The Arches of the Foot

The Arches of the Foot

The foot has three arches: two longitudinal (medial and lateral) arches and one anterior transverse arch (Fig. 1). They are formed by the tarsal and metatarsal bones and supported by ligaments and tendons in the foot.

Their shape allows them to act in the same way as a spring, bearing the weight of the body and absorbing the shock produced during ambulation (walking). The flexibility benefit to the foot by these arches facilitates functions such as walking and running.

In this post, we define the basic anatomy of the arches of the foot – their bony and ligamentous structure, the supporting tendons, and their MAIN clinical correlations

Longitudinal Arches
There are two longitudinal arches in the foot – the medial and lateral arches. They are formed between the tarsal bones and the proximal end of the metatarsals.

The Medial Arch (what we consider to be the main arch of the foot)
The medial arch is the higher of the two longitudinal arches. It is formed by the calcaneus, talus, navicular, three cuneiforms and first three metatarsal bones. It is supported by:
Muscular support: Tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic foot muscles
Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments), medial ligament of the ankle joint.
Bony support: Shape of the bones of the arch.
Other: Plantar aponeurosis (Plantar Fascia).
The Lateral Arch
The lateral arch is the flatter of the two longitudinal arches, and lies on the ground in the standing position. It is formed by the calcaneus, cuboid and 4th and 5th metatarsal bones. It is supported by:
Muscular support: Fibularis longus, flexor digitorum longus, and the intrinsic foot muscles.
Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments).
Bony support: Shape of the bones of the arch.
Other: Plantar aponeurosis (Plantar Fascia).
The Transverse Arch
The transverse arch is located in the coronal plane of the foot. It is formed by the metatarsal bases, the cuboid and the three cuneiform bones. It has:
Muscular support: Fibularis longus and tibialis posterior.
Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments) and deep transverse metatarsal ligaments.
Other support: Plantar aponeurosis (Plantar Fascia).
Bony support: The wedged shape of the bones of the arch.
Clinical Relevance - Pes Cavus (High Arches)
Pes cavus is a foot condition characterised by an unusually high medial longitudinal arch. It can appear in early life and become symptomatic with increasing age. Due to the higher arch, the ability to shock absorb during walking is diminished and an increased degree of stress is placed on the ball and heel of the foot.

Consequently, symptoms will generally include pain in the foot, which can radiate to the ankle, leg, thigh and hip. This pain is transmitted up the lower limb from the foot due to the unusually high stress placed on the hindfoot during the heel strike of the gait cycle.

Causes of pes cavus can be idiopathic, hereditary, due to an underlying congenital foot problem such as club foot, or secondary to neuromuscular damage such as in poliomyelitis.

The condition is generally managed by supporting the foot through the use of special shoes or sole cushioning inserts. Reducing the amount of weight the foot has to bear, via overall weight loss can also improve the symptoms.
Clinical Relevance: Pes Planus (Flat Footed)
Pes planus is a common condition in which the longitudinal arches have been lost. Arches do not develop until about 2-3 years of age, meaning flat feet during infancy is normal.

Because the arches are formed, in part, by the tight tendons of the foot, damage to these tissues through direct injury or trauma can cause pes planus. However in some people, the arches never formed during development.

For most individuals, being flat-footed causes few, if any, symptoms. In children it may result in foot and ankle pain, whilst in adults the feet may ache after prolonged activity.

Treatment generally involves the use of arch-supporting inserts for shoes.
Clinical Relevance - Plantar Fasciitis
One of the most common causes of heel pain. It involves inflammation of the thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up after sitting. The pain is usually worse after exercise, not during it.
Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause remains unclear in many cases of plantar fasciitis.

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

Age. Plantar fasciitis is most common between the ages of 40 and 60.
Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
Foot mechanics. Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.
Obesity. Excess pounds put extra stress on your plantar fascia.
Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage the plantar fascia.
Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk as a way to relieve plantar fasciitis pain might lead to foot, knee, hip or back problems.


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