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| Ref: https://www.sportsandspinal.net.au/) |
The muscles of the anterior compartment of the leg are listed in medio-lateral direction: tibialis anterior (TA), extensor hallucis longus (EHL), extensor digitorum longus (EDL), and peroneus tertius (PT). The name of them refer to “extensor” but they provide ankle dorsiflexion.
In my physiotherapy experience, they are difficult to feel stretched in the stretching procedure that I provide massage rather than stretching. However, stretching is necessary for them.
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| Heel to toe drop calculation (Ref: https://www.permanent365.top/) |
Sometimes, I have seen patients with anterior shin soreness after running. I asked them about how to run, type of running shoes, distance, changing speed as routine questions. The most was indicated to be tibialis anterior because of repetitive ankle dorsiflexion in running. By the way, running with low heel to toe drop will need more muscle workload for ankle dorsiflexion than high heel to toe drop. Distance and changing speed can be a risk factor if muscle fitness is not good enough. Because ground reaction force can impact every landing.
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| Ankle inversion twisting (Ref: https://www.marca.com/en/basketball/nba/) |
In the case of ankle sprain with inversion twisting, I have always assessed extensor digitorum longus, peroneus tertius, peroneus longus, and peroneus brevis, especially if not any swelling at the ATFL ligament. The inversion direction can result in overstretching to their tendon, then develop muscle guarding for a protective mechanism. I have given it a stretch in proper period of healing.
7 ways to stretch anterior leg compartment
Exercise #1: Seat tibialis anterior stretch: bend to plantarflexion with press foot downward.
Exercise #2: Seat peroneus tertius stretch: bend to plantarflexion with press foot upward.
Exercise #3: Seat EDL stretch: bend ankle with 4 toes (index toe to little toe) to plantarflexion.
Exercise #4: Seat EHL stretch: bend ankle with big toe to plantarflexion.
Exercise #5: Sit on heel stretch anterior ankle joint.
Exercise #6: Sit on heel to stretch EDL: sit on heel and 4 toes (index toe to little toe) are pulled to the plantar.
Exercise #7: Sit on heel to stretch EHL: sit on heel and big toe is pulled to the plantar.
(1) Tibialis anterior (TA)
The tibialis anterior muscle has a prismatic belly that arises from the lateral condyle of the tibia, proximal one-third to two-thirds of the lateral surface of the tibial shaft, anterior surface of the interosseous membrane, deep surface of the fascia cruris and intermuscular septum. The insertion of TA is a tendon that begins at about the level of the junction between the lower and middle thirds of the tibia and courses towards the medial border of the foot. The TA tendon inserting vertically on the first metatarsal base and the medial cuneiform bone.
TA’s function for ankle dorsiflexion and ankle inversion. It also plays a role in suspension of the arch and controls supination of the rearfoot. Lesions of the tibialis anterior muscle and tendon are not frequently reported in international literature although pathology like tibialis anterior tendinosis or rupture is not rare.
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| Tibialis anterior muscle (green) Ref: https://mobilephysiotherapyclinic.net/ |
(2) Extensor Hallucis Longus (EHL)
The extensor hallucis longus is a thin muscle situated deep between the tibialis anterior muscle and the extensor digitorum longus (EDL). The EHL arises from the middle half of the fibula and from the interosseous membrane, medial to the origin of the EDL. The muscle belly becomes a long tendon that inserts through the tendon. Its tendon passes behind the superior and inferior extensor retinaculum, crosses the anterior tibial artery and vein from the lateral to the medial side near the ankle, and finally inserts on the dorsal aspect of the base of the distal phalanx of the big toe.
The function of the EHL is to extend the big toe, dorsiflex the foot, adjunct foot eversion and inversion and stretch the plantar aponeurosis.
.jpg) |
| Ref: http://npt.kr/fa/754 |
(3) Extensor Digitorum Longus (EDL)
Extensor Digitorum Longus has the topographical relationships on the lower leg that is on the anterior surface with the fascia of the leg and skin, medial to the tibialis anterior muscle and the extensor hallucis longus (EHL) muscle.
EDL comes from the lateral condyle of the tibia, the proximal 2/3 of the anterior margin of the fibula, the superior part of the interosseous membrane, the deep fascia of the region and the anterior intermuscular septum.
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| Extensor Digitorum Longus (green) (Ref: https://www.kenhub.com/en/) |
It inserts through fibrous expansions of tendons 2nd - 5th onto the middle and distal phalanx of fingers 2nd - 5th. EDL has the following topographical relationships on the leg: the anterior surface with the fascia of the leg and skin; medially with the tibialis anterior muscle and the extensor hallucis longus muscle.
It produces extension of fingers 2nd - 5th and dorsal flexion of the foot, with an additional external rotation (pronation).
(4) Peroneus (Fibula) tertius (PT)
The Peroneus or Fibularis tertius muscles sound like it is in the lateral leg region, same as peroneus longus and brevis, but it is part of the anterior leg region.
Peroneus tertius originates from the distal part of the fibula, the interosseous membrane, and anterior intermuscular septum as a derivation of the extensor digitorum longus muscle.
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| Ref: https://stock.adobe.com/ |
Its inserting into the base of the fifth metatarsal, and also may be inserted in the shaft of the 5th metatarsal and through a thin expansion on 4th interosseous space, the shaft of the fourth metatarsal, or at the base of the fourth metatarsal. It is often described as part of EDL.
PT functions as a crucial contributor in dorsiflexion and eversion, postulated over the years as a stabilizer of the talocrural joint, avoiding forced investment and protecting the anterior talofibular ligament.
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| Peroneus tertius (Yellow arrow) (Ref: https://www.scielo.cl/pdf/ijmorphol/v28n3/art16.pdf) |
The principle to stretch this muscle is the same as the others: stretch to the point where “tightness with pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5 reputations following demonstrated VIDEO.
Reference:
https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000909_web.pdf
https://sciendo.com/it/article/10.2478/jim-2021-0025
https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/s12891-019-2688-8.pdf
https://www.scielo.cl/pdf/ijmorphol/v28n3/art16.pdf
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