THE FOOT

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Desalegn Tadesse
FOOT
• It is subdivided into the ankle, the metatarsus, & the
digits.

• There are five digits consisting of the most medially

positioned great toe (digit I) to the most lateral little toe
(digit V)

• The foot has a superior surface (dorsum of foot) & an

inferior/ plantar surface (sole).

Bones
• There are three groups of bones in the foot:
– tarsal bones (7 in #) - form the skeletal framework for the
ankle
– metatarsals (I to V)
– Phalanges - form bones of the toes 2
Tarsal bones
• are arranged in a proximal group & a distal group with
an intermediate bone b/n the two groups on the medial
side of the foot

Proximal group
• The proximal group consists of two large bones: & the
calcaneus:
– the talus (L. ankle) is the most superior bone of the foot &
sits on top of & is supported by the calcaneus

– the calcaneus (L. heel) is the largest of the tarsal bones

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Talus
• articulates above with the tibia & fibula to form the
ankle joint & anteriorly with navicular.
• has a head, neck, & body.

• the head is projected forward & domed for articulation

with a corresponding circular depression on the
posterior surface of the navicular bone.

• Inferiorly, the articular surface is continuous with

additional articular facets separated by smooth ridges:
– the anterior, middle & posterior facets articulate with adjacent
surfaces on the calcaneus bone

– the other facet, medial to the facets for articulation with the
calcaneus, articulates with a ligament - the plantar
calcaneonavicular ligament (spring ligament)
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• The neck of the talus is marked by a deep groove, the
sulcus tali.

• The superior aspect of the body of the talus is elevated

to fit into the socket formed by the distal ends of the
tibia & fibula to form the ankle joint:
– the upper (trochlear) surface of this elevated region
articulates with the inferior end of the tibia;
– the medial surface articulates with the medial malleolus of
the tibia;
– the larger lateral surface articulates with the lateral malleolus
of the fibula.

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• The inferior surface of the body of the talus has the
posterior calcaneal articular facet for articulation
with the calcaneus.

• The posterior aspect of the body consists of a the

posterior process.

• This process has a lateral tubercle & a medial

tubercle, which bracket b/n them the groove for
tendon of the flexor hallucis longus as it passes
from the leg into the foot.

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Calcaneus (heel bone)
• The calcaneus is the largest & strongest bone in the
foot

• Posteriorly forms the bony framework of the heel &

anteriorly projects forward to articulate with the cuboid
on the lateral side of the foot.

• It transmits the majority of the BW from the talus to the

ground

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• The anterior 2/3rds of the calcaneus's superior surface
articulates with the talus & its anterior surface
articulates with the cuboid.

• The posterior surface of this heel region is circular &

divided into upper, middle, & lower parts:

–the upper part is separated from the calcaneal tendon

by a bursa;
–the middle part attaches the calcaneal tendon (Achilles'
tendon):
–the lower part is covered by subcutaneous tissue, is
the weight-bearing region of the heel, & is continuous
onto the plantar surface of the bone as the calcaneal
tuberosity.
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• The calcaneal tuberosity has a large medial process
& a small lateral process separated from each other
by a V-shaped notch.

• At the anterior end of the plantar surface is the

calcaneal tubercle for the posterior attachment of the
short plantar ligament of the sole of the foot.

• The lateral surface has two slightly raised regions:

 The fibular trochlea (peroneal tubercle) - has two

shallow grooves, which pass, one above, the other
obliquely across, its surface.
– anchors a tendon pulley for the fibularis brevis & fibularis
longus muscles (evertors of the foot).
 Tubercle for attachment of the calcaneofibular part13of
the lateral collateral ligament.
• The medial surface of the calcaneus has on its upper
margin the sustentaculum tali (L. shelf) - projecting
medially & supporting the head of the talus.

• The underside of the sustentaculum tali has a groove

for the tendon of the flexor hallucis longus muscle.

• The superior surface of the sustentaculum tali has a

facet (middle talar articular surface) for articulation
with the corresponding middle facet on the head of the
talus.

• Anterior & posterior talar articular surfaces are on

the superior surface of the calcaneus itself.

• Both the calcaneal sulcus & the sulcus tali together

form the tarsal sinus. 14
Intermediate tarsal bone (navicular )

• The navicular (boat shaped, L. little ship) bone

articulates behind with the talus & articulates in front &
on the lateral side with the distal group of tarsal bones.

• The medial surface of the navicular projects inferiorly

to form the navicular tuberosity for the attachment of
the tibialis posterior tendon

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Distal group
• consists of the cuboid & the cuneiform bones.

The cuboid (Gr. cube)

• is the most lateral bone in the distal row of the tarsus

• articulates behind with the calcaneus & in front with the

bases of the lateral two metatarsals

• Anterior to the tuberosity of the cuboid on the lateral &

inferior surfaces of the bone is a groove for the tendon
of the fibularis longus muscle.

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The cuneiforms (L. wedge)

• There are three cuneiforms: the lateral (1st),

intermediate (2nd), & medial (3rd) cuneiform bones

• articulate behind with the navicular bone & in front with

the bases of the medial three metatarsals

• The lateral cuneiform also articulates with the cuboid.

• The medial cuneiform is the largest bone, & the

intermediate cuneiform is the smallest.

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Metatarsals
• There are five metatarsals in the foot, numbered I to V
from medial to lateral.

• Each metatarsal has a head at the distal end, a

shaft/body in the middle, & a proximal base.

• The head articulates with the proximal phalanx of a toe

& the base articulates with one or more of the distal
group of tarsal bones.

• The plantar surface of the head of metatarsal I also

articulates with two sesamoid bones.

• The sides of the bases of metatarsals II to V also

articulate with each other.
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the tarsometatarsal
joints form an oblique
tarsometatarsal line
joining the midpoints of
the medial & lateral
borders of the foot;
• The lateral side of the
base of metatarsal V
has a tuberosity for the
attachment of the
tendon of the fibularis
brevis muscle.

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The Phalanges
• The phalanges are the bones of the toes.

• Each toe has three phalanges (proximal, middle, &

distal), but the great toe has only proximal & distal.

• Each phalanx consists of a base, a shaft, & a distal

head:
– the base of each proximal phalanx articulates with the head
of the related metatarsal.

– the head of each distal phalanx is nonarticular & flattened

into a crescent-shaped plantar tuberosity under the plantar
pad.

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Joints

Ankle joint
• The ankle refers to the malleolar parts of the distal leg,
proximal to the dorsum & heel of the foot, including the
ankle joint.

• The ankle joint is synovial in type & involves the talus

of the foot & the tibia & fibula of the leg.

• The ankle joint mainly allows hinge-like dorsiflexion &

plantarflexion of the foot on the leg.

• The distal end of the fibula is firmly anchored to the

larger distal end of the tibia by strong ligaments.
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• Together, the fibula & tibia create a deep bracket-
shaped socket for the upper expanded part of the body
of the talus:
–the roof of the socket is formed by the inferior
surface of the distal end of the tibia;

–The medial side of the socket is formed by the

medial malleolus of the tibia;

–the longer lateral side of the socket is formed by the

lateral malleolus of the fibula.

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• The articular surfaces are covered by hyaline cartilage.

• The curved upper surface of the half-cylinder & the two ends are
covered by hyaline cartilage & fit into the bracket-shaped socket
formed by the distal ends of the tibia & fibula.

• When viewed from above, the articular surface of the talus is

much wider anteriorly than it is posteriorly.

• As a result, the bone fits tighter into its socket when the foot is
dorsiflexed & the wider surface of the talus moves into the ankle
joint than when the foot is plantarflexed & the narrower part of
the talus is in the joint.

The joint is therefore most stable when the foot is dorsiflexed.

• The ankle joint is stabilized by medial (deltoid) & lateral

ligaments. 26
Medial ligament
• The medial ligament is large, strong, & triangular in
shape.

• Its apex is attached above to the medial malleolus & its

broad base is attached below to a line that extends
from the tuberosity of the navicular bone in front to the
medial tubercle of the talus behind.

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• The medial ligament is subdivided into four parts based
on the inferior points of attachment:

• the tibionavicular part - the part that attaches to the

tubercle of the navicular & the associated margin of the
plantar calcaneonavicular ligament

• the tibiocalcaneal part - attaches to the

sustentaculum tali

• the posterior tibiotalar part - attaches to the medial

side & medial tubercle of the talus;

• the anterior tibiotalar part - is deep to the

tibionavicular & tibiocalcaneal parts of the medial
ligament & attaches to the medial surface of the talus.
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Lateral ligament
• The lateral ligament of the ankle is composed of three
separate ligaments:

–the anterior talofibular ligament is a short ligament, &

attaches the anterior margin of the lateral malleolus to
the adjacent region of the talus;
–the posterior talofibular ligament runs horizontally
backwards & medially from the malleolar fossa on the
medial side of the lateral malleolus to the posterior
process of the talus;
–the calcaneofibular ligament is attached above to the
malleolar fossa on the posteromedial side of the lateral
malleolus & passes posteroinferiorly to attach below29 to
a tubercle on the lateral surface of the calcaneus.
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Movements of the Ankle Joint
• The main movements are dorsiflexion & plantarflexion,
which occur around a transverse axis passing through
the talus.

• Because the narrow end of the trochlea of the talus lies

loosely b/n the malleoli when the foot is plantarflexed,
small amounts of abduction, adduction, inversion, &
eversion is possible.
–Dorsiflexion of the ankle is produced by the muscles in
the anterior compartment of the leg.

Dorsiflexion is usually limited by the passive resistance

of the triceps surae to stretching & by tension in the
medial & lateral ligaments.
–Plantarflexion of the ankle is produced by the muscles
in the posterior compartment of the leg. 31
Blood Supply of the
Ankle Joint
• malleolar branches of the
fibular & anterior &
posterior tibial arteries.
Nerve Supply of the
Ankle Joint
• the tibial nerve & the deep
fibular nerve, a division of
the common fibular nerve

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Foot Joints

• The joints of the foot involve the tarsals, metatarsals,

& phalanges.

• The important intertarsal joints are the subtalar

(talocalcaneal) joint & the transverse tarsal joint
(calcaneocuboid & talonavicular joints).

 All bones of the foot proximal to the

metatarsophalangeal joints are united by dorsal &
plantar ligaments.

• The bones of the metatarsophalangeal &

interphalangeal joints are united by lateral & medial
collateral ligaments.
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 Inversion & eversion of the foot are the main
movements involving these joints.

• In the foot, flexion & extension occurs in the forefoot at

the metatarsophalangeal & interphalangeal joints

• Inversion is augmented by flexion of the toes

(especially the great & 2nd toes), & eversion by their
extension (especially of the lateral toes).

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Subtalar joint

• This joint is b/n:

–the large posterior calcaneal facet on the inferior
surface of the talus; &
–the corresponding posterior talar facet on the
superior surface of the calcaneus.

• The articular cavity is enclosed by synovial

membrane, which is covered by a fibrous membrane.

• The subtalar joint allows gliding & rotation, which are

involved in inversion & eversion of the foot.

• Lateral, medial, posterior, & interosseous

talocalcaneal ligaments stabilize the joint.
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• The interosseous talocalcaneal ligament lies within the
tarsal sinus, which separates the subtalar &
talocalcaneonavicular joints & is especially strong.

Clinically, the term subtalar joint refers to the

compound functional joint consisting of the anatomical
subtalar joint plus the talocalcaneal part of the
talocalcaneonavicular joint.

 Structurally, the anatomical subtalar joint is a discrete

joint, having its own joint capsule & articular cavity.

 Functionally, the clinical definition is logical because

the two parts of the compound joint function as a unit;
it is impossible for them to function independently.

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• The subtalar joint (by either definition) is where the
majority of inversion & eversion occurs, around an
axis that is oblique.

• The transverse tarsal joint is a compound joint

formed by two separate joints aligned transversely:
– the talonavicular part of the talocalcaneonavicular joint,
– the calcaneocuboid joint.

• At this joint, the midfoot & forefoot rotate as a unit on

the hindfoot around a longitudinal (AP) axis,
augmenting the inversion & eversion movements
occurring at the clinical subtalar joint.

• Transection across the transverse tarsal joint is a 38

standard method for surgical amputation of the foot.
Major Ligaments of the Foot

• The major ligaments of the plantar aspect of the foot

are the:

1. Plantar calcaneonavicular ligament (spring

ligament), which extends across & fills a wedge-
shaped gap b/n the talar shelf & the inferior margin of
the posterior articular surface of the navicular.
– supports the head of the talus
– plays important roles in the transfer of weight from
the talus &
– in maintaining the longitudinal arch of the foot, of
which it is the keystone

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2. Long plantar ligament, which passes from the
plantar surface of the calcaneus to the groove on the
cuboid.
– Some of its fibers extend to the bases of the
metatarsals, thereby forming a tunnel for the tendon
of the fibularis longus.
–  important in maintaining the longitudinal arch of
the foot.

3. Plantar calcaneocuboid ligament (short plantar

ligament), which is located on a plane b/n the plantar
calcaneonavicular & the long plantar ligaments.
– extends from the anterior aspect of the inferior
surface of the calcaneus to the inferior surface of
the cuboid.
– also involved in maintaining the longitudinal arch of
the foot.
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Arches of the Foot
• The foot is composed of numerous bones connected
by ligaments, & hence has considerable flexibility that
allows it to deform with each ground contact, thereby
absorbing much of the shock.

• Furthermore, the tarsal & metatarsal bones are

arranged in longitudinal & transverse arches passively
supported & actively restrained by flexible tendons
that add to the weight-bearing capabilities & resiliency
of the foot.
• The arches:
– distribute weight over the pedal platform (foot),
acting not only as shock absorbers but also as
springboards for propelling it during walking,
running, & jumping.
– add to the foot's ability to adapt to changes in 42
surface contour.
• The longitudinal arch of the foot is composed of
medial & lateral parts

• Functionally, both parts act as a unit with the

transverse arch of the foot, spreading the weight in all
directions.

• The medial longitudinal arch is higher & more

important than the lateral longitudinal arch
– is composed of the calcaneus, talus, navicular, three
cuneiforms, & three metatarsals.
– The talar head is the keystone of the medial longitudinal
arch.
– The tibialis anterior, attaching to the 1st metatarsal & medial
cuneiform, helps strengthen the medial longitudinal arch.
– The fibularis longus tendon, passing from lateral to medial,
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also helps support this arch
• The lateral longitudinal arch is much flatter than the
medial part of the arch & rests on the ground during
standing.

• is made up of the calcaneus, cuboid, & lateral two

metatarsals.

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• The transverse arch of the foot runs from side to side

• is formed by the cuboid, cuneiforms, & bases of the

metatarsals.

• The medial & lateral parts of the longitudinal arch

serve as pillars for the transverse arch.

• The tendons of the fibularis longus & tibialis posterior,

crossing under the sole of the foot like a stirrup, help
maintain the curvature of the transverse arch.

• The integrity of the bony arches of the foot is

maintained by both passive factors & dynamic
supports. 45
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 Passive factors involved in forming & maintaining
the arches of the foot include:

1. The shape of the united bones (both arches, but

especially the transverse arch).

2. Four successive layers of fibrous tissue that bowstring

the longitudinal arch (superficial to deep):
– Plantar aponeurosis.
– Long plantar ligament.
– Plantar calcaneocuboid (short plantar) ligament.
– Plantar calcaneonavicular (spring) ligament.

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 Dynamic supports involved in maintaining the
arches of the foot include:
– Active (reflexive) bracing action of intrinsic muscles
of foot (longitudinal arch).
– Active & tonic contraction of muscles with long
tendons extending into foot:
Flexors hallucis & digitorum longus for the
longitudinal arch.
Fibularis longus & tibialis posterior for the
transverse arch.

 Of these factors, the plantar ligaments & the plantar

aponeurosis bear the greatest stress & are most
important in maintaining the arches of the foot.
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A Pott fracture - dislocation of the ankle occurs when
the foot is forcibly everted.

• This action pulls on the extremely strong medial

ligament, often tearing off the medial malleolus.

• The talus then moves laterally, shearing off the lateral

malleolus or, more commonly, breaking the fibula
superior to the tibiofibular syndesmosis.

• If the tibia is carried anteriorly, the posterior margin of

the distal end of the tibia is also sheared off by the
talus, producing a trimalleolar fracture (the entire distal
end of the tibia is erroneously considered to be a
‘malleolus’)

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