Basic Anatomy of the Dancer's Ankle and Foot

Original Editor - Carin Hunter based on the course by Michelle Green-Smerdon
Top Contributors - Carin Hunter and Kim Jackson
Tibia, Fibula and Talus

The ankle and foot are complex and detailed structures that bear the weight of the whole body, and are designed to showcase a beautiful work of art. The ankle and foot is a very complex system.[1] This part of the body has to cope with high compressive and shearing forces and at the same time it has to offer a high degree of stability. The ankle is the kinetic link of the foot to higher up in the body and the foot is the body's interaction with the ground and has to control multi-axial motions occurring simultaneously.[2]

Transverse-tarsal joint

Very simply, the ankle is made up of three bones, the Tibia, Fibula and Talus and three joints, the transverse-tarsal joint which works together with the talocalcaneal joint, the talocalcaneal joint which controls inversion and eversion and the tibiotalar joint which helps with stability, flexion and extension.

Foot Summary[edit | edit source]

  1. Hind foot[3]
    1. Bones
      1. Talus
        1. This is the highest foot bone
        2. There are no tendons attached to it, only the Deltoid ligament
        3. It is a mostly cartilage surface
        4. It has a poor blood supply and therefore relatively poor healing.
      2. Calcaneous
      3. Lateral and medial malleolus
    2. Joints
      1. Tibiotalar Joint:
        1. The talus is at its widest anteriorly, meaning the joint is more stable in dorsiflexion.
        2. The conforming geometry of the tibiotalar joint is considered to contribute to the stability of the joint. In stance phase, the geometry of the joint alone is sufficient to provide resistance to eversion; otherwise stability is derived from the soft tissue structures.
      2. Subtalar joint:
        1. Absorbs rotational stress from higher up the body
      3. Transverse tarsal joint:
        1. Transitional link between the hindfoot and forefoot
  2. Mid Foot[3]
    1. Bones
      1. Navicular
        1. The navicular has poor blood supply and the main attachment for posterior tibial tendon on medial side.
      2. Cuboid
      3. Three Cuneforms (Medial, Intermedius, Lateral).
        1. These are important for stability along with the plantar and dorsal ligaments.
    2. Joints
      1. Five Tarsal-metatarsal joints, also known as the Lisfranc joint.
    3. Ligaments, muscles and tendons
      1. Plantar fascia ligament
        1. This ligament is responsible for forming arches of feet and shock absorber when dancing.
  3. Forefoot[3]
    1. Bones
      1. 14 Phalanges
      2. 5 Metatarsals
        1. The heads are the main weightbearing surface in the following ballet positions: Releve[4], quarter pointe, demi-pointe, and three quarter pointe.
      3. 2 Sesmoid bones
        1. These are located inside Flexor Hallucis Brevis tendon and allows toe to move up and down
    2. Joints
      1. Metatarsophalangeal joints
    3. Ligaments, muscles and tendons
      1. The 1st metatarsal bone is the location for the attachment of several tendons and is important for it's role in propulsion and weight bearing

Ligaments of the Foot and Ankle[edit | edit source]

  1. Medial Ligaments[5]
    1. Deltoid ligament is fan shaped comprising 4 ligament and resists eversion:
      1. Anterior tibiotalar ligament (deep component)
      2. Tibiocalcaneal ligament
      3. Tibionavicular ligament
      4. Posterior tibiotalar ligament (deep component)
    2. Expansion of joint capsule
      1. Spring ligament: Cradles and supports the talar head
      2. Lisfranc ligaments: Series of ligaments that stabilize tarsometatarsal joints and provide stability to the arch of the foot. The Plantar ligament is stronger than the dorsal ligament.
      3. Inter-metatarsal ligament: This is found between the tarsal bones and keep the metatarsals moving in sync. If the nerve running between these joints gets irritated, this could result in a Morton's neuroma.
        Pointe with Good Alignment
  2. Lateral Ligaments[5]
    1. This is the most commonly injured ligament[6] in dancers
    2. Anterior Talofibular Ligament
      1. Tightens in Plantar flexion
      2. Is the weakest ligament concluded by many authors
    3. Calcaneo-fibular Ligament
      1. Tightens in dorsiflexion
    4. The following ligaments contribute to ankle stability
      1. Posterior Talofibular Ligament
      2. Anterior-Inferior Talofibular Ligament
      3. Posterior-Inferior Talofibular Ligament (Russel et al, 2008)

Ballet Specific Ligament Anatomy[edit | edit source]

  • In a Demi –plié, when the ankle is in dorsiflexion, the Anterior Talofibular Ligament will relax and the Calcaneo-fibular Ligament will be under tension
  • The opposite is expected when en pointe, when the ankle is in plantarflexion, although no studies have been done to examine extreme position en pointe
  • Strain in Anterior Talofibular Ligament increases with increasing Plantarflexion and is further accentuated during compressive loading through the ankle
  • Maximum plantarflexion en pointe places Anterior Talofibular Ligament parallel to fibula, thus functioning as a primary stabilizer of lateral ankle
  • This places Anterior Talofibular Ligament at particular risk at it's weakest and at it's longest at maximal tension force[7]

Syndesmosis[edit | edit source]

Ligament formed by:

  1. Anterior-Inferior Talofibular Ligament
  2. Interosseus membrane
  3. Posterior-Inferior Talofibular Ligament
  4. Transverse ligament
  5. Interosseus ligament

Their function is to hold the tibia and fibula together at the appropriate distance and form a mortise where talus sits.[8]

Muscles of the Foot and Ankle[edit | edit source]

1. Extrinsic Foot Muscles[edit | edit source]

These muscles have contractile portions that lie outside the ankle, in the leg, and the tendons of those muscles insert onto the bones of the foot in such a way that ankle motion occurs when the muscles contract. There are four 4 compartments, separated by fascia. The Superficial Posterior compartment, Deep Posterior Compartment and the Lateral Compartment are all Plantarflexors and the Anterior compartment are the Dorsiflexors.

  1. Superficial Posterior compartment (Plantar flexors)
    1. Gastrocnemius
    2. Soleus
    3. Plantaris
  2. Deep Posterior Compartment (Plantar flexors)
    1. Flexor Hallucis Longus[9]
      1. Action: Inversion
      2. Location: On the plantar surface of 1st toe
    2. Flexor Digitorum Longus
      1. Action: Inversion
      2. Location: On the plantar surface 2nd to 5th toes
    3. Tibialis Posterior[10]
      1. Action: Inversion
      2. Location: navicular, medial cuneiform, 2-4 toes, other cuneiforms, cuboid
  3. Lateral Compartment (Plantar flexors)
    1. Peroneus Longus
      1. Action: Eversion and plantar flexion
      2. Location: First metatarsal, medial cuneiform and 1st toe
    2. Peroneus Brevis
      1. Action: Eversion
      2. Location: All 5 toes
  4. Anterior compartment (Dorsiflexors)
    1. Tibialis anterior
      1. Action: Inversion
      2. Location: 1st toe and medial cuneiform
    2. Extensor Hallucis Longus
      1. Action: Inversion
    3. Extensor Digitorum Longus
    4. Peroneals
      1. Action: Eversion

2. Intrinsic Foot Muscles[edit | edit source]

These muscles all originate and insert within the foot. They are known to move the toes and stabilize the foot. Dancers refer to these muscles as the “core” muscles of the foot.[11]

The three largest muscles are Abductor Hallucis, Flexor digitorum brevis and Quadratus Plantae. They all provide the support and stability of the arch. In dancers, these muscles require strength and control. A dancer needs to learn to work with “straight” toes, which includes providing counter stability to the metatarsals when pointing.

Four Muscle Layers of the Plantar Foot[edit | edit source]

Muscles Tendons Neurovascular structures
Layer One
  • Abductor hallucis
  • Flexor digitorum brevis (FDB)
  • Abductor digiti minimi
First Layer
Layer Two
  • Quadratus plantae        
  • Lumbrical muscles
  • Flexor digitorum longus (FDL)        
  • Flexor hallucis longus (FHL)  
Medial and Lateral Plantar Arteries
Second Layer
Layer Three
  • Flexor hallucis brevis        
  • Oblique and transverse heads of the adductor hallucis        
  • Flexor digiti minimi brevis
Third Layer
Layer Four
  • Dorsal interosseous        
  • Plantar interosseus
  • Peroneus longus
  • Tibialis posterior
Fourth Layer

Plantar fascia[edit | edit source]

  • This is made up of strong fibrous tissue
  • it is known to originates deep within the plantar surface of the calcaneus and inserts on the base of each of the toes
  • When the toes are in dorsiflexion, this tightens the fascia and supports the arch.
  • Windlass mechanism:[12] The windlass mechanism is a mechanical model that describes the manner which plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on plantar fascia[13]


Arches of the foot

Arches[edit | edit source]

What makes up the arches of the foot?

Purpose:[14]

  1. Spring
  2. Weight bearing
  3. Shock absorption
  4. Provides flexibility to the foot to facilitate function
Medial arch of the foot

1. Medial longitudinal arch[15][16][edit | edit source]

  1. Bone
    1. This is the highest arch due to the shape of bones
    2. The first 3 metatarsals
    3. 3 cuneiforms
    4. Navicular
    5. Talus
    6. Calcaneus
  2. Ligament
    1. Spring ligament
    2. Deltoid ligament
    3. Interosseus ligament
    4. Plantar aponeurosis
    5. Long and short plantar ligaments
  3. Muscle
    1. Tibialis posterior
    2. Tibialis anterior
    3. Flexor Hallucis Longus
    4. Flexor Digitorum Longus
    5. Short muscles of the big toe

2. Lateral longitudinal arch[15][edit | edit source]

Lateral Arch of the foot

Only arch to lie on the ground in a standing position

  1. Bone
    1. Shape of the bones
    2. Calcaneus
    3. Cuboid
    4. 4th and 5th metatarsals
  2. Ligament
    1. Long and short plantar ligaments
    2. Interosseus ligament
    3. Plantar aponeurosis
  3. Muscle
    1. Peroneus longus and brevis
    2. Flexor digitorum longus
    3. Short muscles of the little toe
Demi Pointe with weight bearing surface on the Transverse Arch

3. Transverse Arch[15][edit | edit source]

  1. Bone
    1. Wedge shape of the lateral and intermediate cuniform
    2. Metatarsal bases
    3. Cuboid
    4. 3 cuneiforms
  2. Ligament
    1. Deep transverse ligament
    2. Dorsal and plantar ligament
  3. Muscle
    1. Peroneus longus and brevis
    2. Transverse head of adductor hallucis
    3. Slips of tibial posterior

References[edit | edit source]

  1. Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthopaedics and trauma. 2016 Jun 1;30(3):232-8.
  2. Houglum PA, Bertoti DB. Brunnstrom's clinical kinesiology. FA Davis; 2012
  3. 3.0 3.1 3.2 Ficke J, Byerly DW. Anatomy, Bony Pelvis and Lower Limb, Foot. StatPearls [Internet]. 2021 Aug 11.
  4. Veirs KP, Rippetoe JR, Baldwin JD, Lutz K, Haleem AM, Dionne CP. Multi-Segment Assessment of Ankle and Foot Kinematics during Elevé Barefoot Demi-Pointe and En Pointe. In2020 Combined Sections Meeting (CSM) 2020 Feb 13. APTA.
  5. 5.0 5.1 Das A, Bhuyan D. A Review on the Anatomy and Biomechanics of the Foot-Ankle Complex. Asian Journal For Convergence In Technology (AJCT). 2018 Apr 15.
  6. SAH SA, MR ES, Srijit D, Norzana AG. Ankle Injuries in Sports: Anatomical Considerations and Clinical Implications.
  7. Russell JA, McEwan IM, Koutedakis Y, Wyon MA. Clinical anatomy and biomechanics of the ankle in dance. Journal of dance medicine & science. 2008 Sep 1;12(3):75-82.
  8. Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. Journal of athletic training. 2001 Jan;36(1):68.
  9. Murdock CJ, Munjal A, Agyeman K. Anatomy, Bony Pelvis and Lower Limb, Calf Flexor Hallucis Longus Muscle. StatPearls [Internet]. 2021 Aug 6.
  10. Corcoran NM, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Tibialis Posterior Muscle. StatPearls [Internet]. 2020 Sep 17.
  11. Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proceedings of the National Academy of Sciences. 2019 Jan 29;116(5):1645-50.
  12. Metsavaht L, Leporace G. Current trends in the biokinetic analysis of the foot and ankle. Journal of the Foot & Ankle. 2020 Aug 30;14(2):191-6.
  13. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. Journal of athletic training. 2004 Jan 1;39(1):77.
  14. Batenhorst EZ. A Dancer’s View: Analysis and Prevention of Common Dance Injuries.
  15. 15.0 15.1 15.2 Ahonen J. Biomechanics of the foot in dance: a literature review. Journal of Dance Medicine & Science. 2008 Sep 1;12(3):99-108.
  16. Ozdinc SA, Turan FN. Effects of ballet training of children in Turkey on foot anthropometric measurements and medial longitudinal arc development. J. Pak. Med. Assoc. 2016 Jul 1;66(7):869-74.