The Foot & Its Arches

arches arches of the foot cuboid cuneo-navicular cuneocuboid foot foot and arches intercuneiform intermetatarsal joint interphalangeal joint intertarsal joints intrinsic muscles of the foot joints of the foot lateral longitudinal arch medial longitudinal arch metatarsophalangeal joint midtarsal subtalar talocrural tarsometatarsal joint transverse arches

Arches of the foot physiotherapy solihull simon evans

Joints of the Foot

  • Large joints
    • Talocrural
    • Subtalar
    • Midtarsal
  • Also note presence of series of typical synovial plane joints between adjacent tarsal bones (Intertarsal joints):-
    • Cuneo-navicular
    • Intercuneiform
    • Cuneocuboid
      (reinforced by dorsal, plantar and interosseous ligaments)

Tarsometatarsal Joints

  • Bases of metatarsal articulate with…
    • Medial cuneiform (1st MT)
    • 2nd MT is held in a mortise made by all 3 cuneiform (most stable)
    • Lateral cuneiform (3rd MT)
    • Cuboid (4th and 5th MT)
  • Series of plane joints that collectively form an irregular joints line
  • Series of capsules and ligaments forming a variable number of joint cavities

Intermetatarsal Joints

  • Typical synovial plane joints between bases of the 2nd to 5th metatarsals
  • Reinforced by dorsal, plantar and interosseous ligaments

Metatarsophalangeal Joints

  • Typical synovial condyloid joints between rounded head of metatarsal (larger articular surface to allow greater movement of  plantarflexion) and concave base of proximal phalanx (cf hand)
  • Note lax capsule on inferior aspect and support from collateral ligament – from tubercles on MT head pass obliquely to sides of proximal phalanges
  • Also note presence of plantar ligament (volar plate) and transverse ligament

Interphalangeal Joints

  • Typical synovial hinge joints
  • Named according to their position
  • Between distal end of one phalanx and proximal end of the next
  • Simple capsule, lined with synovial membrane
  • Reinforced by collateral ligaments

Arches of the Foot

  • Bones of foot arranged to form a vault
  • Bounded by the:-
    • Medial longitudinal arch
    • Lateral longitudinal arch
    • Transverse arch (anterior and posterior parts)
    • Support is offered from static and dynamic structures (keystone, staples, bowstrings and suspension)
    • Allows foot to fulfil its functions as a mobile adaptor and rigid lever

    Medial Longitudinal Arch

    • Formed by
      • Calcaneum
      • Talus (keystone)
      • Navicular
      • 3 cuneiform
      • Medial 3 metatarsals
    • Supports from
      • Spring ligt, Short and long plantar ligt (important static stabilisers)
      • Medial ½ of plantar aponeurosis (dual role)
      • Long tendons of tibialis posterior and anterior, FDL, FHL and intrinsic muscles of the foot (more important in dynamic situations)

    Lateral Longitudinal Arch

    • Formed by the calcaneum, cuboid (keystone) lateral 2 metatarsals
    • Less stable than MLA
    • Support from
      • Long and short plantar ligaments
      • Plantar ligaments of related joints
      • Peroneus longus (sling) and brevis, lateral part of FDL and intrinsic muscles of the foot

    Transverse Arches

    • 2 Parts:
      • Posterior formed by 3 cuneiform and cuboid (only complete with both feet together) – support from ligaments and shape of bones
      • Anterior – 5 MT heads – support from transverse head of adductor hallucis

    Role of the Arches of the Foot

    • Dynamic stability – change shape to allow foot to meet requirements as a rigid lever
    • Dynamic mobility – adapting to shapes of surfaces
    • Shock absorption/weight dissipation – see trabecular arrangement of bones

    Intrinsic Muscles of the Foot

    • Muscles with proximal and distal attachments within the boundaries of the foot
    • Single muscle on dorsum of foot
      • Extensor digitorum brevis
        • O: Roughened area on anterior part of calcaneus
        • I: Medial part to base of proximal phalanx, remainder blend with tendon of EDL at DDE
    • Remaining muscles arranged in layers:
      • Layer 1 (most superficial – deep to plantar aponeurosis)
        • Abductor hallucis
        • Flexor digitorum brevis
        • Abductor digiti minimi

      • Layer 2
        • Flexor accessorius
        • Lumbricals (compare with those of hand) – note complex action of lumbricals

      • 3rd layer
        • Adductor hallucis – note 2 heads – oblique and transverse
        • Flexor hallucis brevis – note presence of sesamoid bones in distal tendons
        • Flexor digiti minimi

      • 4th layer
        • Dorsal and plantar interossei
        • Axis of motion of toes defined about longitudinal axis of 2nd MT
        • Dorsal interossei – Abduct 2nd, 3rd and 4th toes
          • Bipennate from adjacent sides of MT shafts
          • 1 and 2 insert into 2nd prox. Phalanx
          • 3rd into PP of 3rd toe
          • 4th into PP of 4th toe
        • Plantar interossei – Adduct 3rd, 4th and 5th toes
          • Unipennate
          • From medial side of 3rd, 4th and 5th MT
          • To medial side of proximal phalanges of 3rd, 4th and 5th toes

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