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Anatomy of the Foot and Ankle & Common Problems

The anatomy of the foot is incredibly complex. This introduction to the anatomy of the foot and ankle will be very general and highlight the main structures.

Bones and Joints of the Foot and Ankle

The Ankle

Ankle Joint - lateral

Lateral side of the ankle Joint capsule

The ankle joint or tibiotalar joint is formed where the top of the talus (the uppermost bone in the foot) and the tibia (shin bone) and fibula meet. The ankle joint is both a synovial joint and a hinge joint.  Hinge joints typically allow for only one direction of motion much like a door-hinge.  Consequently, the ankle joint mainly only allows for upward (toes-up; or dorsiflexion) and downward (toes down; or plantarflexion) movements of the foot in relation to the tibia.

Learn About Ankle Sprain

Learn About Achilles Tendonitis – Symptoms, Diagnosis and Treatment

The ankle joint is actually more stable in dorsiflexion (toes up) than in plantarflexion (toes down). Other movements, such as tilting and rotation take place in and around the joints in the foot itself (see subtalar joint below).

Similar to other articular joints, the bones of the ankle joint are lined with articular or hyaline cartilage. This articular cartilage is incredibly smooth and allows for very fluid and pain-free motion of the ankle joint.

Strong ligaments on either each side of the ankle joint give additional stability to the joint. The lateral (outer) ankle is kept stable by the lateral ligament complex which includes the: anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and the calcaneofibular ligament (CFL). As is indicated in their respective names, each ligament connects the fibula to one of two bones in the foot (talus or calcaneus).  These ligaments are commonly injured in ankle sprains in the setting of a twisting injury.

The very robust deltoid ligament complex helps to stabilize the inner side of the ankle (or medial side or the ankle). Because it is so strong, it is less commonly injured than the lateral ligamentous complex (described above). In fact, in the setting of an ankle injury, oftentimes, the portion of the tibia that the deltoid ligament complex is attached to (the medial malleolus) is oftentimes more likely to break than the deltoid itself.

As is the case with all joints, an articular capsule surrounds the tibiotalar joint as well. A synovial membrane lines this capsule and is responsible for producing synovial fluid.  Synovial fluid is a lubricant which helps to promote very smooth and pain-free motion at the ankle joint.

The arteries supplying the ankle joint are branches of the anterior and posterior tibial arteries as well as the peroneal artery.

The nerves of the ankle are derived from the deep and superficial peroneal nerves, the tibial nerves, and the sural and saphenous nerves.

The Foot

Bones of the foot as seen from the medial (arch) side.

The foot is a firm platform that support the weight of the body.  It is made up of many bones including the tarsal bones, the metatarsal bones, and the phalanges (described in more detail below). Many of the bones, particularly of the midfoot, are solidly reinforced with very sturdy ligaments which limit motion.  Consequently, when compared to the hand, despite having similarities in structure, the foot is much less mobile. For instance, while analogous bones do exist between the hand and the foot, such as the metatarsal bones and the phalanges (analogous to the metacarpal bones and phalanges of the hand) the bones of the feet are smaller, more sturdy in nature, and have limited motion when compared to the bones of the hand. This is again a consequence of design for function — the purpose of the foot is much different than that of the hand.

Bones of the foot from the lateral side (side opposite the arch.)

In discussion of the bones of the foot, it is important to discuss the subtalar joint.  It is a common misconception that the tibiotalar joint, in addition to allowing up/down motion of the ankle, allows for side to side motion of the ankle in relation to the leg. However, this side to side motion of the ankle is actually a function of the subtalar joint.  This joint is made up of the talus and the calcaneus (the heel bone). It is important to remember this, as it is actually a separate joint that can develop osteoarthritis independently of the tibiotalar joint.

Below are slightly more detailed descriptions of the bones of the foot.

Tarsal Bones

The tarsal bones work together as a group. The way these bones fit together and interact with one another is very interesting. When the muscles of the foot and leg twist the foot in a particular direction, the tarsal bones lock together to form a very rigid construct. This occurs during the phase of walking called toe-off, which allows you to propel yourself forward without your foot collapsing beneath you.

On the other hand, when muscles pull in the opposite direction, the bones unlock, allowing the foot to conform to whatever surface the foot is in contact with.

There are seven tarsal bones: the calcaneus, talus, cuboid, navicular, and the first, second, and third cuneiforms.

The calcaneus (heel bone) is the largest of the tarsal bones. It transmits the weight of the body to the ground and serves as the attachment point for the muscles of the calf. The calcaneus joins with the talus and cuboid.

The talus (ankle bone) is the second largest of the tarsal bones and sits atop the calcaneus to form the subtalar joint. It is joined on either side with the tibia and fibula to form the tibiotalar joint. The talus forms a joint with four bones: tibia, fibula, calcaneus, and navicular.

The cuboid is on the lateral side (opposite the arch of the foot) and in front of the calcaneus.

The navicular is on the medial (inner) side of the foot, between the talus and the cuneiform bones in front. The navicular forms joints with four bones: the talus and the three cuneiforms.

The first cuneiform forms a joint with four bones: the navicular, second cuneiform, and first and second metatarsals. The second cuneiform forms joints with four bones: the navicular, first and third cuneiforms, and second metatarsal. The third cuneiform forms joints with six bones: the navicular, second cuneiform, cuboid, and second, third, and fourth metatarsals.

Metatarsal Bones

There are 5 metatarsal bones that are numbered 1-5 starting from the inner (medial) aspect of the foot. I.e. the metatarsal associated with the great toe is the labeled the 1st metatarsal.

There is a fairly rigid connection between the metatarsals and tarsal bones.  Consequently, not much movement occurs here at what is considered the midfoot. This is important to bear in mind in the setting of midfoot arthritis. i.e. If an individual is experiencing significant pain from midfoot arthritis, not much foot motion is lost following a mid-foot fusion (the surgical procedure of choice for this condition).

Phalanges

The phalanges are the small bones of the toes. The joints that are formed between the metatarsals and the first phalanx of each toe is called a metatarsophalangeal joint. These joints form the “ball” of the foot, and normal movement in these joints is very important for a normal walking pattern. The most important of these for walking is the 1st metatarsophalangeal joint (the great toe). Furthermore, common problems of the foot usually involve this joint. Osteoarthritis can develop here which can be quite debilitating (this is called hallux rigidus).  Gouty flares tend to involve this joint as well. Finally, a bunion (also called hallux valgus) can also develop here.

The phalanges of the foot are analogous to the phalanges in the hand in terms of their number and general arrangement: there are two phalanges in the great toe, and three in each of the other toes. They differ from the hand, however, in their size and shape. The bodies are shorter in length and tend to be much wider as well.

Soft Tissues of the Foot and Ankle

The soft tissues of the foot and ankle include ligaments, tendons, fascia, nerves and blood vessels. Some of these structures were briefly discussed before.

Ligaments

Medial Ligaments of the Foot

Medial Ligaments of the Foot (arch side of the foot)

Ligaments are strong, dense, and flexible bands of fibrous connective tissue. The function of ligaments is to attach bones to bones and help to stabilize them. Ligaments are often named after the bones they join together. The name may also contain a directional description. For example, the posterior talotibial ligament is on the posterior side (back side) of the foot and connects the talus and the tibia.

As mentioned earlier, two important ligamentous complexes of the ankle included the strong deltoid ligament complex on the medial (or inner) aspect of the ankle and the three lateral (outer ankle) ligaments: the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament (CFL).

 

Ligaments of the lateral side of the foot

Muscles

There are many muscles that help to move and support the ankle and foot. The strong muscles that move the ankle originate in the leg. The most obvious of these are the gastrocnemius and soleus muscles, which are the strong calf muscles that allow you to push up on your toes. The other muscles of the calf that are deeper within the leg are the flexors of the toes (including the flexor hallucis longus and flexor digitorum longus) as well as the larger posterior tibialis muscle which is a strong inverter (swings the ankle inwards) of the ankle and is important to the maintenance of the normal arch of the foot. It is also the muscle that helps to “lock” the tarsal bones of the foot during toe-off (as described above) so you can appropriately propel yourself forward when you walk without your feet collapsing underneath you. Consequently, people who have deficiency of the posterior tibialis tendon (also known as posterior tibial tendon insufficiency) are unable to toe-off and also become flat-footed.

On the outer leg you have the peroneal muscles which include the peroneus (also called fibularis — because it originates on the fibula) longus and the peroneus (or fibularis) brevis muscles.  These two muscles allow you to evert the ankle i.e. swing it outwards. The tendons of these muscles wrap around the lateral malleolus (around the far end of the fibula) and can actually become irritated or torn here, leading to symptoms of pain.

On the front of the leg you have the extensors of the toes (such as extensor hallucis longus, extensor digitorum longus) and the anterior tibialis muscle – the strongest dorsiflexor of the ankle. i.e. weakness of this muscle or tearing of its tendon leads to a foot-drop. The peroneus tertius muscle also is located on the front of the leg.

There are many muscles within the feet itself. However, a more detailed description of these muscles is beyond the scope of this article.

Tendons

Tendons are elastic tissues made up of collagen. They are the continuations of muscles and allow them to firmly connect to bones. There are numerous tendons around the ankle that also help to stabilize and ultimately move the ankle. They are associated with muscles discussed in the section above.  One of the most important tendons is the achilles tendon. This is the tendon on the back of the ankle that represents the attachment of the calf muscles (the gastrocnemius and soleus muscles) to the calcaneus. This tendon can become torn or irritated, causing weakness and/or pain. 

Bones and tendons of the foot

Fascia

Fascia is a broad fibrous sheet-like structure that is found all over the body.  In most situations, it helps to separate soft tissue layers from one another and add a bit of stability as well.  In the foot, the plantar fascia is an important structure on the bottom of the foot that is important for both the normal function of the foot and for maintaining the normal arch of the foot.  Importantly, it is a common cause of heel pain (also known as plantar fasciitis).

plantar-fascia on the bottom of the foot

Common Problems in the Ankle Joint and Foot

  • Plantar fasciitis
  • Calcaneal stress fractures
  • Ankle fracture
  • Ankle ligament sprain
  • Achilles tendonitis
  • Achilles tendon rupture
  • Peroneal tendonitis / tears / subluxation
  • Bunion
  • Tibiotalar, subtalar, midfoot arthritis
  • Hallux rigidus
  • Hammer toes
  • Tarsal tunnel syndrome
  • Flat feet

Comments

  1. I have dislocation and liagment of bones problem will the plates be a option

  2. I am hoping for other people’s experiences with my issue. I fainted, hitting my foot. I went to urgent care and had an x-ray. Bc of swelling breaks didn’t show. I have flat foot deformation so I am used to foot pain. I was trying to resolve health problems so I let pain continue until I realized I had a real problem. I had a break and stage two separation of navicular bone. From point of break it took 15 months to heal and my foot collapsed so the ankle and foot are no longer aligned and the ankle moves in and out. I wear Arizona braces. At the point that bone healed I got a stress fracture just above ankle on opposite side. It healed well. Six months later I suddenly had blinding going to pass out pain going diagonally across shin and along outside bone of leg on collapsed foot side. This began on a Friday night. On Saturday I went to ER sure I had more broken bones. Nope, got a morphine shot. By next day I was still having blinding pain, went to urgent care, no breaks, no answers. Went to my orthopedist on Monday, so glad they could get me in. All x-rayed. Either a stress fracture that would not be show until it begins to heal, or more likely the ankle moving in and out has been tugging the tendon and I tore the tendon at base of tibia/fibula. It would cause this kind of pain. So ten days of wrapping it and staying in wheelchair. I can’t use the boot used for these problems. Ten days are not up yet. The pain has decreased a great deal but I can’t take a step on it yet, taking weight. Pain has migrated to calf. When I try to put weight on it, it feels like the muscles along shin and calf are going to blow. I am 47 years old. This has greatly interfered with my quality of life. Since the first injury, I have gained 65 pounds. My orthopedist cannot do surgery bc my high bmi puts me at risk at hospital he works out of. His partner has offered to see me. I am afraid of having surgery to correct surgery, afraid my weight will keep the surgery from taking and I will be in constant pain. But my doctor has said that without correcting problem, I will be open for injuries to this foot, ankle, and leg for the rest of my life, because I do not stand on a stable platform. I would just like some input.

  3. i can flex my foot up and down, move my big toe up and down, also rotate the foot around. I have no pain…..but…i cannot raise myself up on my right foot. I do not have the lever action when pushing off with my right foot when walking. No pain…just weakness. Can anyone help?

  4. Lisa Cowley says

    Hi
    I uad a fall 3 weeka ago and since then the front part of my ankle is swollen slightly and completely numb ! Will this gradually get better

    Lisa

  5. Wallace MacGregor says

    I have swelling underneath and at side of my small toe on left foot and numbness is now evident. What is the likely diagnosis?

  6. Go to the doctor people! That’s what we’re here for. Not for people to disgnose themselves online

  7. deepak kumar says

    The ligament of mother leg has been broken and she is having lots of pain so what can i do please help me ifsome one is having there

  8. John Colonna says

    There is absence of the posterior 3 quarter of the talus. The adjacent margins of the tibia, remaining portion of the talus and the superior aspect of the calcaneus are irregular containing cyst and edema. To allow the club foot to flex the operation was to cut the talus.

  9. Brandan Noble says

    I love the fact that anything you want to know about can be found via the Internet and resources like this page!
    I just watched my foot fold,Completely sideways trying to catch my balance on a moss covered hill…
    Needless to say, with the backpack blower from landscaping still on my back it wasn’t happening!
    I watched my left foot give it hell to stop my awesomely embarrassing roll down a hill no one should have tried to balance themselves on.
    So here I am at the hospital waiting to get X-rays done and I think to myself…
    I want to know exactly what it could have been that popped on the left side of my left foot.
    And here
    we are.. Real time and I’m great full for this website because now I’m pretty sure I completely tore my ANTERIOR TALOFIBULAR LIGAMENT!
    Let’s see what the Doctor says after the X-rays are looked at!?!🤔

  10. Cindy Schmidler says

    Please consult your healthcare provider to diagnose your foot pain. It is likely that your care provider can provide you with some stretches or exercise to help.

  11. Vernon Delancy says

    Left foot on the inside under the ankle bone . Is that a tendon problem n what can I do to solve it ?

  12. N S Korgaonkar says

    I suddenly began to have pain on the lateral side of left foot. Pain, quite painful, to touch. I also have pain on the bottom of my heel especially after I get up in the moning or sometimes even when I am walking .

  13. Barbara McKinney says

    I suddenly began to have pain on the lateral side of left foot. Pain, quite painful, to touch and extends from opposing side of arch and extends to cuboid? bone. I also have pain on the bottom of my heel especially if I am walking. I cannot recall doing anything to my foot; have had a partial knee replacement L and I may have to have it replaced. Thank you

  14. Can you explain to me why the bones in the dorsal side of my ankle have begun to make a “crunching” sound when I put weight on it, or turn it to the side? Someone said it is “softening” of the bones, due to my age (82.) That may be so …. what can be done about it? I have no pain, just have concern because it only recently occurred.

  15. once the tibia is healed how long does it take to move and walk normally

  16. please tell me the name of the transverse arch just in front of the heel bone.
    Thank you

  17. Abdool K Wookay says

    Hi

    I had a ligament operation on my outside of the ankle but in 2009 but I get severe pain and swelling on the inside of the foot. I think it is the deltoid ligament. Please help as this keeps on recurring.

    Thanks

  18. surya kumari says

    my ankel broken very small piece.how i can i recover without operation

  19. thanks for the tips I have been struggling Plantar Fasciitis for the last 3 months this website about plantarfasciitispaintreatment.com has been unbelievably handy. thanks a lot

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