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Tarsus (Foot) – Anatomy, Function and Conditions

The tarsus is the proximal bony section of the foot, composed of seven bones. It connects the lower leg to the midfoot and is essential for stability, shock absorption, and movement.

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The tarsus is the proximal bony section of the foot, composed of seven bones. It connects the lower leg to the midfoot and is essential for stability, shock absorption, and movement.

What Is the Tarsus?

The tarsus, also known as the ankle region or hindfoot skeleton, is the proximal segment of the foot skeleton. It consists of seven individual bones collectively called the tarsal bones (Ossa tarsi). The tarsus forms the anatomical bridge between the lower leg and the midfoot, playing a central role in weight-bearing, shock absorption, and the complex movements of the foot.

Anatomy and Structure

The seven tarsal bones are arranged in two functional rows:

Proximal Row

Talus (ankle bone): Connects the foot to the lower leg via the upper ankle joint. Uniquely, the talus has no direct muscle attachments.
Calcaneus (heel bone): The largest and strongest tarsal bone, forming the heel and serving as the attachment point for the Achilles tendon.

Intermediate Bone

Navicular bone (Os naviculare): Located on the medial (inner) side of the foot, it is a key component of the longitudinal arch.

Distal Row

Cuboid bone (Os cuboideum): Located on the lateral (outer) side of the foot.
Three cuneiform bones (medial, intermediate, and lateral): Together with the navicular and cuboid, they form the Chopart joint and are essential for maintaining the foot arches.

Functions of the Tarsus

The tarsus fulfills several critical functions in the human musculoskeletal system:

Force transmission: It transfers body weight from the lower leg to the foot and ground.
Shock absorption: Together with the foot arches, it cushions impacts during walking, running, and jumping.
Mobility: The joints between the tarsal bones allow pronation (inward rolling) and supination (outward rolling) of the foot.
Arch support: The tarsus is a key structural component of both the longitudinal and transverse arches of the foot.

Key Joints in the Tarsal Region

Several clinically important joints are located within the tarsal region:

Upper ankle joint (Articulatio talocruralis): Connects the talus, tibia, and fibula; enables dorsiflexion and plantarflexion of the foot.
Subtalar joint (Articulatio subtalaris): Between the talus and calcaneus; responsible for pronation and supination.
Chopart joint (Articulatio tarsi transversa): A transverse joint between the proximal and distal tarsal rows; clinically significant in amputation surgery.
Lisfranc joint (Articulatio tarsometatarsalis): The joint connecting the tarsus to the metatarsus (midfoot).

Common Conditions and Injuries

The tarsus can be affected by a variety of injuries and medical conditions:

Talar fracture: A fracture of the talus, commonly caused by high-energy trauma. Carries a risk of avascular necrosis (bone death due to interrupted blood supply).
Calcaneal fracture: Often caused by falls from height; may result in long-term functional limitations.
Lisfranc injury: Damage to the tarsometatarsal joint, frequently missed in initial assessment; can lead to osteoarthritis if untreated.
Kohler disease: Avascular necrosis of the navicular bone, primarily affecting children.
Tarsal tunnel syndrome: Compression of the tibial nerve within the tarsal tunnel on the medial ankle, analogous to carpal tunnel syndrome in the wrist.
Flatfoot (Pes planus) and high-arched foot (Pes cavus): Structural deformities affecting the biomechanics of the tarsus and entire foot.

Diagnosis

A range of diagnostic tools is used to evaluate tarsal conditions:

Conventional X-ray: Standard imaging for fractures and deformities in two planes (dorsoplantar and lateral views).
Computed tomography (CT): Provides detailed visualization of complex fractures and joint involvement.
Magnetic resonance imaging (MRI): Assesses soft tissues, ligaments, tendons, and early bone changes such as stress fractures or necrosis.
Ultrasound: Used to examine tendons, ligaments, and soft tissue changes.

Treatment

Treatment of tarsal conditions depends on the type and severity of the injury or disease:

Conservative treatment: Immobilization in a cast or orthosis, offloading, physiotherapy, and anti-inflammatory medications (NSAIDs).
Surgical treatment: Osteosynthesis (surgical fracture fixation) for displaced fractures, arthrodesis (joint fusion) for severe osteoarthritis, and reconstructive procedures for deformities.
Physiotherapy and rehabilitation: Targeted physiotherapy after injury or surgery is essential to restore strength, stability, and range of motion in the foot.

References

Schünke M., Schulte E., Schumacher U. - Prometheus Atlas of Anatomy: General Anatomy and the Musculoskeletal System. Thieme Publishers, Stuttgart, 5th Edition (2018).
Rockwood C.A., Green D.P. - Rockwood and Green's Fractures in Adults. Wolters Kluwer Health, 8th Edition (2015).
Maffulli N., Easley M. - Minimally Invasive Surgery of the Foot and Ankle. Springer Verlag (2011).

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