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Chapter 10

The Ankle and Foot

Joints
Manual of Structural
Kinesiology
22nd Edition
R.T. Floyd, EdD, ATC, CSCS

© McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC.
 The Ankle and Foot Joint 1

26 bones
19 large (extrinsic) muscles
20 small (intrinsic) muscles
More than 100 ligaments
Support & propulsion
• Foot trouble - common ailment
• Poor foot mechanics leads to foot discomfort
• No substitute for adequate muscular development,
strength, endurance, proprioception & proper foot
mechanics

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 The Ankle and Foot Joint 2

Walking
• Stance phase
• Heel-strike occurs
when landing on heel,
foot should be in
supination
• Midstance immediately
follows with foot moving
into pronation
• Toe-off follows
midstance, foots
returns to supination
prior to & during push
off
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 The Ankle and Foot Joint 3

Walking
• Swing phase
• occurs when foot
leaves ground & leg
moves forward to
another point of
contact

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 The Ankle and Foot Joint 4

Problems arise
• foot is too rigid & does not pronate adequately
• foot remains in pronation past midstance
Walking
• one foot is always in contact with ground
Running
• point when neither foot is in contact with ground

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 Bones 1

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 Bones 2

26 bones in each foot that form arch

Body weight is transferred from tibia to talus & calcaneus
(tarsal bones)
5 other rear & midfoot tarsal bones
• Navicular - between talus & 3 cuneiform bones
• Cuboid - between calcaneus and 4th & 5th metatarsals
• 5 metatarsals - anterior to tarsals
• 5 phalanges
• 3 phalanxes in each except 1st toe (2 phalanxes)
• 2 sesamoids beneath 1st metatarsophalangeal joint

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 Bones 3

Distal malleoli of tibia &

fibula
• Enlarged & protrude
horizontally & inferiorly
• Serve as pulley for
posterior tendons to
increase mechanical
advantage of muscles
in performing inversion
& eversion actions

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 Bones 4

Pulley for posterior tendons

• Fibularis (peroneus) brevis
& fibularis (peroneus)
longus – immediately
behind lateral malleolus
• “Tom, Dick & Harry”
muscles immediately
posterior to medial
malleolus
• Tibialis posterior
• Flexor digitorum longus
• Flexor hallucis longus
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 Joints 1

Tibiofibular joint
• Syndesmotic
amphiarthrodial joint
• Joined at both proximal &
distal tibiofibular joints
• Ligaments and a strong,
dense interosseus
membrane between tibia &
fibula shafts provide support
• Minimal movement possible
• Distal joint becomes
sprained occasionally in
heavy contact sport
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 Joints 2

Tibiofibular joint
• Syndesmosis joint
sprain
• “High ankle sprain”
primarily involves anterior
inferior tibiofibular
ligament
• More severe injuries can
involve posterior
tibiofibular ligament,
interosseus ligament &
interosseus membrane
• often leads to the need for
surgical reduction and
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 Joints 3

Ankle joint (talocrural joint)

• Hinge or ginglymus-type joint
• Talus, distal tibia, & distal fibula
• 50 degrees of plantar flexion
• 15 to 20 degrees of dorsiflexion
• Greater range of dorsiflexion with
knee flexed (reduces gastrocnemius
& plantaris tension)
• Fibula rotates 3 to 5 degrees externally with ankle dorsiflexion &
3 to 5 degrees internally during plantarflexion
• Distal syndesmosis joint widens by 1 to 2 millimeters during full
dorsiflexion
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 Joints 4

Subtalar (talocalcaneal) &

transverse tarsal (talonavicular &
calcaneocuboid) joints
• Inversion & eversion occurs here
• Classified as gliding or arthrodial
• Combined movement of
• 20 to 30 degrees of inversion
• 5 to 15 degrees of eversion
• Due to the arthrodial makeup of these joints and there gliding
movements a slight amount of foot adduction/abduction occurs with
inversion/eversion, respectively
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 Joints 6

Metatarsophalangeal joints
• Phalanges join metatarsals
• Classified as condyloid-type joints
• Great toe metatarsophalangeal (MP)
joint flexes 45 degrees & extends 70
degrees
• MP joints of the four lesser toes
• 40 degrees of flexion
• 40 degrees of extension
• also abduct & adduct minimally

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 Joints 8
Ankle sprains are a very common injury
• Sprains involve stretching or tearing of one or more ligaments
• Most common ankle sprain results from excessive inversion that
causes damage to lateral ligamentous structures, primarily anterior
talofibular ligament & calcaneofibular ligament

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 Joints 9

Ankle sprains very common injury

• Excessive eversion forces injures deltoid ligament
(medially) - less common
• which may also occur in combination with the previously mentioned
syndesmosis high ankle sprain

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 Joints 10

Ligaments in foot & ankle maintain

arches
Two longitudinal arches
• Medial longitudinal arch - extends
from calcaneus bone to talus,
navicular, 3 cuneiforms and
proximal ends of 3 medial
metatarsals
• Lateral longitudinal arch - extends
from calcaneus to cuboid and
proximal ends of 4th & 5th
metatarsals
• Long arches may be high,
medium or low
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 Joints 11

Transverse arch
• extends across foot
from 1st metatarsal to
the 5th metatarsal

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 Joints 12
Plantar fascia (plantar
aponeurosis)
• structure extending from the
medial calcaneal tuberosity
to the proximal phalanges of
the toes
• assists in stabilizing the
medial longitudinal arch
• Plantar fasciitis
• common painful condition
involving plantar fascia

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 Muscles 3

Lower leg - divided into 4 compartments

• Dense fascia - tightly surrounds & binds each
• Facilitates venous return & prevents excessive swelling of muscles
during exercise

• Anterior compartment
• Dorsiflexor group - tibialis anterior, fibularis (peroneus) tertius,
extensor digitorum longus & extensor hallucis longus

• Lateral compartment
• Fibularis (peroneus) longus & fibularis (peroneus) brevis (two most
powerful evertors)

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 Muscles 4

Superficial posterior
compartment
• Gastrocnemius, soleus, &
plantaris - plantar flexors
Deep posterior compartment
• Flexor digitorum longus,
flexor hallucis longus,
popliteus & tibialis
posterior
• All are plantar flexors &
invertors except popliteus
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 Muscles 5

Compartment Syndrome
• Most common in anterior compartment
• May be acute or chronic
• May occur secondarily to injury, trauma or overuse
• Symptoms include sharp pain, particularly with increased
movement actively or passively, swelling and weakness in
the muscles of the involved compartment
• Depending on severity, emergency surgery may be
indicated to release the fascia in order to prevent
permanent tissue damage
• Many compartment syndromes may be adequately
addressed with proper acute management

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 Muscles 6

Acute & chronic injuries are common

• “Shin splints” - common term describing painful leg
condition often associated with running activities
• Not a specific diagnosis
• Attributed to a number of different specific musculotendinous
injuries
• Most often involves tibialis posterior, medial soleus or anterior
tibialis, but may also involve extensor digitorum longus
• May be partially prevented by stretching plantar flexors &
strengthening dorsiflexors

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 Muscles 7

Painful cramps - acute muscle spasm in gastrocnemius &

soleus
• Occur somewhat commonly
• May be relieved through active & passive dorsiflexion
Complete rupture of Achilles tendon
• very disabling injury
Several ankle & foot muscles produce more than one
movement

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 Muscles 8

Ankle & foot joint muscles by

function
• Plantar flexors
• Gastrocnemius
• Flexor digitorum longus
• Flexor hallucis longus
• Fibularis (peroneus) longus
• Fibularis (peroneus) brevis
• Plantaris
• Soleus
• Tibialis posterior
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 Muscles 9

Ankle & foot joint muscles by

function
• Evertors
• Fibularis (peroneus) longus
• Fibularis (peroneus) brevis
• Fibularis (peroneus) tertius
• Extensor digitorum longus

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 Muscles 10

Ankle & foot joint muscles by function

• Dorsiflexors
• Tibialis anterior
• Fibularis (peroneus) tertius
• Extensor digitorum longus (extensor of
lesser toes)
• Extensor hallucis longus (extensor of
great toe)

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 Muscles 11

Ankle & foot joint muscles by function

• Invertors
• Tibialis anterior
• Tibialis posterior
• Flexor digitorum longus (flexor of
lesser toes)
• Flexor hallucis longus (flexor of great
toe)

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 Gastrocnemius Muscle

Plantar flexion of ankle

Flexion of knee

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 Soleus Muscle

Plantar flexion of ankle

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 Fibularis (Peroneus) Longus Muscle

Eversion of foot

Plantar flexion of ankle

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 Tibialis Anterior Muscle

Dorsiflexion
of ankle

Inversion of
foot

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 Tibialis Posterior Muscle

Plantar flexion
of ankle

Inversion of
foot

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 Intrinsic Muscles of the Foot 1

• All originate & insert within

the foot
• Extensor digitorum brevis
is on dorsum of foot
• Remainder are in a plantar
compartment in 4 layers
on plantar surface of foot

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 Ankle Dorsiflexion

Agonists
• Tibialis anterior
• Extensor digitorum longus
• Fibularis (peroneus) tertius
• Extensor hallucis longus

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