Posted by: Indonesian Children | September 11, 2009

ANATOMY : Human foot

The human foot combines mechanical complexity and structural strength. The ankle serves as foundation, shock absorber, and propulsion engine. The foot can sustain enormous pressure (several tons over the course of a one-mile run) and provides flexibility and resiliency.

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws or nails.

The foot and ankle contain:

  • 26 bones (One-quarter of the bones in the human body are in the feet.);
  • 33 joints;
  • more than 100 muscles, tendons (fibrous tissues that connect muscles to bones), and ligaments (fibrous tissues that connect bones to other bones); and
  • a network of blood vessels, nerves, skin, and soft tissue.

These components work together to provide the body with support, balance, and mobility. A structural flaw or malfunction in any one part can result in the development of problems elsewhere in the body. Abnormalities in other parts of the body can lead to problems in the feet.

Human foot

 Anatomy

  • The human foot and ankle is a strong and complex mechanical structure containing 26 bones, 33 joints, and more than a hundred muscles, tendons, and ligaments.
  • An anthropometric study of 1197 North American adult Caucasian males (men age 35.5 years) found that a mans foot length was 26.3 cm with a standard deviation of 1.2 cm.
  • The foot can be subdivided into the hindfoot, the midfoot, and the forefoot:
  • The hindfoot is composed of the talus or heel bone and the calcaneus or ankle bone. The two long bones of the lower leg, the tibia and fibula, are connected to the top of the talus to form the ankle. Connected to the talus at the subtalar joint, the calcaneus, the largest bone of the foot, is cushioned inferiorly by a layer of fat.

The five irregular bones of the midfoot  — the cuboid, navicular, and three cuneiform bones — form the arches of the foot which serves as a shock absorber. The midfoot is connected to the hind- and forefoot by muscles and the plantar fascia.

The forefoot is composed of five toes and the corresponding five proximal long bones forming the metatarsus. Similar to the fingers of the hand, the bones of the toes are called phalanges and the big toe has two phalanges while the other four toes have three phalanges. The joints between the phalanges are called interphalangeal and the those between the metatarsus and phalanges metatarsophalangeal (MTP).

Parts of the Foot
Structurally, the foot has three main parts: the forefoot, the midfoot, and the hindfoot.

Top View of Foot Bones Side View of Foot Bones
Top View of Foot Bones Side View of Foot Bones
Click on the images to view a larger version.

The forefoot is composed of the five toes (called phalanges) and their connecting long bones (metatarsals). Each toe (phalanx) is made up of several small bones. The big toe (also known as the hallux) has two phalanx bones—distal and proximal. It has one joint, called the interphalangeal joint. The big toe articulates with the head of the first metatarsal and is called the first metatarsophalangeal joint (MTPJ for short). Underneath the first metatarsal head are two tiny, round bones called sesamoids. The other four toes each have three bones and two joints. The phalanges are connected to the metatarsals by five metatarsal phalangeal joints at the ball of the foot. The forefoot bears half the body’s weight and balances pressure on the ball of the foot.

The midfoot has five irregularly shaped tarsal bones, forms the foot’s arch, and serves as a shock absorber. The bones of the midfoot are connected to the forefoot and the hindfoot by muscles and the plantar fascia (arch ligament).

The hindfoot is composed of three joints and links the midfoot to the ankle (talus). The top of the talus is connected to the two long bones of the lower leg (tibia and fibula), forming a hinge that allows the foot to move up and down. The heel bone (calcaneus) is the largest bone in the foot. It joins the talus to form the subtalar joint. The bottom of the heel bone is cushioned by a layer of fat.

Musles, Tendons, and Ligaments
A network of muscles, tendons, and ligaments supports the bones and joints in the foot.

Front View of
Foot Muscles
Side View of
Foot Muscles
Back View of
Foot Muscles
Front View of Foot Muscles Side View of Foot Muscles Back View of Foot Muscles
Click on the images to view a larger version.

There are 20 muscles in the foot that give the foot its shape by holding the bones in position and expand and contract to impart movement. The main muscles of the foot are:

  • the anterior tibial, which enables the foot to move upward;
  • the posterior tibial, which supports the arch;
  • the peroneal tibial, which controls movement on the outside of the ankle;
  • the extensors, which help the ankle raise the toes to initiate the act of stepping forward; and
  • the flexors, which help stabilize the toes against the ground.

Skeleton

A human foot – Enlarge to view legend

There can be many sesamoid bones near the metatarsophalangeal joints, although they are only regularly present in the distal portion of the first metatarsal bone.

Arches

The human foot has two longitudinal arches and a transverse arch maintained by the interlocking shapes of the foot bones, strong ligaments, and pulling muscles during activity. The slight mobility of these arches when weight is applied to and removed from the foot makes walking and running more economical in terms of energy. As can be examined in a footprint, the medial longitudinal arch curves above the ground. This arch stretches from the heel bone over the “keystone” ankle bone to the three medial metatarsals. In contrast, the lateral longitudinal arch is very low. With the cuboid serving as its keystone, it redistributes part of the weight to the calcaneus and the distal end of the fifth metatarsal. The two longitudinal arches serve as pillars for the transverse arch which run obliquely across the tarsometatarsal joints. Excessive strain on the tendons and ligaments of the feet can result in fallen arches or flat feet.

Muscles

The muscles acting on the foot can be classified into extrinsic muscles, those originating on the anterior or posterior aspect of the lower leg, and intrinsic muscles, originating on the dorsal or plantar aspects of the footExtrinsic

Anterior leg muscles

All muscles originating on the lower leg except the popliteus muscle are attached to the bones of the foot. The tibia and fibula and the interosseous membrane separate these muscles into anterior and posterior groups, in their turn subdivided into subgroups and layers.

Anterior group

Extensor group: tibialis anterior originates on the proximal half of the tibia and the interosseous membrane and is inserted near the tarsometatarsal joint of the first digit. In the non-weight-bearing leg tibialis anterior flexes the foot dorsally and lift its medial edge (supination). In the weight-bearing leg it brings the leg towards the back of the foot, like in rapid walking. Extensor digitorum longus arises on the lateral tibial condyle and along the fibula to be inserted on the second to fifth digits and proximally on the fifth metatarsal. The extensor digitorum longus acts similar to the tibialis anterior except that it also dorsiflexes the digits. Extensor hallucis longus originates medially on the fibula and is inserted on the first digit. As the name implies it dorsiflexes the big toe and also acts on the ankle in the unstressed leg. In the weight-bearing leg it acts similar to the tibialis anterior.

Peroneal group: peroneus longus arises on the proximal aspect of the fibula and peroneus brevis below it on the same bone. Together, their tendons pass behind the lateral malleolus. Distally, peroneus longus crosses the plantar side of the foot to reach its insertion on the first tarsometatarsal joint, while peroneus brevis reaches the proximal part of the fifth metatarsal. These two muscles are the strongest pronators and aid in plantar flexion. Longus also acts like a bowstring that braces the transverse arch of the foot.

   
Deep and superficial layers of posterior leg muscles

Posterior group

The superficial layer of posterior leg muscles is formed by the triceps surae and the plantaris. The triceps surae consists of the soleus and the two heads of the gastrocnemius. The heads of gastrocnemius arise on the femur, proximal to the condyles, and soleus arises on the proximal dorsal parts of the tibia and fibula. The tendons of these muscles merge to be inserted onto the calcaneus as the Achilles tendon. Plantaris originates on the femur proximal to the lateral head of the gastrocnemius and its long tendon is embedded medially into the Achilles tendon. The triceps surae is the primary plantar flexor and its strength becomes most obvious during ballet dancing. It is fully activated only with the knee extended because the gastrocnemius is shortened during knee flexion. During walking it not only lifts the heel, but also flexes the knee, assisted by the plantaris.

In the deep layer of posterior muscles tibialis posterior arises proximally on the back of the interosseous membrane and adjoining bones and divides into two parts in the sole of the foot to attach to the tarsus. In the non-weight-bearing leg, it produces plantar flexion and supination, and, in the weight-bearing leg, it proximates the heel to the calf. flexor hallucis longus arises on the back of the fibula (i.e. on the lateral side), and its relatively thick muscle belly extends distally down to the flexor retinaculum where it passes over to the medial side to stretch across the sole to the distal phalanx of the first digit. The popliteus is also part of this group, but, with its oblique course across the back of the knee, does not act on the foot.

Intrinsic
  • On the back (top) of the foot, the tendons of extensor digitorum brevis and extensor hallucis brevis lie deep to the system of long extrinsic extensor tendons. They both arise on the calcaneus and extend into the dorsal aponeurosis of digits one to four, just beyond the penultimate joints. They act to dorsiflex the digits.
   
Dorsal and plantar aspects of foot

Similar to the intrinsic muscles of the hand, there are three groups of muscles in the sole of foot, those of the first and last digits, and a central group:

Muscles of the big toe: abductor hallucis stretches medially along the border of the sole, from the calcaneus to the first digit. Below its tendon, the tendons of the long flexors pass through the tarsal canal. It is an abductor and a weak flexor, and also helps maintain the arch of the foot. flexor hallucis brevis arises on the medial cuneiform bone and related ligaments and tendons. An important plantar flexor, it is crucial for ballet dancing. Both these muscles are inserted with two heads proximally and distally to the first metatarsophalangeal joint. Adductor hallucis is part of this group, though it originally formed a separate system (see contrahens.) It has two heads, the oblique head originating obliquely across the central part of the midfoot, and the transverse head originating near the metatarsophalangeal joints of digits five to three. Both heads are inserted into the lateral sesamoid bone of the first digit. Adductor hallucis acts as a tensor of the plantar arches and also adducts the big toe and then might plantar flex the proximal phalanx.

Muscles of the little toe: Stretching laterally from the calcaneus to the proximal phalanx of the fifth digit, abductor digiti minimi form the lateral margin of the foot and is the largest of the muscles of the fifth digit. Arising from the base of the fifth metatarsal, flexor digiti minimi is inserted together with abductor on the first phalanx. Often absent, opponens digiti minimi originates near the cuboid bone and is inserted on the fifth metatarsal bone. These three muscles act to support the arch of the foot and to plantar flex the fifth digit.

 
Central muscles of foot

Central muscle group: The four lumbricales arise on the medial side of the tendons of flexor digitorum longus and are inserted on the medial margins of the proximal phalanges. Quadratus plantae originates with two slips from the lateral and medial margins of the calcaneus and inserts into the lateral margin of the flexor digitorum tendon. It is also known as flexor accessorius. Flexor digitorum brevis arise inferiorly on the calcaneus and its three tendons are inserted into the middle phalanges of digits two to four (sometimes also the fifth digit). These tendons divide before their insertions and the tendons of flexor digitorum longus pass through these divisions. Flexor digitorum brevis flexes the middle phalanges. It is occasionally absent. Between the toes, the dorsal and plantar interossei stretch from the metatarsals to the proximal phalanges of digits two to five. The plantar interossei adducts and the dorsal interossei abducts these digits and are also plantar flexors at the metatarsophalangeal joints.

Medical aspects

  • Due to their position and function, feet are exposed to a variety of potential infections and injuries, including athlete’s foot, bunions, ingrown toenails, Morton’s neuroma, plantar fasciitis, plantar warts and stress fractures. In addition, there are several genetic conditions that can affect the shape and function of the feet, including a club foot or flat feet.
  • This leaves humans more vulnerable to medical problems that are caused by poor leg and foot alignments. Also, the wearing of shoes, sneakers and boots can impede proper alignment and movement within the ankle and foot. For example, high heels are known to throw off the natural weight balance (this can also affect the lower back). For the sake of posture, flat soles and heels are advised.

A doctor who specializes in the treatment of the feet practices podiatry and is called a podiatrist. A pedorthist specializes in the use and modification of footwear to treat problems related to the lower limbs.

Smaller muscles enable the toes to lift and curl.

There are elastic tissues (tendons) in the foot that connect the muscles to the bones and joints. The largest and strongest tendon of the foot is the Achilles tendon, which extends from the calf muscle to the heel. Its strength and joint function facilitate running, jumping, walking up stairs, and raising the body onto the toes. Ligaments hold the tendons in place and stabilize the joints. The longest of these, the plantar fascia, forms the arch on the sole of the foot from the heel to the toes. By stretching and contracting, it allows the arch to curve or flatten, providing balance and giving the foot strength to initiate the act of walking. Medial ligaments on the inside and lateral ligaments on outside of the foot provide stability and enable the foot to move up and down. Skin, blood vessels, and nerves give the foot its shape and durability, provide cell regeneration and essential muscular nourishment, and control its varied movements.

In culture

Worldwide, different cultures treat and perceive feet very differently:

  • Many societies have “foot taboos”:
    • In countries strongly influenced by Buddhism (e.g., Thailand, Nepal), feet are the least respected parts of the body and strong taboos obtain against touching with feet, pointing with feet, or exposing the sole of the foot toward someone. In Thai custom, feet should not be in a higher position than someone’s head and must never face someone or an image of the Buddha. In Nepal, sleeping on the floor with someone’s feet oriented toward another sleeper is considered entirely unacceptable.
    • Traditional Arab culture also has the same anti-foot bias as in the Nepal or Thailand cultures.
  • In traditional China (10th through 20th Centuries), the practice of female foot binding stunted the growth of the feet of young girls, resulting in a very tiny, intensely painful, and aesthetically desirable (though deformed) foot- this was often nicknamed ‘Pink Socking’ as it left the foot bright pink.
  • Within several Christian denominations, foot washing is a religious ritual possibly originating in the hospitality customs of the Levant.
  • Foot fetishism is a sexual interest and preoccupation with feet and hosiery. Playing footsie is also a term dealing with rubbing each other’s feet, and can have sexual connotations, while a foot job is a sex act involving the feet.

 

Footwear customs

Customs about footwear while indoors vary significantly from place to place and usually depend on climate, weather, and other factors:

  • It is customary to remove one’s footwear when entering a home:
  • In some cultures, bare feet may be considered unsightly or offensive. In Thailand, it is considered extremely offensive to show someone the sole of your foot, although the practice of going barefoot is common, due to various reasons including hot climate and tradition.
  • In many religious subgroups of Uzbekistan, touching another’s foot is a sign of affection. However, more conservative families consider this to be an act of promiscuity.
  • The feet are one of the most common places to be tickled on the human body. The soles generally tend to be sensitive to tickling.

It is customary that the wearing of toe rings in public be limited to close shoe toes only.

Customary measurement

  • One way to measure short distances on the ground is by placing one foot directly in front of the other; this led to the adoption of the foot as a unit of length, even though not all human feet correspond to this measure.
  • It is a myth that the Imperial “foot” (304.8 mm) is about the length of the average European male foot. The average today is less than 280 mm and 90% of the population is within 20 mm of that. Although many men today have feet that are 11.5 inches long (size 12-13): most are less than size 11. In the past, the average length would have been even less. The overall length of most shoes however, is above one “foot”. Tradition has it that the Imperial foot was based upon the size of Hercules‘ foot or the size of the king of England’s foot.

Evolutionary variations

  • A paw is the soft foot of a mammal, generally a quadruped, that has claws or nails. A hard foot is called a hoof.
  • Depending on style of locomotion, animals can be classified as plantigrade (sole-walking), digitigrade (toe-walking), or ungulate (nail-walking).
  • The metatarsals are the bones that make up the main part of the foot in humans, and part of the leg in large animals or paw in smaller animals. The number of metatarsals are directly related to the mode of locomotion  — five digits being the most primitive setup, with many larger animals having their digits reduced to two (elk, cow, sheep) or one (horse).
  • The metatarsal bones of feet and paws are tightly grouped compared to, most notably, the human hand where the thumb metacarpal diverges from the rest of the metacarpus.

 

 

 

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CLINIC FOR CHILDREN 

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646 

http://childrenclinic.wordpress.com/ 

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO 

email : judarwanto@gmail.com 

 

 

 

 

 

                                                                                                            

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.


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