertion

lesser trochanter of the femur

iliacus action

hip flexion, hip external rotation

iliacus nerve

Femoral nerve

rectus femoris origin

anterior inferior iliac spine (AIIS)

rectus femoris insertion

patella via quadriceps tendon

rectus femoris action

hip flexion, knee extension

rectus femoris nerve

femoral nerve

vastus lateralis origin

lateral lip of linea aspera, gluteal tuberosity

vastus lateralis insertion

tibial tuberosity (via the quadriceps tendon, patella and patellar tendon)

vastus lateralis action

knee extension

vastus lateralis nerve

femoral nerve

vastus medialis origin

medial lip of linea aspera 

vastus medialis insertion

tibial tuberosity (via the quadriceps tendon, patella and patellar tendon)

vastus medialis action

knee extension

vastus medialis nerve

femoral nerve

vastus intermedius origin

anterior and lateral shaft of femur

vastus intermedius insertion

tibial tuberosity (via the quadriceps tendon, patella and patellar tendon)

vastus intermedius action

knee extension

vastus intermedius nerve

femoral nerve

sartorius origin

Anterior superior iliac spine (ASIS)

sartorius insertion

pes anserine (anterior, medial tibia)

sartorius action

hip flexion, hip external rotation, hip abduction, knee flexion

sartorius nerve

Femoral nerve

Psoas minor

incorporated into inguinal ligament

psoas major

hip flexion and external rotation

Iliacus

hip flexion and external rotation

Gluteus maximus

hip extension, external rotation, abduction, and adduction

gluteus medius

hip abduction, flexion, internal rotation, extension, and external rotation, and pelvic stabilization

gluteus minimus

hip abduction, flexion, internal rotation, extension, and external rotation, and pelvic stabilization

Tensor fascia latae

fascia latae tension, and hip abduction, flexion, and internal rotation

Piriformis

hip external rotation, abduction, extension, and hip stabilization

Obturator internus

hip external rotation, adduction, and extension

Superior and inferior gemellus

hip external rotation, adduction, extension

Quadratus femoris

hip external rotation and adduction

Sartorius

hip flexion, abduction, and external rotation, and knee joint flexion and internal rotation

rectus femoris

hip flexion and knee extension

vastus medialis

knee extension

vastus lateralis

knee extension

vastus intermedius

knee extension

Pectineus

hip adduction, external rotation, and flexion

Adductor longus

hip adduction flexion and extension

Adductor brevis

hip adduction flexion and extension

Gracilis

hip adduction and flexion, and knee flexion and internal rotation

Obturator externus

hip adduction, external rotation, and pelvic stabilization

Adductor minimus

hip adduction, extension, flexion

adductor magnus

hip adduction, extension, flexion, and pelvic stabilization

biceps femoris long head

hip extension and knee flexion, external rotation, and pelvic stabilization

biceps femoris short head

knee flexion and external rotation

semitendinosis

hip extension and knee flexion, internal rotation, and pelvic stabilization

semimembranosis

hip extension and knee flexion, internal rotation, and pelvic stabilization

gastrocnemius

plantar flexion and knee flexion

soleus

plantar flexion

Plantaris

negligible

Tibialis posterior

plantar flexion, supination, and longitudinal and transverse arch support

Flexor digitorum longus

plantar flexion and supination

Flexor hallucis longus

plantar flexion, supination, and medial longitudinal arch support

Popliteus

knee flexion and internal rotation

Tibialis anterior

dorsiflexion and supination

Extensor hallucis longus

dorsiflexion, pronation, supination, and great toe extension

Extensor digitorum longus

dorsiflexion, pronation, and 2-5 toe extension

Fibularis tertius

dorsiflexion and pronation

Fibularis longus

plantar flexion, pronation, and transverse arch support

fibularis brevis

plantar flexion and pronation

Extensor digitorum brevis

2-4 toes extension

Extensor hallucis brevis

1st toe extension