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The tibialis posterior muscle originates on the inner posterior border of the fibula laterally. [2] It is also attached to the interosseous membrane medially, which attaches to the tibia and fibula. [2] The tendon of the tibialis posterior muscle (sometimes called the posterior tibial tendon) descends posterior to the medial malleolus. [2]
Accessory navicular bone may cause a continuous stretch and stress on the tibialis posterior tendon which can progress to chronic disabling pain and may cause tendon rupture or secondary flat foot deformity; when this occurs this condition is commonly known as accessory navicular syndrome.
The flexor digitorum longus runs along the medial posterior side of the lower leg and aids in flexions of the toes (apart from the big toe). The flexor digitorum longus muscle arises from the posterior surface of the body of the tibia, from immediately below the soleal line to within 7 or 8 cm of its lower extremity, medial to the tibial origin of the tibialis posterior muscle.
The plantar calcaneonavicular ligamentous complex is a broad and thick band with three constituent ligaments. These connect the anterior margin of the sustentaculum tali of the calcaneus to the plantar surface of the navicular bone.
The flexor hallucis longus is situated on the fibular side of the leg. It arises from the inferior two-thirds of the posterior surface of the body of the fibula, with the exception of 2.5 cm at its lowest part; from the lower part of the interosseous membrane; from an intermuscular septum between it and the peroneus muscles, laterally, and from the fascia covering the tibialis posterior, medially.
Enumerated from the medial side, the four canals which it forms transmit the tendons of the tibialis posterior and flexor digitorum longus muscles; the posterior tibial artery and tibial nerve, which run through a broad space beneath the ligament; and lastly, in a canal formed partly by the talus, the tendon of the flexor hallucis longus.
The tibial malleolar sulcus, also known as the malleolar groove, is the smooth, vertical depression found on the posterior aspect of the medial malleolus. [1] [2] [3] This groove is traversed by the tendons of the tibialis posterior and flexor digitorum longus muscles. [1] [4] There are two malleolar sulci, medial and lateral. [2]
The tibial nerve, posterior tibial artery, posterior tibial vein, and flexor tendons travel in a bundle along this pathway through the tarsal tunnel, in the following order from anteromedial to posterolateral: Tibialis posterior tendon. [2] Flexor digitorum longus tendon. [2] Posterior tibial artery. [2] Posterior tibial vein. [1] Tibial nerve. [2]