The dorsal side of your foot, also known as the top of your foot, is a pretty complicated area, full of all sorts of parts that work together to help you move, stay balanced, and support your weight. If you want to understand what’s going on when you have foot or ankle pain, it’s helpful to understand the different parts of your foot.
That’s why it’s so important for doctors and other healthcare professionals to have a solid understanding of foot anatomy — it helps them accurately diagnose and treat foot and ankle issues. Knowing what’s on the surface of the foot can also help narrow down what might be going on.
The foot itself is often described as being divided into three parts: the hindfoot, the midfoot, and the forefoot. It also has a medial (inner) and lateral (outer) column, which have different amounts of movement.
In this article, we’ll dig deep into the anatomy of the dorsal side of the foot. We’ll cover the bones, joints, ligaments, muscles, and nerves, and talk about what each of them does.
Bones and joints of the dorsal foot
The dorsal side of your foot is a complex structure made up of bones and joints that work together to provide stability, flexibility, and movement. Here’s a closer look at the components that make up the dorsal foot:
Bones of the Dorsal Foot
- Talus: The talus bone connects to the tibia and fibula to form your ankle joint. Around 70% of the talus is covered in hyaline cartilage, which helps the joint move smoothly. The talus doesn’t get much blood flow, which can make healing difficult.
- Navicular: On the inner side of your foot, the navicular bone connects to the talus at the back and the cuneiform bones at the front. You can feel the navicular tuberosity as a bump on the inner top of your foot.
- Cuneiforms: There are three cuneiform bones—medial, intermediate, and lateral—that connect to the navicular bone behind them and the metatarsals in front. They help form the transverse arch of your foot.
- Cuboid: On the outer side of your foot, the cuboid bone connects to the calcaneus at the back and the fourth and fifth metatarsals at the front. It’s part of the outer column of your foot.
- Metatarsals: Five metatarsal bones make up the midfoot, connecting the tarsal bones to the phalanges (toe bones). The metatarsals are numbered 1 to 5, starting on the inner side of your foot.
- Phalanges: Your toes are made up of fourteen phalanges. Each toe has three phalanges (proximal, middle, and distal), except for your big toe, which only has two (proximal and distal). The phalanges connect to the metatarsals at the metatarsophalangeal (MTP) joints.
Joints of the Dorsal Foot
- Talocrural Joint: This joint is formed where the tibia, fibula, and talus meet. It’s mostly responsible for dorsiflexion (raising your foot up) and plantarflexion (pointing your foot down).
- Talonavicular Joint: This joint connects the talus to the navicular bone and helps with inversion (turning your foot inward) and eversion (turning your foot outward).
- Cuneonavicular Joint: This connects the navicular bone to the cuneiform bones and allows for gliding movements.
- Cuboideonavicular Joint: This connects the cuboid and navicular bones and allows for gliding movements.
- Tarsometatarsal (TMT) Joints: These joints connect the tarsal bones (cuneiforms and cuboid) to the metatarsals. They’re also known as the Lisfranc joint complex. Movement here is limited but important for stability. The 1st TMT joint allows about 1.6° of motion; the 2nd TMT joint allows about 0.6° of motion; the 3rd TMT joint allows about 3.5° of motion; the 4th TMT joint allows about 9.6° of motion; and the 5th TMT joint allows about 10.2° of motion.
- Metatarsophalangeal (MTP) Joints: These joints connect the metatarsals to the phalanges, allowing you to raise and lower your toes. The MTP joints allow for about 90° of hyperextension and 30-50° of flexion.
- Interphalangeal (IP) Joints: These joints connect the phalanges to each other, allowing you to bend and straighten your toes.
Ligaments of the dorsal foot and ankle
Ligaments play a crucial role in stabilizing the foot and ankle, allowing us to walk, run, and jump with confidence. Several ligaments are particularly important to the dorsal (top) side of the foot.
Ankle ligaments (relevant to dorsal stability)
- Anterior talofibular ligament (ATFL). Located on the outer (lateral) side of the ankle, the ATFL is one of the most commonly injured ligaments in ankle sprains. It prevents the ankle from sliding too far forward.
- Calcaneofibular ligament (CFL). Also on the lateral side, the CFL provides stability to the ankle joint and helps prevent excessive inversion (turning inward).
- Anterior inferior tibiofibular ligament (AITFL). This ligament connects the tibia and fibula bones just above the ankle joint. An AITFL injury can result in a syndesmosis sprain, sometimes called a “high ankle sprain,” which is more severe and takes longer to heal than a typical ankle sprain.
Dorsal foot ligaments
- Lisfranc ligaments. These ligaments are critical to midfoot stability, connecting the metatarsals (long bones of the foot) to the tarsal bones (bones of the ankle and midfoot). Injury to the Lisfranc ligaments can lead to significant instability and pain.
- Intermetatarsal ligaments. Located between the bases of the metatarsals, these ligaments contribute to the stability of the transverse arch of the foot. They’re also critical to midfoot stability.
Other supporting structures
- The interosseous membrane. This strong, fibrous sheet connects the tibia and fibula along their entire length, contributing to overall lower leg stability and helping to distribute weight-bearing forces.
- The syndesmosis. As mentioned earlier, the syndesmosis is the fibrous joint between the distal (lower) tibia and fibula. It stabilizes the ankle mortise, the “socket” formed by the tibia and fibula that holds the talus bone of the foot.
Understanding the anatomy and function of these ligaments is essential for diagnosing and treating foot and ankle injuries effectively.
Muscles and tendons of the dorsal foot
The dorsal side of your foot is crisscrossed with muscles and tendons that allow you to move your foot and toes. These muscles can be divided into two groups: extrinsic and intrinsic.
Extrinsic muscles (tendons crossing the dorsal foot)
Extrinsic muscles are located in the lower leg, and their tendons cross the ankle joint to insert into the foot. These muscles are responsible for dorsiflexion (lifting the foot up) and plantarflexion (pointing the foot down), as well as inversion (turning the sole of the foot inward) and eversion (turning the sole of the foot outward).
- Anterior tibialis: This muscle dorsiflexes and inverts the foot. Its tendon is easily visible on the dorsal side of the ankle.
- Extensor hallucis longus: As the name suggests, this muscle extends your big toe, and it also helps with dorsiflexion. Its tendon runs along the top of your foot to your big toe.
- Extensor digitorum longus: This muscle extends your four smaller toes and assists with dorsiflexion. It splits into four tendons that run along the top of your foot to each of the four toes.
- Peroneus tertius: This muscle dorsiflexes and everts the foot. Its tendon is located on the front and outer side of your ankle and foot.
Intrinsic muscles (located entirely within the foot)
Intrinsic muscles are located entirely within the foot. These muscles help with fine motor movements of the toes and provide support for the arch of the foot.
- Extensor hallucis brevis: This muscle extends your big toe. It’s located on the top of your foot.
- Extensor digitorum brevis: This muscle extends your second, third, and fourth toes. It’s also located on the top of your foot. The outermost part of this muscle is sometimes called the peroneus brevis.
Functional considerations
For normal walking and running, it’s important to have the right balance of strength and flexibility in the muscles of your foot and ankle.
For example, you need a proper balance between the dorsiflexors (which lift your foot up) and the plantarflexors (which point your foot down).
The tendons of the extrinsic muscles need to glide smoothly over the top of the foot for efficient movement. If these tendons become inflamed or restricted, it can cause pain and limit your range of motion.
Nerves of the dorsal foot
The dorsal side of the foot is served by a network of nerves that provide sensation and control muscle movement. Here are some of the key nerves:
Superficial peroneal nerve
The superficial peroneal nerve is responsible for providing sensory innervation to the dorsum, or upper surface, of the foot. This nerve splits into the medial and intermediate dorsal cutaneous nerves.
Deep peroneal nerve
The deep peroneal nerve controls the muscles in the anterior compartment of the leg. It also provides sensation to the space between your big toe and second toe.
Saphenous nerve
The saphenous nerve provides sensation to the medial, or inner, side of your foot. It runs along the medial malleolus, which is the bony bump on the inside of your ankle.
Sural nerve
The sural nerve provides sensation to the lateral, or outer, side of your foot. It runs along the lateral malleolus, the bony bump on the outside of your ankle.
Clinical significance
Because of their location, the nerves in your feet can sometimes be compressed or injured.
Nerve entrapment
Compression of the deep peroneal nerve can cause pain and numbness in the dorsal foot. This compression may occur because of tight shoes or trauma to the foot.
Surgical considerations
Surgeons have to be aware of the location of the nerves in the foot to avoid injury during foot and ankle procedures. Anatomical variability is common, so surgeons must carefully identify and protect these nerves during surgery.
Key Takeaways
The dorsal side of the foot is more than just the top of your foot; it’s a complex network of bones, joints, ligaments, muscles, and nerves working together.
Understanding how all these pieces function together is crucial for figuring out, diagnosing, and treating foot and ankle problems. The foot’s ability to handle different surfaces and cushion each step depends on these structures working in sync.
If you’re a healthcare professional who deals with foot and ankle issues, a solid grasp of dorsal foot anatomy is a must. It’s the foundation for providing effective care and helping people stay active and pain-free.