External landmarks and palpation
During inspection and palpation of the dorsum of the foot, a number of important anatomical structures can be identified that serve as the key to understanding the topography of this region.
On the medial (inner) border of the foot, the main bony landmark is the tuberosity of the navicular bone (tuberositas ossis navicularis). It is located in the middle of the inner border and is easily palpable beneath the skin, approximately 3–4 centimeters distal to the medial malleolus. A dense cord—the tendon of the tibialis anterior muscle (m. tibialis anterior)—can be traced to this tuberosity.
Slightly lateral to the tendon of the tibialis anterior muscle lies the tendon of the extensor hallucis longus muscle (m. extensor hallucis longus). It becomes particularly prominent and easily palpable in the area of the great toe when the patient is asked to perform active dorsiflexion of it.
On the lateral border of the foot, the tuberosity of the fifth metatarsal bone (tuberositas ossis metatarsalis V) is easily palpated. In the distal part of the dorsum of the foot, the tendons of the extensor digitorum longus muscle (m. extensor digitorum longus) are also clearly visible. Their contours stand out sharply beneath the skin during dorsiflexion of the 2nd–5th toes.
Topographical boundaries of the dorsum of the foot
The boundaries separating the dorsum of the foot from the plantar surface are drawn along conventional projection lines connecting bony prominences.
- Lateral boundary: represented by a line drawn from the midpoint of the height of the calcaneus directly to the middle of the head of the fifth metatarsal bone.
- Medial boundary: constructed similarly, but on the medial side—it is a line running from the midpoint of the height of the calcaneus to the middle of the head of the first metatarsal bone.
These lines clearly divide two functionally and anatomically distinct zones of the foot.
Transverse arches of the foot
The bony apparatus of the foot is organized into arches that provide shock absorption during walking. There are two main transverse arches, each with its own bony foundation and musculotendinous strengthening apparatus.
- Distal transverse arch:
- Formed by: metatarsal bones.
- Reinforced by: the transverse head of the abductor hallucis muscle (caput transversum m. adductoris hallucis).
- Proximal transverse arch:
- Formed by: tarsal bones.
- Reinforced by: the tendons of the tibialis posterior muscle (m. tibialis posterior) and fibularis longus muscle (m. fibularis longus).
Clinical significance: If the reinforcing musculoligamentous apparatus weakens, the arches lower. This leads to anatomical flattening of the foot and the development of a pathological condition — flatfoot.
Ligamentous apparatus and formation of canals
A special role in topography and biomechanics is played by the long plantar ligament (lig. plantare longum). Its fibers are divided into two layers:
- Deep fibers firmly attach to the tuberosity of the cuboid bone (tuberositas ossis cuboidei).
- Superficial fibers extend further and fixate to the bases of the metatarsal bones.
Passing over the sulcus of the cuboid bone (sulcus ossis cuboidei), this powerful ligament turns the bone sulcus into a closed osteofibrous canal. Inside this canal runs an important anatomical structure — the tendon of the fibularis longus muscle (m. fibularis (peroneus) longus).
Briefly: answers to topical questions
What intrinsic muscles are located on the dorsum of the foot?
The dorsum of the foot contains intrinsic short extensors and dorsal interosseous muscles.
- Extensor digitorum brevis (m. extensor digitorum brevis) — located in the dorsal subfascial space.
- Extensor hallucis brevis (m. extensor hallucis brevis) — located in the dorsal subfascial space; the dorsalis pedis artery lies in the same layer as the short extensors.
- Dorsal interosseous muscles (mm. interossei dorsales) — covered by the deep fascia, which separates them from the overlying tendons.
What fascial spaces are distinguished on the dorsum of the foot?
A single dorsal subfascial space is distinguished on the dorsum of the foot. It is located beneath the proper fascia of the dorsum of the foot, which laterally and medially attaches to the first and fifth metatarsal bones. The deep (inferior) wall of this space is formed by the deep fascia covering the metatarsal bones and dorsal interosseous muscles. Inside the space are the tendons of the long extensors within synovial sheaths, the short extensors of the toes, and the neurovascular bundle.
Which neurovascular bundle passes in the deep layer of the dorsum of the foot?
The neurovascular bundle of the dorsum of the foot includes the artery, veins, and nerve passing in the subfascial space.
- Dorsalis pedis artery (a. dorsalis pedis) — lies in the same layer as the short extensors, lateral to the tendon of the extensor hallucis longus.
- Dorsal veins of the foot (vv. dorsales pedis) — accompany the artery of the same name.
- Deep fibular nerve (n. fibularis [peroneus] profundus) — lies medial to the artery.
The projection line of the bundle runs from the midpoint of the intermalleolar distance to the first interdigital space.
Which veins form the dorsal venous network of the foot?
The dorsal venous network of the foot (rete venosum dorsale pedis) is formed by small subcutaneous veins. The following vessels successively participate in its formation:
- Dorsal digital veins of the foot (vv. digitales dorsales pedis).
- Dorsal metatarsal veins of the foot (vv. metatarsales dorsales pedis).
- Dorsal venous arch of the foot (arcus venosus dorsalis pedis) — collects blood from the metatarsal veins and itself forms part of the dorsal venous network.
Proximally, the medial and lateral marginal veins depart from this network.
Class and exam questions
Where and how to find the tuberosity of the navicular bone?
It is located in the middle of the medial border of the foot, 3–4 cm distal to the medial malleolus. The landmark is the tendon of the tibialis anterior muscle, which attaches to this tuberosity.
How are the boundaries between the dorsum and sole of the foot determined?
The lateral border runs from the midpoint of the height of the calcaneus to the middle of the head of the fifth metatarsal bone. The medial border runs from the midpoint of the height of the calcaneus to the middle of the head of the first metatarsal bone.
What passes through the osteofibrous canal of the cuboid bone?
In this canal, formed by the sulcus of the cuboid bone and the long plantar ligament, runs the tendon of the fibularis longus muscle (m. fibularis longus).
Which structures reinforce the proximal transverse arch of the foot?
The proximal transverse arch, consisting of the tarsal bones, is reinforced by the tendons of the tibialis posterior and fibularis longus muscles.
What else to study on this topic
- Topography and branching of the dorsalis pedis artery (a. dorsalis pedis)
- Innervation of the skin and muscles of the dorsum of the foot
- Proper fasciae and fascial spaces of the dorsum of the foot
- Short extensors of the toes: anatomy and function
- Surgical approaches in operations on the tarsal bones
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