02/07/2023
🔈 SURFACE ANATOMY OF FOOT
The tendons in the ankle region can be identified satisfactorily only when their muscles are acting. If the foot is actively inverted, the tendon of the tibialis posterior may be palpated as it passes posterior and distal to the medial malleolus, then superior to the sustentaculum tali, to reach its attachment to the tuberosity of the navicular. Hence, the tibialis posterior tendon is the guide to the navicular. The tendon of the tibialis posterior also indicates the site for palpating the posterior tibial pulse (halfway between the medial malleolus and the calcaneal tendon.
The tendons of the fibularis longus and brevis may be followed distally, posterior and inferior to the lateral malleolus, and then anteriorly along the lateral aspect of the foot. The fibularis longus tendon can be palpated as far as the cuboid, and then, it disappears as it turns into the sole. The fibularis brevis tendon can easily be traced to its attachment to the dorsal surface of the tuberosity on the base of the 5th metatarsal. This tuberosity is located at the middle of the lateral border of the foot. With toes actively extended, the small fleshy belly of the extensor digitorum brevis may be seen and palpated anterior to the lateral malleolus. Its position should be observed and palpated so that it may not be mistaken subsequently for an abnormal edema (swelling).
The tendons on the anterior aspect of the ankle (from medial to lateral side) are easily palpated when the foot is dorsiflexed:
• The large tendon of the tibialis anterior leaves the cover of the superior extensor tendon, from which level the tendon is invested by a continuous synovial sheath; the tendon may be traced to its attachment to the 1st cuneiform and the base of the 1st metatarsal.
• The tendon of the extensor hallucis longus , obvious when the great toe is extended against resistance, may be followed to its attachment to the base of the distal phalanx of the great toe.
• The tendons of the extensor digitorum longus may be followed easily to their attachments to the lateral four toes.
• The tendon of the fibularis tertius may also be traced to its attachment to the base of the 5th metatarsal. This muscle is of minor importance and may be absent.
