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Updated: Jan 3 2015

[Blocked from Release] Motion & Muscles of the Foot

Planes of motion in the foot

  • Pronation and supination are a combination of the motion of the three main joints of the foot
 
Pronation
Supination
Ankle joint
dorsiflexion
plantar flexion
Subtalar joint
eversion
inversion
Transverse tarsal joint
abduction
adduction

Anterior tibial muscle / tendon
  • Origin
    • Gerdy's tubercle
  • Innervation
    • DPN (L3-4)
  • Function
    • ankle dorsiflexion
  • Clinical conditions
    • Anterior tibialis rupture
      • presents as sudden onset of dorsiflexion weakness in the active elderly patient
    • Mononeuralgia diabetica
      • foot drop in diabetics
 
Posterior tibial muscle / tendon
  • Insertion
    • inserts on or has confluence with ligamentous structures with every tarsal and metatarsal bone
      • except 1st metatarsal
  • Innervation
    • L4-5
  • Function
    • supinates and inverts the hindfoot
  • Injury
    • will lead to inability to initiate heel rise from stance position
  • Physical exam
    • when checking muscle strength of the tibialis posterior muscle, keep the foot everted and plantar flexed to negate recruitment of the anterior tibial muscle with inversion
 
Flexor hallucis longus tendon / muscle
  • Anatomy
    • lies deep and dorsal to FDL tendon at Henry's knot Vulnerable
  • At risk during
    • at posteromedial corner of subtalar joint during arthrodesis
  • Valuable for augmentation in
    • chronic insertional Achilles tendonitis
      • close to distal Achilles tendon
      • can be harvested as vascularized substitute
 
Abductor Hallucis
  • Function
    • primary antagonist to adductor hallucis
  • innervation comes from proximal 3rd of muscles
    • allows you to be aggressive with mobilization and plantarward retraction which is required in
      • adequate release of PTN in distal tarsal tunnel release
      • Baxter's nerve release (must incise deep fascia)
      • decompressing deep plantar space in compartment syndrome
      • exposing Henry's knot for flexor transfer in PTTI

 

Private Note