Where is toes

Anatomical structures tendons, bones, joints, etc tend to hurt exactly where they are injured or inflamed. Therefore a basic understanding of surface anatomy allows the clinician to quickly establish the diagnosis or at least narrow the differential diagnosis.

For those conditions that require surgery a detailed understanding of anatomy is critical to ensure that the procedure is performed efficiently and without injuring any important structures. With a good grasp of foot anatomy it readily becomes apparent which surgical approaches can be used to access various areas of the foot and ankle.

There are a variety of anatomical structures that make up the anatomy of the foot and ankle Figure 1 including bones, joints, ligaments, muscles, tendons, and nerves. These will be reviewed in the sections of this chapter. The foot is traditionally divided into three regions: the hindfoot , the midfoot , and the forefoot Figure 2.

Additionally, the lower leg often refers to the area between the knee and the ankle and this area is critical to the functioning of the foot. The Hindfoot begins at the ankle joint and stops at the transverse tarsal joint a combination of the talonavicular and calcaneal-cuboid joints. The bones of the hindfoot are the talus and the calcaneus. The Midfoot begins at the transverse tarsal joint and ends where the metatarsals begin --at the tarsometatarsal TMT joint.

While the midfoot has several more joints than the hindfoot, these joints have limited mobility. The five bones of the midfoot comprise the navicular, cuboid, and the three cuneiforms medial, middle, and lateral. The Forefoot is composed of the metatarsals, phalanges, and sesamoids. The bones that make up the forefoot are those that are last to leave the ground during walking.

There are twenty-one bones in the forefoot: five metatarsals, fourteen phalanges, and two sesamoids. The great toe has only a proximal and distal phalanx, but the four lesser toes each have proximal, middle, and distal phalanges, which are much small than those of the great toe.

There are two sesamoid bones embedded in the flexor hallucis brevis tendons that sit under the first metatarsal at the level of the great toe joint 1st metatarsophalangeal joint. The foot is sometimes described as having two columns Figure 3.

The medial column is more mobile and consists of the talus, navicular, medial cuneiform, 1st metatarsal, and great toe. The lateral column is stiffer and includes the calcaneus, cuboid, and the 4th and 5th metatarsals. The foot is comprised of 28 bones Figure 1. Where two bones meet a joint is formed —often supported by strong ligaments.

It is helpful to think of the joints of the foot based on their mobility Table 1. A few of the joints are quite mobile and are required for the foot to function normally from a biomechanical point of view. These are often referred to as essential joints. There are some joints that move a moderate amount, and there are other joints that are held tightly together with strong ligaments.

These non-mobile joints are sometimes referred to as non-essential joints. This may be a poor term in that it incorrectly implies that the joints are not important; they are important. Rather the correct sense is only that movement from these joints is less critical. Bones of the lower leg and hindfoot: Tibia, Fibula, Talus, Calcaneus. Joints of the hindfoot: Ankle Tibiotalar , Subtalar. The foot is connected to the body where the talus articulates with the tibia and fibula.

The tibia and fibula are held together by the tibiofibular syndesmosis, a collection of 5 ligaments. The prominence on the medial side of the distal tibia is known as the medial malleolus; the distal aspect of the fibula is known as the lateral malleolus. The talus is the top most proximal bone of the foot. The talus connects to the calcaneus on the underside through the subtalar joint , and distally it connects to the navicular through the talonavicular joint. These articulations allow the foot to rotate smoothly around the talus.

Owing primarily to the fact that no tendons attach to it and that most of its surface is cartilage, the talus has a relatively poor blood supply. The lack of a robust blood supply means that injuries to this bone take greater time to heal than might be the case with other bones—and some injuries will not heal at all.

The talus is generally thought of as having three parts: the body, the head, and the neck Figure 5. The talar body, which is roughly square in shape and is topped by the dome, connects the talus to the lower leg at the ankle joint. The talar head is adjacent to the navicular bone to form the talonavicular joint. The talar neck is located between the body and head of the talus.

The talar neck is one of the few areas of the talus not covered with cartilage, and is thus the point of entry for the blood vessels supplying the talus. The calcaneus is commonly known as the heel bone. The calcaneus is the largest bone in the foot, and along with the talus, it makes up the area of the foot known as the hind-foot. There are three protrusions anterior, middle, and posterior facet on the superior surface of the calcaneus that allow the talus to sit on top of the calcaneus, forming the subtalar joint Figure 6.

The calcaneus also connects to the cuboid bone to form the calcaneal-cuboid joint. The subtalar joint moves in concert with the talonavicular joint and the calcaneocuboid joint , two joints located near the front of the talus. Bones of the midfoot : Cuboid, Navicular, Cuneiform 3. Joints of the midfoot: talonavicular, calcaneocuboid, intercunneiform, tarsometatarsal TMT. The cuboid bone is a square-shaped bone on the lateral aspect of the foot. The main joint formed with the cuboid is the calcaneocuboid joint , where the distal aspect of the calcaneus articulates with the cuboid.

The navicular is distal to the talus and connects with it through the talonavicular joint. The distal aspect connects to each of the three cuneiform bones. Like the talus, the navicular has a poor blood supply. Many tendons attach these muscles to the bones and ligaments that hold the bones together to maintain the foot's arch.

The main tendon of the foot is the Achilles tendon , which runs from the calf muscle to the heel. The Achilles tendon makes it possible to run, jump, climb stairs and stand on your toes. Get involved with the arthritis community. Every gift to the Arthritis Foundation will help people with arthritis across the U.

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Become a Volunteer More About Volunteering. By taking part in the Live Yes! And all it takes is just 10 minutes. Both of these structures are made up of small fibers of a material called collagen. The collagen fibers are bundled together to form a rope-like structure. Ligaments and tendons come in many different sizes, and like rope, are made up of many smaller fibers. The thicker the ligament or tendon the stronger it is. The large Achilles tendon is the most important tendon for walking, running, and jumping.

It attaches the calf muscles to the heel bone to allow us to rise up on our toes. The posterior tibial tendon attaches one of the smaller muscles of the calf to the underside of the foot. This tendon helps support the arch and allows us to turn the foot inward.

The toes have tendons attached on the bottom that bend the toes down and attached on the top of the toes that straighten the toes. The anterior tibial tendon allows us to raise the foot. Two tendons run behind the outer bump of the ankle lateral malleolus and attach to the outside edge of the foot.

These two tendons help turn the foot outward. Many small ligaments hold the bones of the foot together. Most of these ligaments form part of the joint capsule around each of the joints of the foot. A joint capsule is a watertight sack that forms around all joints. It is made up of the ligaments around the joint and soft tissue between the ligaments that fills in the gaps and forms the sack. You can freely give, refuse or withdraw your consent at any time by accessing our cookie settings tool.

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