and
henna, and wearing a
metti (
toe ring) on the second toe, for her wedding The human foot is a strong and complex mechanical structure containing 26
bones, 33
joints (20 of which are actively articulated), and more than one hundred
muscles,
tendons, and
ligaments. The joints of the foot are the
ankle and
subtalar joint and the
interphalangeal joints of the foot. An anthropometric study of 1197 North American adult Caucasian males (mean age 35.5 years) found that a man's foot length was 26.3 cm with a
standard deviation of 1.2 cm. The foot can be subdivided into the hindfoot, the midfoot, and the forefoot: The
hindfoot is composed of the
talus (or ankle bone) and the
calcaneus (or heel bone). The two long bones of the lower leg, the
tibia and
fibula, are connected to the top of the talus to form the
ankle. Connected to the talus at the
subtalar joint, the calcaneus, the largest bone of the foot, is cushioned underneath by a layer of fat.
Arches The human foot has two
longitudinal arches and a transverse arch maintained by the interlocking shapes of the foot bones, strong ligaments, and pulling muscles during activity. The slight mobility of these arches when weight is applied to and removed from the foot makes walking and running more economical in terms of energy. As can be examined in a footprint, the medial longitudinal arch curves above the ground. This arch stretches from the heel bone over the "keystone" ankle bone to the three medial metatarsals. In contrast, the lateral longitudinal arch is very low. With the cuboid serving as its keystone, it redistributes part of the weight to the calcaneus and the distal end of the fifth metatarsal. The two longitudinal arches serve as pillars for the transverse arch which run obliquely across the tarsometatarsal joints. Excessive strain on the tendons and ligaments of the feet can result in fallen arches or
flat feet.
Muscles The muscles acting on the foot can be classified into
extrinsic muscles, those originating on the anterior or posterior aspect of the lower leg, and
intrinsic muscles, originating on the dorsal (top) or plantar (base) aspects of the foot.
Extrinsic All muscles originating on the lower leg except the
popliteus muscle are attached to the bones of the foot. The tibia and fibula and the
interosseous membrane separate these muscles into anterior and posterior groups, in their turn subdivided into subgroups and layers.
Anterior group Extensor group: the
tibialis anterior originates on the proximal half of the tibia and the
interosseous membrane and is inserted near the
tarsometatarsal joint of the first digit. In the non-weight-bearing leg, the tibialis anterior dorsiflexes the foot and lift its medial edge (
supination). In the weight-bearing leg, it brings the leg toward the back of the foot, like in rapid walking. The
extensor digitorum longus arises on the lateral tibial condyle and along the fibula, and is inserted on the second to fifth digits and proximally on the fifth metatarsal. The extensor digitorum longus acts similar to the tibialis anterior except that it also dorsiflexes the digits. The
extensor hallucis longus originates medially on the fibula and is inserted on the first digit. It dorsiflexes the big toe and also acts on the ankle in the unstressed leg. In the weight-bearing leg, it acts similarly to the tibialis anterior.
Peroneal group: the
peroneus longus arises on the proximal aspect of the fibula and
peroneus brevis below it. Together, their tendons pass behind the lateral
malleolus. Distally, the peroneus longus crosses the plantar side of the foot to reach its insertion on the first tarsometatarsal joint, while the peroneus brevis reaches the proximal part of the fifth metatarsal. These two muscles are the strongest pronators and aid in plantar flexion. The peroneus longus also acts like a bowstring that braces the transverse arch of the foot.
Posterior group The
superficial layer of posterior leg muscles is formed by the
triceps surae and the
plantaris. The triceps surae consists of the
soleus and the two heads of the
gastrocnemius. The heads of gastrocnemius arise on the
femur, proximal to the condyles, and the soleus arises on the proximal dorsal parts of the tibia and fibula. The tendons of these muscles merge to be inserted onto the calcaneus as the
Achilles tendon. The plantaris originates on the femur proximal to the lateral head of the gastrocnemius and its long tendon is embedded medially into the Achilles tendon. The triceps surae is the primary plantar flexor. Its strength becomes most obvious during ballet dancing. It is fully activated only with the knee extended, because the gastrocnemius is shortened during flexion of the knee. During walking it not only lifts the heel, but also flexes the knee, assisted by the plantaris. In the
deep layer of posterior muscles, the
tibialis posterior arises proximally on the back of the
interosseous membrane and adjoining bones, and divides into two parts in the
sole of the foot to attach to the tarsus. In the non-weight-bearing leg, it produces plantar flexion and supination, and, in the weight-bearing leg, it proximates the heel to the calf. The
flexor hallucis longus arises on the back of the fibula on the lateral side, and its relatively thick muscle belly extends distally down to the
flexor retinaculum where it passes over to the medial side to stretch across the sole to the distal phalanx of the first digit. The
popliteus is also part of this group, but, with its oblique course across the back of the knee, does not act on the foot.
Intrinsic On the top of the foot, the tendons of
extensor digitorum brevis and
extensor hallucis brevis lie deep in the system of long extrinsic extensor tendons. They both arise on the calcaneus and extend into the dorsal
aponeurosis of digits one to four, just beyond the penultimate joints. They act to dorsiflex the digits. Similar to the intrinsic muscles of the hand, there are three groups of muscles in the
sole of foot, those of the first and last digits, and a central group:
Muscles of the big toe: the
abductor hallucis stretches medially along the border of the sole, from the calcaneus to the first digit. Below its tendon, the tendons of the long flexors pass through the
tarsal canal. The
abductor hallucis is an abductor and a weak flexor, and also helps maintain the arch of the foot. The
flexor hallucis brevis arises on the medial cuneiform bone and related ligaments and tendons. An important plantar flexor, it is crucial to ballet dancing. Both these muscles are inserted with two heads proximally and distally to the first
metatarsophalangeal joint. The
adductor hallucis is part of this group, though it originally formed a separate system (see
contrahens). It has two heads, the oblique head originating obliquely across the central part of the midfoot, and the transverse head originating near the metatarsophalangeal joints of digits five to three. Both heads are inserted into the lateral
sesamoid bone of the first digit. The adductor hallucis acts as a tensor of the plantar arches and also adducts the big toe and might plantar flex the proximal phalanx.
Muscles of the little toe: Stretching laterally from the calcaneus to the proximal phalanx of the fifth digit, the
abductor digiti minimi form the lateral margin of the foot and are the largest of the muscles of the fifth digit. Arising from the base of the fifth metatarsal, the
flexor digiti minimi is inserted together with abductor on the first phalanx. Often absent, the
opponens digiti minimi originates near the cuboid bone and is inserted on the fifth metatarsal bone. These three muscles act to support the arch of the foot and to plantar flex the fifth digit.
Central muscle group: The four
lumbricals arise on the medial side of the tendons of
flexor digitorum longus and are inserted on the medial margins of the proximal phalanges. The
quadratus plantae originates with two slips from the lateral and medial margins of the calcaneus and inserts into the lateral margin of the flexor digitorum tendon. It is also known as the flexor accessorius. The
flexor digitorum brevis arises inferiorly on the calcaneus and its three tendons are inserted into the middle phalanges of digits two to four (sometimes also the fifth digit). These tendons divide before their insertions and the tendons of flexor digitorum longus pass through these divisions. Flexor digitorum brevis flexes the middle phalanges. It is occasionally absent. Between the toes, the
dorsal and
plantar interossei stretch from the metatarsals to the proximal phalanges of digits two to five. The plantar interossei adduct and the dorsal interossei abduct these digits, and are also plantar flexors at the metatarsophalangeal joints. ==Clinical significance==