Healthcare and Medicine Reference
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Fig. 6.12 The tibialis anterior continues the spiral from the outside
of the knee across the shinbone to the inside of the ankle.
Fig. 6.11 From the ASIS, the Spiral Line passes down the anterior
edge of the iliotibial tract and directly onto the tibialis anterior.
The lower leg
The tibialis anterior passes down and in, crossing the
lower shinbone to attach to the joint capsule between
the 1st cuneiform and 1st metatarsal. In standard
anatomy, this would seem to be the end point of the SPL
until we look around to the other side of that joint
capsule to find a direct fascial connection with the pero-
neus longus, likewise with a bifurcated tendon into
those same bones and joint capsule (Fig. 6.14). In other
words, there is both a fascial and mechanical continuity
between the tibialis anterior and the peroneus longus.
Again, this can be easily dissected to maintain the fascial
continuity of this 'sling' (Fig. 6.15). This connection has
been noted before, 1 but can now be understood as part
of a larger picture (see below on the SPL and foot
The arches and the stirrup'
The stirrup under the arch is fairly inaccessible in the
foot itself, and can best be worked from the lower leg.
Oddly, the two ends of this sling, the tibialis anterior
and the fibularis (peroneus) longus, lie next to each
other on the anterolateral aspect of the lower leg (Fig.
6.16 or see Fig. 5.8, p.118). As we noted in looking at the
Lateral Line (Ch. 5), there is a fascial intermuscular
septum between the two muscles (see Fig. 5.7).
In the case of a pronated foot, you will often find that
the tibialis anterior is locked long, and the peroneus
locked short. Therefore, in these cases, the fascia of the
tibialis anterior needs to be lifted and that of the peroneus
lengthened interiorly, and the tibialis often needs addi-
tional strengthening work. In a supinated foot, the reverse
treatment applies (DVD ref: Spiral Line, 33 :5046:44).
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