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 a network of ligaments and tendons. The purpose of the arches is to act as a spring, bearing the body weight and absorbing shock during locomotion, thus allowing flexibility and facilitating the functions of walking and running. In this article, an in-depth examination of the anatomy, structure, and clinical correlations of the foot arches is made.
The foot has two longitudinal arches – the medial and lateral arches. They are formed by the tarsal bones and the heads of the metatarsal bones.
The medial arch is the higher of the two longitudinal arches. It is composed of the calcaneus, talus, navicular, three cuneiforms, and the first three metatarsal bones. Support is provided by musculature (Tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic foot muscles), ligaments (Plantar ligaments such as the long plantar, short plantar and plantar calcaneonavicular ligaments, as well as the medial ligament of the ankle joint), bones (The shape of the bones forming the arch), and other structures (Plantar aponeurosis).
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 the fourth and fifth metatarsal bones. It is supported by musculature (Fibularis longus, flexor digitorum longus, and the intrinsic foot muscles), ligaments (Plantar ligaments including the long plantar, short plantar and plantar calcaneonavicular ligaments), bones (The shape of the bones forming the arch), and other structures (Plantar aponeurosis).
The transverse arch is located in the coronal plane of the foot. It is made up of the metatarsal bases, the cuboid bone, and the three cuneiform bones. Structures that provide support to the transverse arch include musculature (Fibularis longus and tibialis posterior), ligaments (Plantar ligaments such as the long plantar, short plantar and plantar calcaneonavicular ligaments, and deep transverse metatarsal ligaments), bones (The wedged shape of the bones forming the arch), and other structures (Plantar aponeurosis).
Pes cavus is a foot condition characterized by an abnormally high medial longitudinal arch. It can manifest at an early age and become problematic with increasing age. Due to the higher arch, the foot is unable to effectively absorb shock during walking, resulting in increased stress on the ball and heel of the foot. This typically leads to symptoms such as pain in the foot, which can be felt in the ankle, leg, thigh, and hip. The higher stress placed on the hindfoot during the heel strike of the gait cycle is what causes the sensation of pain to be transmitted up the lower extremity.
The cause of pes cavus can be attributed to various factors, such as idiopathic, hereditary, congenital (for example, club foot) and neuromuscular damage (such as in poliomyelitis). Management may include the use of special shoes or sole cushioning inserts to support the foot, as well as overall weight loss in order to reduce the weight bearing load on the foot.
Pes planus is a common condition in which the longitudinal arches have been lost.
The foot is made up of the calcaneus (heel bone), talus, navicular, three cuneiforms and first three metatarsal bones, which together form the two longitudinal arches: the medial arch and the lateral arch. The transverse arch is located in the coronal plane of the foot, and is formed by the metatarsal bases, the cuboid and the three cuneiform bones.
The medial arch, which is the higher of the two longitudinal arches, is supported by the muscular and ligamentous components of the foot. Muscular support comes in the form of the tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic foot muscles. Ligamentous support is provided by the plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments), as well as the medial ligament of the ankle joint. Additionally, the bony structure in the shape of the bones of the arch offers support, as does the plantar aponeurosis.
The lateral arch is the flatter of the two longitudinal arches, and is formed by the calcaneus, cuboid and 4th and 5th metatarsal bones. The muscular components of the foot provide support for the lateral arch in the form of the fibularis longus, flexor digitorum longus, and the intrinsic foot muscles. The plantar ligaments offer additional support (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments), as does the bony structure in the shape of the bones of the arch, and the plantar aponeurosis.
The transverse arch is maintained by muscular support from the fibularis longus and tibialis posterior, ligamentous support from the plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments) and deep transverse metatarsal ligaments, and the plantar aponeurosis. The wedged shape of the bones of the arch additionally provides support for the transverse arch.
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, leading to pain in the foot which can radiate to the ankle, leg, thigh and hip, due to the higher arch's decreased ability to shock absorb during walking. The cause 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 managed by supporting the foot through the use of special shoes or sole cushioning inserts, as well as encouraging overall weight loss in order to reduce the amount of weight the foot has to bear.
Pes planus, or flat feet, is a common condition in which the longitudinal arches have been lost. While arches do not develop until about 2-3 years of age, meaning flat feet during infancy is normal, damage to the tendons of the foot through direct injury or trauma can cause pes planus. For most individuals, being flat-footed causes few, if any, symptoms. In children it may result in foot and ankle pain, whereas in adults the feet may ache after prolonged activity. Treatment, if indicated, generally involves the use of arch-supporting inserts for shoes.
