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Muscles
The foot relies on more than thirty muscles and tendons for motion and stability—not only in the foot itself but indirectly in areas above the foot. The muscles give the foot its shape by holding the bones in position. Without muscle support, the skeleton and all its bones would collapse. Much of the foot support comes from muscles that attach higher up in the leg, with tendons coming down into and attaching to bones of the foot. Many other important muscles are exclusively found within the foot itself.
All the muscles of the foot, ankle, and leg play a vital role in foot movements. Because of the extensive nature of the structure and function of all these muscles, this discussion will be limited to only the most important muscles and muscle groups.
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TIBIALIS POSTERIOR MUSCLE
The tibialis posterior is a long muscle that attaches to the two leg bones—the tibia and fibula—in the middle of the back calf under the large gastrocnemius and soleus muscles (just below the knee). The tibialis posterior muscle runs down the back of the leg around the inside of the ankle (the medial side) and into the bottom of the foot, inserting into different bones. Contracting this muscle allows you to point your foot down (an action called plantar flexion). It also turns the foot inward. The ability to rise on your toes also requires the function of the tibialis posterior muscle.
The tibialis posterior is one of the most important muscles associated with many foot, ankle, and knee problems. It’s a key stabilizing muscle for the mid- and hind-foot. When this muscle does not work properly, it can cause a variety of non-specific symptoms, which can be difficult to diagnose.
Because of its importance in supporting the medial arch, abnormal inhibition or “weakness” of this muscle, perhaps its most common problem, causes poor arch support that can lead to excess pronation and other problems. Secondary to tibialis posterior inhibition is often tightness of the gastrocnemius and/or soleus muscles, and sometimes pain in the Achilles tendon. (Recall that abnormal muscle inhibition is a neuromuscular condition similar to a weak muscle.)
TIBIALIS ANTERIOR MUSCLE
The tibialis anterior is also a long muscle and attaches predominantly on the upper half of the tibia on the front of the leg (and slightly to the outside) just below the knee, where it is easily felt as a relatively large mass. It runs downward and becomes a large tendon crossing the ankle, easily visible when lifting the foot. It continues below the ankle and attaches into the first metatarsal bone and the first cuneform bone.
The tibialis anterior muscle raises the foot upward (an action called dorsal flexion) and assists in turning the foot inward. Like the tibialis posterior, when inhibited (weak), it can cause instability of the ankle, and may be responsible for problems in the first metatarsal joint. It may also be a common cause of so-called shin splints, although the posterior tibialis is also commonly involved.
PERONEUS MUSCLES
The peroneus longus and brevis muscles attach mostly on the fibula on the outside, or lateral side, of the leg, with some parts attached to the tibia. These muscles become a tendon just above the ankle and can be seen just behind the bony end of the fibula (called the lateral malleolus)—the bony protuberance of the outside ankle—where it attaches to the ankle. The longus portion of the peroneus attaches into the cuneform bone and first metatarsal bone, with the brevis attaching to the fifth metatarsal bone.
The peroneus longus and brevis muscles stabilize the outside of the ankle, allowing the outer foot to elevate or evert while the ankle is plantar flexed (foot pointed down). If you try to contract this muscle by pointing your foot down and out, you can easily see and feel it on the outside of the leg.
The peroneus tertius muscle is a much shorter but important muscle that also stabilizes the outside of the ankle. This muscle attaches on the lower portion of the fibula bone on the outside of the ankle and inserts into the fifth metatarsal bone. It allows the outside of the foot to turn upward with the ankle. This muscle is often involved is common ankle sprains, and if it does not heal properly after trauma can help maintain a chronic ankle problem.
GASTROCNEMIUS AND SOLEUS MUSCLES
The bulk of calf muscle on the back of the leg is made up of the gastrocnemius and soleus muscles. Together, these two muscles are sometimes referred to as the triceps surae. They attach into the upper leg bones and, in part, above the knee into the back of the thighbone, the femur. These muscles are important for rising on our toes during any movement. These two muscles form the Achilles tendon beginning at about the middle of the calf. This tendon runs downward and attaches into the back of the calcaneus bone. Both the muscles and the Achilles tendon provide great support for the foot through stability of the heel.
PLANTAR MUSCLES
There are four layers of muscles on the bottom of the foot consisting of a dozen separate muscles. Overall, these have grabbing actions important for walking, running, foot coordination, and balance. These actions are best observed when barefoot. Wearing shoes can render these and other foot muscles less active and could lead to chronic foot problems. Walking and moving while barefoot improves these and other foot and leg muscle functions.
