Foot and Ankle Anatomy

  • Nicola MaffulliEmail author
  • Alessio Giai Via
  • Francesco Oliva
Part of the Orthopaedic Study Guide Series book series (ORTHSTUDY)


The foot is the most complex structure, formed by 28 bones, 33 joints, and 112 ligaments, which are controlled by extrinsic and intrinsic muscles. The foot can be divided into the hindfoot (talus and calcaneus bones); the midfoot, which is formed by the cuboid, navicular, and three cuneiform bones; and the forefoot. The forefoot is composed of five metatarsal bones and the corresponding five toes.

In this chapter, we focus on aspects of anatomy relevant to common pathologies and surgery of the foot and ankle.


  1. 1.
    Oliva F, Del Frate D, Ferran NA, Maffulli N. Peroneal tendons subluxation. Sports Med ArthroscRev. 2009;17:105–11.CrossRefGoogle Scholar
  2. 2.
    Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int. 2000;21:400–3.CrossRefGoogle Scholar
  3. 3.
    Maffulli N, Giai Via A, Oliva F. Arthroscopic-assisted Broström-Gould repair sports injuries. Berlin, Heidelberg: Springer; 2014.Google Scholar
  4. 4.
    Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am. 1995;77:847–55.CrossRefGoogle Scholar
  5. 5.
    Kumai T, Takakura Y, Rufai A, et al. The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat. 2002;200:457–65.CrossRefGoogle Scholar
  6. 6.
    Colville MR, Marder RA, Boyle JJ, et al. Strain measurement in lateral ankle ligaments. Am J Sports Med. 1990;18:196–200.CrossRefGoogle Scholar
  7. 7.
    Ferran NA, Oliva F, Maffulli N. Ankle instability. Sports Med Arthrosc Rev. 2009;17:139–45.CrossRefGoogle Scholar
  8. 8.
    McMinn RMH. Last’s anatomy regional and applied. 9th ed. Edinburgh: Churchill Livingstone; 1994. p. 265.Google Scholar
  9. 9.
    Pisani G. The coxa pedis. Foot Ankle Surg. 1994;1:67–74.CrossRefGoogle Scholar
  10. 10.
    Peicha G, Labovitz J, Seibert FJ, et al. The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study. J Bone Joint Surg Br. 2002;84:981–5.CrossRefGoogle Scholar
  11. 11.
    Eleftheriou K, Rosenfeld PF. Lisfranc injury in the athlete. Evidence supporting management from sprain to fracture dislocation. Foot Ankle Clin. 2013;18:219–36.CrossRefGoogle Scholar
  12. 12.
    Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 2002;30:871–8.CrossRefGoogle Scholar
  13. 13.
    de Palma L, Santucci A, Sabetta SP, et al. Anatomy of the Lisfranc joint complex. Foot Ankle Int. 1997;18:356–64.CrossRefGoogle Scholar
  14. 14.
    Oliva F, Ferran N, Maffulli N. Peroneal retinaculoplasty with anchors for peroneal tendon subluxation. Bull Hosp Joint Dis. 2006;63:113–6.Google Scholar
  15. 15.
    Viidik A. Tensile strength properties of Achilles tendon systems in trained and untrained rabbits. Acta Orthop Scand. 1962;10:261–72.Google Scholar
  16. 16.
    Maffulli N, Giai Via A, Oliva F. Chronic achilles tendon disorders tendinopathy and chronic rupture. Clin Sports Med. 2015;34(4):607–24.CrossRefGoogle Scholar
  17. 17.
    Maffulli N, Giai Via A, Oliva F. Achilles injuries in the athlete: non-insertional. Oper Tech Sports Med. 2014;22:321–30.CrossRefGoogle Scholar
  18. 18.
    Dalton S, Cawston TE, Riley GP, Bayley IJ, Hazleman BL. Human shoulder tendon biopsy samples in organ culture produce procollagenase and tissue inhibitor of metalloproteinases. Ann Rheum Dis. 1995;54:571–7.CrossRefGoogle Scholar
  19. 19.
    Choi HR, Kondo S, Hirose K, et al. Expression and enzymatic activity of MMP-2 during healing process of the acute suprasupinatus tendon tear in rabbits. J Orthop Res. 2002;20:927–33.CrossRefGoogle Scholar
  20. 20.
    Oliva F, Piccilrilli E, Berardi AC, Frizziero A, Tarantino U, Maffulli N. Hormones and tendinopathies: the current evidence. Br Med Bull. 2016;2016:1–20.Google Scholar
  21. 21.
    Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012;10:95.CrossRefGoogle Scholar
  22. 22.
    Oliva F, Berardi AC, Misiti S, et al. Thyroid hormones and tendon: current views and future perspectives. Concise review. Muscles Ligaments Tendons J. 2013;3:201–3.PubMedPubMedCentralGoogle Scholar
  23. 23.
    de Oliveira RR, Lemos A, de Castro Silveira PV, et al. Alterations of tendons in patients with diabetes mellitus: a systematic review. Diabet Med. 2011;28:886–95.CrossRefGoogle Scholar
  24. 24.
    Li Y, Fessel G, Georgiadis M, et al. Advanced glycation end-products diminish tendon collagen fiber sliding. Matrix Biol. 2013;32:169–77.CrossRefGoogle Scholar
  25. 25.
    Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Res Int. 2014;2014:13.CrossRefGoogle Scholar
  26. 26.
    Hallgren A, Björkman A, Chemnitz A, Dahlin LB. Subjective outcome related to donor site morbidity after sural nerve graft harvesting: a survey in 41 patients. BMC Surg. 2013;13:39.CrossRefGoogle Scholar
  27. 27.
    Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998;26(2):266–70.CrossRefGoogle Scholar
  28. 28.
    Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012;470:2268–73.CrossRefGoogle Scholar
  29. 29.
    Kou J. AAOS Clinical Practice Guideline: acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:511–3.CrossRefGoogle Scholar
  30. 30.
    Maffulli N, Giai Via A, Oliva F. Achilles tendon rupture. In: Volpi P, editor. arthroscopy and sport injuries: applications in high-level athletes. Switzerland: Springer; 2015.Google Scholar
  31. 31.
    Maffulli N, Oliva F, Giai VA. Minimally invasive surgery for Achilles tendon pathologies. In: Volpi P, editor. Sports injuries. Berlin, Heidelberg: Springer; 2014.Google Scholar
  32. 32.
    Lee MS, Vanore JV, Thomas JL, et al. Clinical practice guideline adult flatfoot: diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005;44:79–113.CrossRefGoogle Scholar
  33. 33.
    Saxena A, Alessio Giai Via A, Maffulli N, Chi H. Subtalar arthroereisis implant removal in adults: a prospective study of 100 patients. J Foot Ankle Surg. 2016;55(3):500–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicola Maffulli
    • 1
    • 2
    Email author
  • Alessio Giai Via
    • 3
  • Francesco Oliva
    • 4
  1. 1.Department of Musculoskeletal Disorders, School of Medicine and SurgeryUniversity of SalernoSalernoItaly
  2. 2.Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End HospitalLondonUK
  3. 3.Department of Orthopaedic SurgerySant’Anna Hospital, San Fermo della BattagliaComoItaly
  4. 4.Department of Orthopaedic and TraumatologyUniversity of Rome “Tor Vergata”, School of MedicineRomeItaly

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