ARCHES OF FOOT

WHY THERE ARE ARCHES?

A segmented structure can hold up weight only if it is built
in the form of arches
 Weight will be distributed on:
1) The Heel (behind)
2) Heads of metatarsal bones (in front):
Pressure will be minimized on nerves & vessels in sole
Forward propulsive action will be easier
WEIGHT DISTRIBUTION
 ARCHES OF FOOT
The foot typically having 3 arches: medial & lateral
longitudinal arches & a transverse arch, of which the
medial longitudinal arch is the largest.

The arches are not present at birth but evolve with

the progression of weight-bearing.
MEDIAL LONGITUDINAL ARCH
 ARCHES OF FOOT
The flattened longitudinal arches in all children
examined b/w 11 & 14 months of age. By 5 years of
age, as children approached gait parameters similar
to those of adults, the majority of children had
developed an adult like arch.
 ARCHES OF FOOT
The longitudinal arch is continuous both
medially& laterally through the foot, but because
the arch is higher medially, the medial side usually
is the side of reference.

 The lateral arch is lower than the medial arch .

 MEDIAL & LATERAL
LONGITUDINAL ARCH

Medial longitudinal arch Lateral longitudinal arch

 MEDIAL & LATERAL
LONGITUDINAL ARCH
 ARCHES OF FOOT
The talus rests at the top of the vault of the
foot & is considered to be the “keystone” of the
arch.

All weight transferred from the body to the

heel or the forefoot must pass through the talus.
 TRANSVERSE ARCH

 It is easiest to visualize in the midfoot at the

tarsometatarsal joints. At the anterior tarsals, the
middle cuneiform bone forms the keystone of the
arch.
The shape & arrangement of the bones are
responsible for stability of the plantar arches. The
wedge-shaped midtarsal bones provide an inherent
stability to the transverse arch.
TRANSVERSE ARCH
 FUNCTIONS OF ARCHES
The plantar arches are adapted uniquely to serve
two mobility & stability weight-bearing functions.

First, the foot must accept weight during early

stance phase and adapt to various surface shapes.
 FUNCTIONS OF ARCHES
To accomplish this WB-mobility function, the
plantar arches must be flexible enough to allow
the foot to
1.Dampen the impact of weight-bearing forces,
2.Dampen superimposed rotational motions, and
3.Adapt to changes in the supporting surface.
 FUNCTIONS OF ARCHES
To accomplish WB stability functions, the arches must
allow :
1.Distribution of weight through the foot for proper WB.
2.Conversion of the flexible foot to a rigid lever.
FUNCTIONS OF THE ARCHES

The mobility-stability functions of the arches of

the WB foot may be examined by looking at the
role of the plantar aponeurosis & by looking at the
distribution of weight through the foot in different
activities.
 FUNCTIONS
Distribution of body weight
Serves as a lever to propel the body forward in
walking & running
Protection of soft tissue structures
Acts as a Shock absorption
 MEDIAL LONGITUDINAL ARCH

Higher than lateral arch

Formed of: Calcaneum, talus

(key stone), navicular, three
cuneiform & first three
metatarsal bones
 LATERAL LONGITUDINAL ARCH

Lower than medial arch

Formed of: Calcaneum,
cuboid (key stone), fourth &
fifth metatarsal bones
 TRANSVERSE ARCH:

It is only half an arch

It is formed of: bases of

metatarsal bones, cuboid &
three cuneiform bones
FACTORS MAINTAINING
ARCHES OF FOOT
Shape of bones
Strength of ligaments
Tone of muscles
 MECHANISM OF ARCH SUPPORT
SHAPE OF BONES
Bones are wedge-shaped
with the thin edge lying
inferiorly

This applies particularly to

the bone occupying the center
of the arch “keystone”
MECHANISM OF ARCH SUPPORT
MECHANISM OF ARCH SUPPORT
MECHANISM OF ARCH SUPPORT
Inferior edges of bones are tied together
MECHANISM OF ARCH SUPPORT
MECHANISM OF ARCH SUPPORT
Inferior edges of bones are tied together

Medial longitudinal arch: Short lig.,tibialis posterior.

Lateral longitudinal arch: Long & Short plantar lig,
calcaneocuboid ligament.
Transverse arch: Deep transverse ligaments, transverse
head of adductor hallucis, dorsal interossei.
MECHANISM OF ARCH SUPPORT
Tying the ends of the arch together
MECHANISM OF ARCH SUPPORT
TYING THE ENDS OF THE ARCH TOGETHER

Medial longtitudinal arch: Plantar fascia, medial

part of FDL & brevis, FHL, FHB, ABDH.

Lateral longtitudinal arch: Plantar aponeurosis,

lateral part of FDL & brevis, abductor digiti minimi,
flexor digiti minimi.
Transverse arch: Peroneus longus.
MECHANISM OF ARCH SUPPORT
MECHANISM OF ARCH SUPPORT
MECHANISM OF ARCH SUPPORT
Suspending the arch from above
TRANSVERSE ARCH
MECHANISM OF ARCH SUPPORT
SUSPENDING THE ARCH FROM ABOVE

Medial longtitudinal arch: Tibialis anterior, Tibialis

posterior, Medial ligament of ankle joint.
Lateral longtitudinal arch: Peroneus longus, & brevis
Transverse arch: Peroneus longus.
 MUSCULAR CONTRIBUTIONS
The intrinsic muscles of the foot contract periodically in
quiet stance, to provide brief periods of unloading for the
ligaments supporting the foot.

In gait, however, both the longitudinally & transversely

oriented muscles become active & contribute support to
arches of the foot.
 Key muscular support is provided to the medial
longitudinal arch during gait by the extrinsic muscles
that pass posterior to the medial malleolus & inserting
on the plantar foot: namely, the tibialis anterior, tibialis
posterior, the FDL, & the FHL muscles
 PERONEUS LONGUS
The peroneus longus provides lateral stability as its
tendon passes behind the lateral malleolus, glides along
the lateral cuboid just behind the base of the 5th
metatarsal, then courses the entire length of the
transverse arch to insert into the base of the 1st
metatarsal.
PERONEUS LONGUS TENDON
These medial & lateral muscles provide a dynamic
sling to support the arches of the foot during the
entire stance phase of walking & enhance adaptation
to uneven surfaces.
 FOOT DEFORMITIES
1.Pesplanus
2.Flexible flat feet
3.Forefoot varus deformity
4.Pescavus
5.Hallux valgus
6.Hammer toe
 PES PLANUS (FLAT FOOT)
A condition in which the medial longitudinal arch
is depressed
The forefoot is everted
The head of talus is forced downward & medially
The causes are both congenital & acquired
1.FLAT FOOT ( PES PLANUS )
The pronation of subtalar & TTJ seen in normal
bilateral stance are exaggerated. Rather than seeing the
TTJ reverse to absorb the excessive pronation of the
hindfoot, the navicular is pushed down by the pressure
of the plantarflexed & adducted talar head, which
produces a low medial arch.
 2.FLEXIBLE FLAT FOOT
The most common form of flat foot is termed a
flexible flat foot is marked by an arch that reappears
when the foot is non–weight-bearing position .
Treatment is focused on limiting excessive pronation
by using footwear or orthotic devices.
3.FOREFOOT VARUS DEFORMITY

Excessive pronation of the hindfoot associated with

a forefoot varus deformity. With hindfoot pronation
in WB, the forefoot must supinate at the TMT joints
to maintain appropriate weight distribution across the
metatarsal heads.
 FOREFOOT VARUS DEFORMITY

If adaptive tissue changes result in a

sustained TMT supination, the
deformity is known as a forefoot varus
(same as a fixed supination twist).
 4.PESCAVUS
Deformity of high arched.
Occurs when metatarsals bone are plantar flexed
relative to hind foot –fore foot plantaris –which increases
the height & curvature of the longitudinal arch.
PESCAVUS
 CAUSES OF PESCAVUS
Progressive neurological disorders
Hereditary sensory-motor neuropathies.
Hereditary sensory & autonomic neuropathies
Friedreich ataxia
Spinal or brain tumor
Spinal muscular atrophy
 5.HALLUX VALGUS
Hallux valgus may be associated with a reduction in
1ST MTP joint ROM, gradual lateral subluxation of
the toe flexor tendons crossing the 1ST MTP joint,
reduced WB on the great toe & increased WB on the
metatarsal head.
These structural changes can lead to pain & difficulty
during walking. People with a pronated foot may push
off during walking with a greater than normal adductor
moment on the great toe that pushes the toe into a
valgus (MTP joint adducted) position.
 HALLUX VALGUS

Localized swelling & pain at the medial or dorsal

aspect of the first MTP joint may be related to an
inflamed medial bursa & is commonly called a bunion.
The person with a flat foot & excessive pronation, may
have instability & excessive mobility of the 1st ray,
which contributes to hallux valgus deformity.

A hallux valgus is not unique to a pronated foot but

may be associated with various foot deformities.
6.HAMMER TOE DEFORMITY

Radiographic image of a foot from a

healthy subject
(A) A foot from a subject with diabetes
& peripheral neuropathy
(B).The diabetic foot shows a hammer
toe deformity (hyperextension at the
MTP joint and flexion at the IP joint).
 HAMMER TOE DEFORMITY
Excessive extension at the MTP joint in a resting
position is called a “hammer toe deformity”.
This MTP joint angle is higher in patients with diabetes
& peripheral neuropathy, possibly because of weakness
in the intrinsic foot muscles that stabilize the MTP joint.
Presumably, because the toes cannot participate
properly in WB, hammer toe deformity has been
associated with increased pressures under the
metatarsal heads that can result in pain or skin
breakdown.
 PLANTAR FASCIITIS

The heel pain that was greatest in the morning when

got out of bed for the first step.
The pain decreases after several steps but increased
again with prolonged walking. These signs are classic
for plantar fasciitis (inflammation of the plantar
aponeurosis).
PLANTAR FASCIITIS
The pain typically is localized at the medial calcaneal
tubercle, where the plantar aponeurosis inserts, but the
pain can spread distally down the fascia toward the toes.
 Toe extension may also increase pain because
extending the toes places additional tension on the
fascia.Pronated foot may contribute to excessive
stress on the plantar fascia.
 ANKLE SPRAIN
The anterior talofibular ligament is the weakest & most
commonly torn of the LCL’S.

 This ligament is most easily stressed when the ankle is in a

plantarflexed & inverted position, such as when a
basketball player lands on another player’s foot.
ANKLE SPRAIN
Rupture of the ATFL often results in anterolateral
rotatory instability of the ankle.

The posterior talofibular ligament is the strongest of

the collateral ligaments and is rarely torn in isolation.