What muscles, tendons, and ligaments are used in the back of the heel when standing on tiptoes?

Muscles, Tendons, and Ligaments Used in the Back of the Heel When Standing on Tiptoes

When standing on tiptoes, the primary structures involved in the back of the heel are the gastrocnemius and soleus muscles, which form the triceps surae complex, and their conjoined Achilles tendon that inserts into the calcaneus. 1

Primary Anatomical Structures

Muscles

• Gastrocnemius muscle: A two-headed superficial muscle in the posterior compartment of the calf

  • Originates from the medial and lateral condyles of the femur
  • Forms the upper, more visible portion of the calf

• Soleus muscle: A flat muscle lying underneath the gastrocnemius

  • Originates from the posterior surfaces of the tibia and fibula
  • Forms the lower portion of the calf

• Plantaris muscle: A small muscle that may contribute minimally to the Achilles tendon 2

Tendons

• Achilles tendon (tendo calcaneus): The strongest and thickest tendon in the human body 1
  • Formed by the conjoined tendons of the gastrocnemius and soleus muscles
  • Begins near the middle of the calf
  • Inserts into the posterior surface of the calcaneus (heel bone)
  • Has a crescent-shaped insertion with significant medial and lateral projections
  • Subjected to forces up to 12.5 times body weight during activities like running 1

Ligaments

While not directly involved in the active movement of standing on tiptoes, the following ligaments provide stability:

• Calcaneofibular ligament
• Posterior talofibular ligament
• Posterior tibiofibular ligament

Biomechanical Function

When standing on tiptoes:

1. The gastrocnemius-soleus complex contracts concentrically
2. This contraction pulls on the Achilles tendon
3. The Achilles tendon transmits this force to the calcaneus
4. The calcaneus rotates around the ankle joint axis, causing plantar flexion
5. The forefoot bears the body weight as the heel rises 3

Research shows that during a heel-rise test (standing on tiptoes until exhaustion), the average person can perform approximately 25 repetitions before fatigue 4. The gastrocnemius and soleus muscles demonstrate different fatigue patterns during this activity, with the gastrocnemius showing a larger decrease in mean power frequency during the eccentric phase 4.

Clinical Relevance

The strength and function of these structures are critical for:

• Normal gait mechanics
• Balance and stability
• Athletic performance
• Activities requiring plantar flexion

Dysfunction in this muscle-tendon complex can lead to:

• Achilles tendinopathy, which is common among adult runners 5
• Insertional Achilles tendonitis, characterized by posterior heel pain and swelling 5
• Decreased ankle range of motion, as seen in conditions like tip-toe behavior in some individuals 6

Rehabilitation Considerations

For injuries affecting these structures:

• Eccentric strength training is particularly effective for Achilles tendinopathy 5
• Stretching and deep friction massage of the gastrocnemius-soleus complex are generally helpful 5
• Anatomic misalignment can be treated with appropriate orthotics 5
• Heel lifts may help unload the tendon for pain relief 5

Understanding the complex anatomy and biomechanics of the posterior heel structures is essential for proper diagnosis and treatment of conditions affecting this area.