The extensor hallucis longus Surface Anatomy

Location

The extensor hallucis longus muscle originates on the anteromedial aspect of the fibula and the lateral aspect of the interosseous membrane. Its muscular belly ends at the distal head of the tibia. Its tendon runs over the medial ankle and directly over the first metatarsal and proximal phalanx to insert on the proximal head of the distal phalanx of the great toe.

The tendon of the extensor hallucis longus in normally visible at rest over the first metatarsal, but asking the patient to extend their great toe will make it more prominent if you are unable to see it.

Significance

The tendon of the extensor hallucis longus is a great landmark to locate the dorsalis pedis pulse because the dorsalis pedis artery runs directly lateral to the tendon as it passes over the navicular and medial cuneiform bones.

Weakness of the extensor hallucis longus muscle is commonly caused by a peroneal nerve palsy or a lumbar radiculopathy. Testing the integrity of the extensor hallucis longus muscle is the easiest way to assess an L5 nerve root palsy.