The first footOn moon

Human Foot performs

- supports weight of body - serves as lever to propel body in walking & running

Child starts walking without support at 18 months age

Myelination of pyramidal tracts begin

Arches begin to get shape

These functions are carried out by

1. Foot skeleton made of series of small bones - Foot acts as a segmented lever with multiple joints thus becomes pliable and adapts to uneven surfaces

2. Long Flexors and Intrinsic muscles of foot act on forepart of foot and assist propulsive action of gastrocnemius and soleus

These functions are carried out by

2. Long Flexors and Intrinsic muscles of foot act on forepart of foot and assist propulsive action of gastrocnemius and soleus

Arches of foot

1. Longitudinal2. Transverse Concavity of both arches directedto the plantar surface

Functions of arches

1. Proportional distribution of weight

Body weight

120 pounds

Rt. Foot - Talus

60 poundsLt. Foot - Talus

60 pounds

Rt. Calcaneus

30 poundsHeads of

5 Meta tarsals

30 pounds

6 Bearing points

4 metatarsals + 2 sesmaoids under hallux

Each 5 founds123

45

6

Functions of arches

2. Arched foot acts as a segmented lever

Fore part of foot short muscles and long flexors assist gastrocnemius and soleus helps in take off of fore part from ground

Lumbricals prevent buckling from contraction of Flex. Dig. Longus

Functions of arches

3. Plantar concavity protects plantar vessels and nerves from compression

Flat foot – compression leads to Metatarsalgia

Functions of arches

4. Arched foot is dynamic and pliable

- When foot is on the ground arch flattens

- Off the ground restores original contour

Acts like a spring board

Functions of arches

5. Invertors lift foot on medial side shifts weight to lat.border Tibialis anterior, Tibialis posterior

Evertors lift foot on lateral side shift weight to med. Border Peroneus longus, brevis assisted by Per. Tertius

LATERALMEDIAL

Tib.PosteriorTib.Anterior

Per.LongusPer.BrevisPer.Tertius

Longitudinal arch

Medial and lateral Transverse

Medial Longitudinal arch

Medial Longitudinal arch

Talus

Tibia

CalcaneusSpring Lig.

Navicular

Med.Cun.

1st Met.Tar.

Sesam.Bone

Medial Longitudinal archSummit of archArt. Surf.Talus

Post.pillarMed.Tub.Calcaneus

Ant.pillarHeads of 1st to 3rd Met.Tar

Vulnerable partHead of Talus“Key stone”

The medial longitudinal arch

This arch is very tall(which is why the medial side of the foot is missingfrom a footprint ) and is extremely resilient due to its large number of component bones.

Lateral Longitudinal arch

Post.pillarMed.Tub.Calcaneus

Ant.pillarHeads of 4th & 5th Met.tar.

Summit of archSub Talar Joint

Vulnerable partCalcaneo-cuboid jnt.

Lateral Longitudinal arch

5th Metatarsal

Cuboid

Talus

Calcaneus

Peroneus longus Suspension

The lateral longitudinal arch

The arch is flat and contains relatively less no. of bonesHence more rigidBears the body weight before the medial arch comes into playNote the foot print

The medial and lateral longitudinal arches of the foot

Transverse arch

When med. Borders of both feet are approximated a complete transverse arch is formed

Each foot represents a half dome

Made of prox. By 3 cuneiformsand cuboidDistally bases of 5 metatarsals

Transverse arch

Factors maintaining arches of footMed. Long. Arch:1 Shape of bones wedge shape with thin edge downwards Talus “key stone” rests on concave art.surface of navicular and on sustentaculum tali of calcaneus

2 Intersegmental tiers - like staples Plantar ligs. Spring Lig. (supported from below by Tib.Post.) permanent stretch of spr.lig. Produces flat foot.

3. Factors acting as tie beams Plantar aponeurosis, Abd.Hallucis, Med.part of Flex.dig.brevis, Tendon of Flex.Hal.Longus, Med.part of tendon of Flex.dig.longus, Flex.hal.brevis

4. Suspending arch from above Tendon of Tib.anterior, Sup.fibres of Delt.Lig. Tend. Of Tib.Post.

Factors maintaining arches of footLat. Long. Arch:

1 Calcaneal angle of cuboid supports ant lower art.surf. of calcaneus – upward tilt of long axis of calcaneus

2 Intersegmental tiers - like staples Long and short plantar ligs.

3. Factors acting as tie beams Plantar aponeurosis, Abd.dig.minimi, Lat.part of Flex.dig.brevis, Lat.part of tendon of Flex.dig.longus, Flex.dig.min.brevis

4. Suspending arch from above Tendon of Per.brevis and tertius exert sling action Peroneus longus – long course below foot - sustentacular action

Factors maintaining arches of footTransverse Arch:

1 Shape of bones Wedge shaped 3 cuneiforms Bases of middle 3 metatarsals accentuate arch

2 Intersegmental tiers - like staples Deep transverse ligs, other intrinsic plantar ligs. Dorsal interossei, Oblique and transverse heads of add. hallucis

3. Factors acting as tie beams Tendons of per. Longus and Tib. Posterior

4. Acting from above Per. Longus and tertius on lat. Side Tib.anterior on med. Side

Factors which maintain long. Arches also maintain Trans.arch.

Deformities of the foot

1 Pes planus – Flat foot

2 Pes Cavus – High arched foot Exaggeration of long. Arch Toes dorsiflexed at metatarso-phalang. Joints plantarflexed at inter-phalang. Joints - Claw foot

3. Club Foot – Talipes – congenital or acquired

a. Talipes equinus – Toes dorsiflexed and directed to ground similar to horseb. Talipes calcaneus – Heel remains on ground toes are upturnedc. Talipes varus – Foot fixed in inversion and adduction

d. Foot fixed in eversion and abduction

Deformities of the foot

Foot print (Normal)

Flat foott(Pes planus)

Highly arched foot (Pes cavus)

Deformities of the foot

March Foot

Neck of intermediate metatarsals undergodecalcification

Minor injury may lead to pathological fracture

Commonly observed in soldiers prolonged walk afterprolonged sedentary rest

Deformities of the foot

Hallux vulgus

Great toe adducted towards midline1st Metatarsal abducted wearing of narrow pointed shoes results in undue prominence of medial part of metatarsal head anda bunion may develop