Patients with back pain due to irritation of the L5 and S1 nerve roots often cope with calf cramps, especially at night. Strong calf muscles are responsible for being able to walk on toes. These muscles are especially important at the stage of pushing off walking on level surfaces, as well as on slopes and steps.
To experience the strength of the calf muscles, the best way is to have the patient stand on one leg. Then the patient lifts the heel from the floor. Usually between the floor surface and the bottom surface of the heel there is at least a gap of 5 inches.
When a patient is examined to walk on toes, it is necessary to evaluate not only the ability to perform this type of walking, but also the patient's ability to raise the heel of the floor by about 4-5 inches.
Similarly, when a patient is asked to tag along, at least there should be a gap of 3-3.5 inches between the floor and under the surface of the big toe, known as the first metatarsal joint.
Muscles that perform plantar flexion of the foot:
- medial gastrocnemius (L5, S1 through the tibial nerve)
- lateral gastroniemias (L5, S1 through the tibial nerve)
- soleus (L5, S1 through the tibial nerve)
- tibialis posterior (L5, S1 through the posterior tibial nerve)
- flexor digitorum longus (L5, S1 through the posterior tibial nerve)
- flexor hallucis longus (L5, S1 through the posterior tibial nerve)
- peroneus longus (L5, S1 through the superior fibular nerve)
- peroneus brevis (L5, S1 through the superior fibular nerve)
