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 The Journal of
Bone and Joint Surgery
American Volume
VOLUME 46-A, No. 3 APRIL 1964

Phasic Activity of Intrinsic Muscles of the Foot *t

BY ROGER MANN, M.D.t, AND VERNE T. INMAN, M.D., PH.D.t,
SAN FRANCISCO, CALIFORNIA

From the Biomechanics Laboratory, University of California, San Francisco and Berkeley

An electromyographic study was done of the phasic activity of six intrinsic

muscles of the foot: the extensor digitorum brevis, abductor hallucis, flexor hallucis
brevis, flexor digitorum brevis, abductor digiti minimi, and the dorsal interosseus
muscle between the third and fourth toe. Experimental conditions were: walking on
level ground, up and down a 10-degree slope, and up and down stairs; standing on
toes; and quiet standing.

FIG. 1
Sites of electrode placement: A, abductor digiti minimi B, extensor digitorum brevis; C, dorsal
interosseus; D, abductor hallucis; E, flexor digitorum brevis; F, flexor hallucis brevis.

Methods
Twelve subjects whose ages ranged from fifteen to twenty-five years partici-
pated. None had any gross abnormalities which could produce an altered walking
pattern. Each foot was carefully examined and the characteristics of the arch were
recorded. The right foot was studied in all cases. The skin over the site for electrode
placement was cleaned and a one-centimeter subcutaneous lidocaine wheal was
produced through which the sterilized electrodes were placed (Fig. 1).
Electrodes consisted of 36-gauge, enamel-coated, stainless-steel wire. The
electrode was prepared by cleaning its tip of enamel, stringing it through a 26-gauge
* One of the four Vernon P. Thompson Resident-Training Program award-winning papers.
Read at the Annual Meeting of the Western Orthopedic Association, Seattle, Washington, Septem-
ber 25, 1963.
t This study was supported by Veterans Administration Contract V-lO05M-2075.
t Biomechanics Laboratory, School of Medicine, University of California, San Francisco 22,
California.
469
 470 ROGER MANN AND V. T. INMAN

disposable hypodermic needle, and then bending the wire to produce a one-milli-
meter barb. The needle, with the electrode, was placed into each muscle; the needle
was then withdrawn, leaving the electrode in place. Two such electrodes were placed
into each muscle studied.
Placement of the electrodes was verified as follows: Each muscle was stimulated
through each individual electrode with a square wave current from a Grass S-4E
stimulator. If adequate muscle contraction was not obtained, the electrode was
removed and a new one inserted. In addition, the signal produced by a voluntary
contraction of the muscle was monitored on an oscilloscope and loudspeaker before
and after each experiment.
The electrode sites were covered with a bandage and the wires were brought up
behind the malleoli to a junction box, which was taped to the lateral aspect of the
right leg. The subject wore a sock and a rubber boot on each foot. The boot was the
type used for skin diving; it was soft, distensible, had no heel or arch, and readily
conformed to the foot. The right boot was equipped with a metal strip on its heel
and toe.
In all cases the subject walked on a carbon-particle or copper mat through
which a small direct current (four to eight volts) was passed. It was thus possible
to record heel and toe strike from the metal strips on the boot. In order to ensure
the greatest possible accuracy in relating the activity of each foot muscle studied
to the whole walking cycle, electrodes were also placed in the tibialis anterior and
gastrocnemius muscles.
Each subject was instructed to walk at his natural speed. Every run was carefully
supervised for splinting of the experimental foot, abnormal arm or leg movements,
and gait peculiarities. No difficulties arose because of pain in the experimental foot.
Level walking was performed on a forty-foot mat on which five to seven com-
plete steps could be taken; the lO-degree slope was twelve feet long, permitting
two or three complete steps; the stairs consisted of six standard steps (six-inch
rise and nine-inch tread) with a platform on top. Quiet standing was performed by
having the subject place the feet a comfortable distance apart (approximately eight
to twelve inches) and bear equal weight on each foot. Electromyographic recording
was carried out for approximately fifteen seconds.
The electrical activity from each muscle was relayed from the junction box
on the subject's right leg through an overhead boom into the amplifier. The am-
plifier had a band width of twenty to thirty thousand cycles per second and an
equivalent peak-to-peak noise level of five microvolts.
The signal was recorded on an eight-channel Offner Dynagraph. Simultaneous
recordings were made each time from the tibialis anterior and gastrocnemius mus-
cles, as well as from the heel and toe contacts.
Data were reduced as follows: For each experimental condition, the average
step length for the subject was computed, as well as the extent of variation from this
mean for each individual step. The electromyographic record for each step was then
enlarged or reduced proportionately by means of a pantograph. For each experi-
mental condition and for each muscle, the records of the individual steps were
superimposed, and a composite record of the phasic activity of each muscle was
thus obtained. (It is obvious that the amplitudes of the records were altered by this
method; however, only the phasic activity was considered in this study.)
The composite was then mathematically expanded to a ten-centimeter scale
so that all the results could be compared and expressed as per cent of the full walking
cycle.
From this scale was obtained the ideal or average activity which is reported ~
herein.
THE JOURNAL OF BONE AND JOINT SURGERY
 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 471

Results
All or parts of the records obtained from eight of twelve subjects were accurate
enoughto warrant reduction. The discarded records were inadequate because of the
manytechnicalproblems that arose. In several cases, although electrode placement
wasaccurateand voluntary contractions produced normal electromyograms, phasic
activitycould not be recorded. Sometimes the heel-toe device did not record prop-
erly;in other cases, an electrical artefact was produced, probably by movement of
theelectrodes,either within or outside the muscle.
Three of the eight subjects had asymptomatic bilateral flat-foot. Their patterns
for level walking differed from the patterns of subjects with normal feet. There
wasessentially no difference in electrical activity between normal and flat-footed
subjects during stair climbing or descending, walking down and up slopes, or
standingon the toes.
Level Walking
The electrical activity of the six intrinsic muscles studied occurred only during
the stance phase (Figs. 2 and 3).
The abductor digiti minimi and extensor digitorum brevis muscles became
active at approximately 20 per cent of the cycle. In normal feet, the abductor
halluois,flexor digitorum brevis, and flexor hallucis brevis muscles showed activity
at 38,40, and 28 per cent of the cycle, respectively. In subjects with pronated feet,
these musclesshowed activity at 0, 26, and 14 per cent of the cycle. The activity in
both the normal and pronated feet ceased near toe-off.
The onset of activity in the interosseus and gastrocnemius muscles was at 35
and 15 per cent of the cycle, respectively. Activity ceased at 65 per cent and 56
per cent, and there was no difference between normal and pronated feet. The
tibialisanterior became active just before toe-off, and activity continued throughout
the swingphase until early stance.
The amplitude was nearly constant for all the muscles except for the tibialis
anterior, which displayed decreased activity just before heel-strike.
Upslope Walking
The onset of electrical activity of four of the intrinsic muscles (Fig. 4) occurred
at about 30 per cent of the cycle, while the abductor digiti minimi and extensor
digitorum brevis began to show activity at 18 and 10 per cent. Gastrocnemius
activity began at 25 per cent of the cycle; the tibialis anterior was the only one of
the muscles under study that was active during swing phase (from 60 per cent of
the previous cycle until 34 per cent of the new cycle). All the intrinsic muscles and
the gastrocnemius remained active until just before toe-off, at 70 per cent.
The amplitude of the electromyogram was nearly constant, except for that of
the tibialis anterior, which had two peaks of activity.
Downslope Walking
Four of the intrinsic muscles became active in the first 7 per cent of the cycle
(Fig. 5). The extensor digitorum brevis and the interosseus muscles did not become
active until 42 and 16 per cent of the cycle, respectively. None of the intrinsic mus-
cles ceased activity until just before toe-off, at 67 per cent. The gastrocnemius
showed activity by 7 per cent of the cycle and ceased at 57 per cent. The tibialis
anterior was active from 52 per cent of the previous cycle until 18 per cent of the
new cycle. The amplitude was nearly constant throughout stance phase for the
intrinsic muscles and the gastrocnemius; the tibialis anterior again showed two
peaks of activity.
VOL. 46·A. NO.3. APRIL 1964
 472 ROGER MANN AND V. T. INMAN

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THE JOURNAL OF BONE AND JOINT SURGERY

 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 473

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 474 ROGER MANN AND V. T. INMAN

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THE JOURNAL OF BONE AND JOINT SURGERY

 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 475

Walking Up Stairs
Four of the intrinsic muscles showed activity in the first 4 per cent of the cycle
and stopped just before toe-off at 66 per cent (Fig. 6). The dorsal interosseus muscle
became active at 33 per cent of the cycle and the gastrocnemius at 21 per cent. Both
ceased activity at toe-off.
Under this experimental condition, the extensor digitorum brevis became active
during swing phase, along with the tibialis anterior. Activity for each started at
61 and 56 per cent of the cycle and ceased at 3 and 7 per cent, respectively.
The amplitude of the electromyographic record for each individual muscle
was constant in all cases.
Walking Down Stairs
The abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and in-
terosseus muscles became active in the first 9 per cent of the cycle, whereas the
abductor digiti minimi became active in late swing phase, at 90 per cent of the
previous cycle (Fig. 7). All continued their activity until 60 to 70 per cent of the

FIG. 8
Axis of subtalar joint.

cycle, except for the abductor digiti minimi muscle, whose activity declined at 46
per cent of the cycle.
Under this condition, the extensor digitorum brevis and the gastrocnemius
muscles both were active during swing phase; their activity began at 59 and 65
per cent, respectively, and ceased at 38 and 55 per cent.
The tibialis anterior muscle did not evidence any consistent phasic activity.
There was no peak in the record, except in that of the gastrocnemius muscle, near
heel-strike.
Standing on Toes
All the instrinsie muscles were active when the subject was standing on his toes.
 476 ROGER MANN AND V. T. INMAN

The onset of activity was the same for all the muscles.The activity of the gastrocne-
mius coincidedwith that of the intrinsic muscles. The tibialis anterior muscle was
electrically silent.

Quiet Standing
There was no electrical activity recorded from the intrinsic muscles, except
for sporadic bursts of activity at intervals of five to ten seconds in some subjects.

Discussion
Before discussing the different electromyographic patterns obtained in each
experimental condition, it is appropriate to summarize the investigations of others
regarding the axes of motion of the foot and the musclesthat control rotation about
them.
The axis ofthe subtalar joint has been shown by Manter and Hicks to pass from.
medial to lateral at an angleof 16degreesto the longitudinalaxis ofthe foot (Fig. 8) and

A FIG. 9 B
Arrows represent resultant axes of rotation of the calcaneocuboid and talonavicular joints: A,
pronated foot. When the resultant axes are parallel to each other, free motion of the talonavicular
and calcaneocuboid joints is possible. B, supinated foot. When the resultant axes are divergent,
motion is restricted in the transverse tarsal articulation since each individual joint has a different
axis of rotation.

from superior to inferior at 42 degrees to the vertical. The motion at the subtalar
joint was studied by Close and Inman and shown to be progressively greater
when subjects with normal feet, pronated feet, and fiat-foot were compared.
Wright and associates studied the motion at the subtalar joint during the stance
phase of walking; they found an increase in motion at the joint in subjects walking
downslopeand in subjects with pronated feet.
The axes of the transverse tarsal or mid-tarsal joint as described by Elftman 4
consist of two axes for the calcaneocuboidjoint and two axes for the talonavicular
joint. From the two calcaneocuboid axes, Elftman calculated the resultant axis
about which the combined movements of the transverse tarsal joint must occur
(Fig. 9). In the pronated foot, the resultants of the axes of the transverse tarsal
joint are parallel to each other, allowing free motion to occur about a single axis.
In the supinated foot, the resultants are divergent, and motion in the transverse
tarsal joint is restricted, since the component joints (talonavicular and calcaneocu-
THE JOURNAL OF BONE AND JOINT SURGERY
 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 477
boid)are attempting to rotate through their own axes which no longer coincide.
It is obviousthat the latter system is more stable mechanically.
Sincethe transverse tarsal joint has the head of the talus in common with the
subtalar joint, supination of the subtalar joint produces increased stability of the
transversetarsal joint 3. This foot stability is necessary when excessive forces are
appliedto the foot just before toe-off.
In Figure lO-A, it can be seen that the triceps surae muscle is a powerful
supinatorat the subtalar joint when the fore part of the foot is fixed on the floor.
The pull of the main intrinsic muscles, that is, the abductor hallucis, flexor
hallucisbrevis, flexor digitorum brevis, and abductor digiti minimi, lies essentially
in the long axis of the foot and perpendicular to the transverse tarsal joints. Thus,
it can be stated that the intrinsic muscles exert considerable flexion force on the
forepart of the foot and play the principal role in the muscle stabilization of the
transverse tarsal joint; they are, therefore, the main contributors to the muscle
support of the arch (Fig. lO-B).

SUBTALAR
AXIS
.

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PULL OF
TRICEPS SURAE

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FIG. lO-A FIG. lO-B

Approximate direction of force exerted bv the triceps surae (Fig. lO-A) and the intrinsic muscles
of the foot (Fig. lO-B). "

It should be kept in mind that control of the transverse tarsal joint is provided
by muscle, ligament, and bone. Exactly to what extent each of these participates
at the joint during locomotion is not known. It should be noted that external rota-
tion of the tibia causes movement of the talus, which in turn transmits sufficient
forceto the transverse tarsal joint to raise the arch without direct use of muscle
power4.
With these facts in mind regarding the various axes of the foot, we can now
considerthe electromyographic patterns obtained in the present study .
..----Ineach experimental condition, it can be seen that, for the most part, the in-
trinsicmuscles acted as a group. This is especially true with regard to the abductor
digitiminimi, flexor hal1ucis brevis, abductor hallucis, and flexor digitorum brevis.
In level walking, the intrinsic muscles in subjects with normal feet showed the
onsetof activity in the main intrinsic mass at approximately 35 per cent of the cycle,
as contrasted with 0 to 26 per cent for the flat-footed subjects. In all cases, activity
ceasedjust before toe-off. During downslope walking, however, activity occurred
from 0 to 7 per cent of the cycle, again with cessation just before toe-off.
The electromyographic findings in this study are in accord with the observa-
tions of Wright and associates of onset and degree of subtalar rotation during
stance in a normal and a flat-footed subject (Fig. 11).
In level walking, pronation occurred early and, in the normal subject, supina-
VOL. 46-A. xo, 3, APRIL 1964
 478 ROGER MANN AND V. T. INMAN

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THE JOURNAL OF BONE AND JOINT SURGERY
 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 479
tion began at 35 to 40 per cent of the cycle, whereas it began at approximately
10 per cent of the cycle in the subject with pronated feet. The rotation at the
subtalar joint was one of progressive supination, reaching a peak at 57 per cent
of the cycle for the subject with normal feet and 67 per cent for the one with flat-
foot 8. This progressive supination can be linked to the period of activity in the in-
trinsic muscles recorded in this study.
During upslope walking, there was delayed rotation in the subtalar joint of the
fiat-footed subject, but the normal subject showed nearly the same pattern as he
did in level walking. Once again, the electrical activity in this study can be related
to the patterns of subtalar rotation.

PER CENT OF WALKING CYCLE

o 50 100
I I I
40

LEVEL
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~ 40 [

UPSLOPE
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DOWN STAIRS

FIG. 13
Fore-and-aft shear on the foot during walking. Positive indicates fore and negative indicates aft.
(Modified from Cunningham 2.)

In the downslope pattern, one can observe activity in the intrinsic muscles
from heel-strike on and, concomitantly, rapid supination in the subtalar joint of the
subject with flat-foot and to a lesser degree in the one with normal feet.
If these changes are considered in the light of our knowledge about the subtalar
and transverse tarsal axes, the following observations can be made.
In level walking, in a subject with normal feet, there is no activity in the in-
trinsic muscles from heel-strike until 40 per cent of the cycle. In a subject with
pronated feet, there is no activity for the first 10 per cent of the cycle. Just before
toe-off in level walking, when the forces (Fig. 12) are greatest, maximum supination
(Fig. 11) occurs and there is optimum transverse tarsal stabilization. In a normal
subject, this stabilization begins at approximately 40 per cent of the cycle as
demonstrated by the degree and rapidity of subtalar motion and confirmed by
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480 ROGER MANN AND V. T. INMAN

electrical activity in the intrinsic muscles. In a subject with pronated feet, this
stabilization starts in the first 10 per cent of the cycle and gradually progresses to
toe-off. Again, this greatest period of subtalar rotation is paralleled by activity in
the intrinsic muscles.
In upslope walking, the degree of supination and transverse tarsal stabiliza-
tion is delayed until the center of gravity passes over the relatively flexible fore part
of the foot at approximately 30 per cent of the cycle; rapid supination then takes
place and there is optimum transverse tarsal stabilization for the forces (Fig. 13)
created by the propulsion of toe-off. The delay in foot stabilization is paralleled by
delayed activity in the intrinsic muscles.
In walking down a slope, the body requires the foot to be a rigid lever a.rrri
early in the cycle to counteract the moment created by the accelerating body. The
magnitudes of the vertical and fore-and-aft shear floor reactions are greater for
downslope walking than for any of the other experimental conditions (Figs. 12 and
13). Early supination 8 and transverse tarsal stabilization occur together with early
activity in the intrinsic muscles.
The electromyographic recordings made during the ascent and descent of stairs
closely resemble those made during downslope walking. In ascent or descent of
stairs, the subject strikes each step with his toes and metatarsal heads first and the
heel does not as a rule come into contact with the tread. Thus the foot is loaded very
rapidly after initial contact. If one considers the excessive and rapidly applied load
upon the fore part of the foot (Figs. 12 and 13) while descending and, to a lesser
extent, while ascending stairs 2, it is obvious that complete stabilization of the foot
would be essential to stabilize the body by no later than 5 to 10 per cent of the cycle.
Rigidity of the foot is also required during standing on the toes. It can be seen
in the recordings made during this experimental condition that all the irrtr.irrsic
muscles were active.
When a person is standing quietly, there is no activity in the intrinsic muscles
(except for short bursts of activity, which presumably are evidence of postural ad-
justments). This electrical silence supports the concept that muscle activity is not
necessary to maintain the arch of the loaded foot when it is at rest.

Summary and Conclusions

1. The intrinsic muscles of the foot act as a functional unit.
2. The electrical activity of the intrinsic muscles of the foot closely paralleled
the progressive supination at the subtalar joint during level, upslope, and downslope
walking.
3. Since such a close relationship exists between the intrinsic muscles and the
axes of the subtalar and transverse tarsal joints, they may be considered to play
the principal active role in the stabilization of the foot during propulsion.
4. The pronated foot requires greater intrinsic muscle activity to stabilize
the transverse tarsal and subtalar joints than does the normal foot.
5. Muscle activity is not necessary to support the arches of the fully loaded
foot at rest.

References
1. CLOSE,J. R., and INMAC'l,V. T.: The Action of the Subtalar Joint. Prosthetic Devices Research
Project, University of California, Berkeley. Series 11, Issue 24, May 1953.
2. CUNNINGHAM,D. M.: Components of Floor Reactions During Walking. Prosthetic Devices
Research Project, Institute of Engineering Research, University of California, Berkeley. Series
11, Issue 14, November 1950 (reissued October 1958).
3. ELFTMAN,HERBERT: The Ankle Joints and the Foot. In Human Limbs and Their Substitutes,
edited by P. E. Klopsteg and P. D. Wilson, pp. 417-419. New York, McGraw-Hill, 195-!.
4. ELFTMAN,HERBERT: The Transverse Tarsal Joint and Its Control. Clin. Orthop., 16: -!1--!6,
1960.
THE JOURNALOF BONEANDJOINTSURGERY
 PHASIC ACTIVITY OF INTRINSIC MUSCLES OF THE FOOT 481
5. HICKS,J. H.: The Mechanics of the Foot. 1. The Joints. J. Anat., 87: 345-357, 1953.
6. HICKS,J. H.: The Mechanics of the Foot. II. The Plantar Aponeurosis and the Arch. J. Anat.,
88: 25-30, 1954.
7. MANTER,J. T.: Movements of the Subtalar and Transverse Tarsal Joints. Anat. Rec., 80:
397-410, 1941.
8. WRIGHT,D. G.; DESAI, S. M.; and HENDERSON,W. H.: Action of the Subtalar and Ankle-Joint
Complex During the Stance Phase of Walking. J. Bone and Joint Surg., 46-A: 361-382, March
1964.

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