Arches of Foot & Walking Cycle

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 ARCHES  OF  FOOT 

  • Human foot is composed of series of small bones with multiple joints & act as segmented lever.
  • Skeleton of the foot is arched, longitudinally & transversely with the concavity directed towards plantar surface of the foot.

FUNCTIONS :-

  • Adapt the foot to uneven surfaces.
  • Keep the foot pliable & dynamic as a spring board, which helps in jumping & jolting.
  • Help in proportional distribution of body weight to the ground.
  • Help in propulsion of the body during locomotion.
  • Protect the plantar vessels & nerves from compression.
CLASSIFICATION :-

Arches of foot are classified into..

2 Longitudinal Arches - 

  • Medial Longitudinal Arch  &  
  • Lateral Longitudinal Arch

1 Transverse Arch -


MEDIAL  LONGITUDINAL  ARCH :-


Formation of the Arch -

Bones forming- Calcaneus, talus, navicular, 3 cuneiforms & 3 medial metatarsal bones up to their heads including two sesamoid bones.

Summit- Trochlear upper surface of the talus

Anterior pillar- Heads of medial 3 metatarsal bones

Posterior pillar- Medial tubercle of calcaneus

Most vulnerable part- Head of the talus, acts as Keystone.

Characteristic feature- Resiliency

Factors Maintaining the Arch -

Shape of the bones- Wedge-shape

Intersegmental tiers- (bind the bones)

  • Plantar calcaneo-navicular or Spring ligament

Tie-beams- (prevent separation of the pillars)

  • Plantar aponeurosis, abductor hallucis, flexor hallucis longus, flexor hallucis brevis, flexor digitorum longus & flexor digitorum brevis.

Suspension of the arch by-

  • Sling action- From above by tibialis anterior & deltoid ligament.
  • Sustentacular action- From below by tibialis posterior.


LATERAL  LONGITUDINAL  ARCH :-


Formation of the Arch - 

Bones forming- Calcaneus, cuboid & 4th 5th metatarsal bones up to their heads.

Summit- Subtalar joint

Anterior pillar- Heads of 4th 5th metatarsal bones

Posterior pillar- Medial tubercle of calcaneus

Most vulnerable part- Calcaneo-cuboid joint

Characteristic feature- Rigidity

Factors Maintaining the Arch -

Shape of the bones- Triangular-shaped bony projection calcanean angle of cuboid, maintains the upward tilt of calcaneus.

Intersegmental tiers- (bind the bones)

  • Long & short plantar ligaments.

Tie-beams- (prevent separation of the pillars)

  • Plantar aponeurosis, abductor digiti minimi, flexor digitorum longus, flexor digitorum brevis & flexor digiti minimi brevis.

Suspension of the arch by-

  • Sling action- From above by peroneus brevis & peroneus tertius.
  • Sustentacular action- From below by peroneus longus.



TRANSVERSE  ARCH :-

  • Each foot presents a half-dome of transverse arch with concavity directed downward & medially.
  • When the medial borders of both feet are approximated a complete transverse arch is formed.

Formation of the Arch -

Bones forming- Bases of metatarsal bones, cuboid & 3 cuneiform bones.

Summit- Trochlear upper surface of the talus

Pillars- Pillars of longitudinal arches

Factors Maintaining the Arch - 

Shape of the bones- Wedge-shape

Intersegmental tiers- (bind the bones)

  • Intrinsic plantar ligaments, dorsal interossei, adductor hallucis.

Tie-beams- (prevent separation of the pillars)

  • Peroneus longus & tibialis posterior.

Suspension of the arch by-

  • Sling action- From above by tibialis anterior medially & peroneus brevis, peroneus tertius laterally.
  • Sustentacular action- From below by tibialis posterior medially & peroneus longus laterally.


APPLIED  ASPECTS :-

  • Failure of arch support depends upon the duration of stress & not upon the severity of stress.

Foot Deformities Affecting the Arches of Foot-

Pes Planus / Flat Foot-

  • Disappearance of arches of foot
  • Cause- Rapid increase in body weight, prolonged standing, fatigue, faulty foot-wear, bad walking.

Pes Cavus / High Arched Foot-

  • Exaggeration of longitudinal arches with plantar flexion at transverse tarsal joint, so that the anterior part of the foot drops below the level of posterior part.
  • Associated with Claw-foot where the toes are dorsiflexed at metatarso-phalangeal joints & plantar flexed at interphalangeal joints.

Talipes / Club Foot-  (Congenital / Acquired)

  • Talipes Equinus- Foot is fixed in plantar flexed position & only the toes are on the ground, so that the individual run using the toes similar to a horse.
  • Talipes Calcaneus- Foot is fixed in dorsiflexed position & only the heel is on the ground.
  • Talipes Varus- Foot is fixed in inversion & adduction at subtalar joint.
  • Talipes Valgus- Foot is fixed in eversion & abduction.

  • Congenital Club foot may be associated with combinations of above deformities in the form of..
    • Congenital Talipes Equinovarus (CTEV) – most common
    • Congenital Talipes Calcaneovalgus (CTCV)
  • Cause-

    • Failure of muscle growth to keep pace with skeletal growth.
    • Imbalance in the growth of different muscles or tendons.

March Foot-

  • Pathological fracture at the neck of intermediate metatarsal bone due to decalcification.
  • Commonly observed in soldiers due to forced walk for prolonged time causing march fracture.

Hallux Valgus- 

  • Great toe is adducted towards the axis of the foot due to abduction of first metatarsal bone.

Cause- 

  • Wearing of narrow pointed shoes leading to deviation of great toe & undue prominence of first metatarsal head medially.
  • A bunion bursa forms overlying the prominent area.

Hammer Toe-

  • Hyperextension at metatarsophalangeal & distal interphalangeal joints along with hyperflexion at proximal interphalangeal joint of the toe.
  • 2nd or 3rd toe is usually affected.

 



 WALKING  CYCLE 

  • In walking, a person makes about 1700 – 1800 foot strikes in every mile.
  • A walking cycle includes the period from heel-strike of one foot to the heel-strike of the same foot.
  • Normal walking on level ground consists of a series of swing and stance phases in succession.

Swing phase

  • It takes place when the lower limb is off the ground.
  • During each cycle the head is displaced upward twice in stance phase and undergoes corresponding downward movement in swing phase.
  • Such vertical displacements of head (5 cm) are known as bobbing of the head.
  • The person bends the trunk to the side on which he stands for purpose of balancing.
  • Simultaneously the arm undergoes alternate forward swing with opposite leg.
Subdivisions- Acceleration, Mid-swing & Deceleration.

Stance phase

  • In this phase the foot strikes the ground and bears weight.
Subdivisions- Heel strike, Foot flat, Mid-stance, Heel off, Toe off.

Sequence of Movements in Walking Cycle :- 

Swing Phase 

At first, Hip, knee & ankle are flexed

Hip flexors & dorsiflexors of the foot are active at the beginning

Limb begins to extend and is fully extended

Hip extensors are maximally active at heel-strike

Stance Phase 

Knee flexes slightly and again undergoes full extension at the end

Foot is then bent at the metatarso-phalangeal joints

Plantar flexors of foot are most active during take-off

Toes tend to flex and grip the ground

Long extensors and the intrinsic muscles of foot stabilize the toes

Invertors and evertors of foot are the important stabilizers and produce a shift of weight distribution among the heads of metatarsals

The downward pelvic tilt on the unsupported side is minimized by the abductors of hip


DISTURBANCES  OF  GAIT

Ataxic Gait :-

  • Observed in Tabes dorsalis.
  • The patient walks on a wide base, lift the advancing led too high and slap the feet on the ground.

Hemiplegic Gait :-

  • Affected leg is rigid and is swung from hip in a semicircle by the movements of trunk.
  • The patient leans to the affected side.

Scissors Gait :-

  • In spastic paraplegia, the legs are adducted, crossing alternately in front of one another.

Staggering Gait :-

  • Observed in drunken state or in drug poisoning or in flocculo-nodular lobe syndrome.
  • The patient is unable to walk on a straight line.

Waddling Gait :-

  • This results from dislocation of hips or muscular dystrophies.
  • There is downward tilt of the pelvis to the unsupported side.

Cerebellar Gait :-

  • Marked irregularity and unsteadiness associated with vertigo.

Propulsion Gait :-

  • In parkinsonism the patient has a stooped posture.
  • Walks with short quick steps.
  • Beginning of the movement is slow but unable to stop the movement when required.

Limping Gait :-

  • Short steps to get rid of weight from the painful limb.
  • Sound limb is brought forward quickly to land on the floor.




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