Fibularis [peroneus] longus

Fibularis [peroneus] brevis

Fibularis [peroneus] longus

Fibularis [peroneus] brevis

Figure 12-8. Muscles related to movement of the foot. A, Extensor muscles of the leg. B, Lateral (fibular) muscles. C, Triceps surae muscles. D, Deep flexor muscles.

Trendelenburg Sign

the plantar surface of the foot from compression during weight bearing; they help the foot absorb shock during impact with the ground; and they help store mechanical energy and release it to improve the efficiency of locomotion. Integrity of the arches depends primarily on ligamentous support, in addition to bone alignment and support from extrinsic muscles of the foot. The middle and lateral cuneiform bones are shaped and positioned to play the role of keystone in the transverse arch. Their wedge shape, wider dorsally than on their plantar surface, helps prevent their descent through the arch.

The plantar fascia, the long and short plantar ligaments, the spring ligament, the collateral liga ments of the ankle, and the interosseous ligament of the subtalar joint all contribute important soft tissue support to the arches of the foot (Fig. 12-10). Research indicates that support of the arches depends on several structures; no single structure provides primary support.1-3

Abnormalities in arches in runners are associated with different injury patterns4: Runners with high arches report more ankle and bony injuries,5 and those with low arches report more knee and soft tissue injuries. Deformed arches resulting from disruptions of the supporting ligaments and from weak and tight muscles lead to direct impairment of the arches.

Subtalar Neutral Position. The concept of the subtalar neutral position helps to illustrate postural

Navicular Intermediate cuneiform Medial cuneiform Base of metatarsal I


Medial and lateral sesamoid bone

Distal phalanx Middle phalanx Proximal phalanx

Medial and lateral sesamoid bone

Tuberosity of metatarsal V

Cuboid, tuberosity

Tarsal bones

Tuberosity of metatarsal V

Head Neck Medial malleolar facet Body Posterior process of talus, medial tubercule Sustentaculum tali

Calcaneus, medial process of calcaneal tuberosity

Groove for tendon of flexor hallucis longi

> Talus

Cuboid, tuberosity

Tarsal bones

Trochlea of talus Neck

Lateral malleolar facet

Posterior process of talus, lateral tubercule

Calcaneus -Fibular trochlea Calcaneal tuberosity

Transverse tarsal joint* Navicular (Intermediate cuneiform Lateral cuneiform y Tarsometatarsal joints** Metatarsal

Tarsal sinus

Tarsal sinus

Transverse tarsal joint*

Cuboid Tarsometatarsal joints**

Head of metatarsal V Tuberosity of metatarsal V

Extensor digitorum longus and brevis muscles, tendon Dorsal fascia of foot Dorsal interosseus of foot Dorsal interosseus of foot IV (Opponens digiti minimi) Abductor digiti minimi Flexor digiti minimi brevis -(Lateral plantar eminence)A Plantar interosseus III Plantar interosseus II Plantar aponeurosis

Dorsal interosseus of foot II

Extensor hallucis longus and brevis muscles, tendons Dorsal interosseus of foot I Plantar interosseus I Adductor hallucis, oblique head Abductor hallucis -XL"-^ Flexor hallucis longus, tendon yT(Medial plantar eminence) Flexor hallucis brevis Flexor digitorum longus and brevis muscles, tendon (Intermediate plantar eminence)

Figure 12-9 The three arches of the foot. A, Medial longitudinal arch. B, Lateral longitudinal arch. C, Transverse arch.

compensations in the foot. The neutral position of the subtalar joint is defined as neither pronated nor supinated.6 Subtalar neutral position appears to maximize the area of contact between the talus and calcaneus. Movements away from the subtalar neutral position into pronation or supination decrease the contact area.7 Medial deviation of the calcaneus in relation to the leg constitutes a varus deformity; lateral deviation of the hindfoot on the leg is a val-gus deformity (Fig. 12-11).

In upright stance with the tibias approximately vertical, a medially aligned hindfoot (i.e., a hindfoot

Collateral ligaments

Deep transverse metatarsal ligament

Tuberosity of fifth_

metatarsal bone Groove for fibularis [peroneus] longus, tendon

Long plantar ligament Plantar calcaneocuboid ligament Calcaneofibular ligament Long plantar ligament

Medial process of calcaneal tuberosity Calcaneal tuberosity

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