1. Arches of Foot

2. Architecture of foot – Purpose Why we need arches Standing Weight bearing Rigid Walking Propel Spring board

3. Arches of foot - classification Longitudinal Medial Lateral Transverse Anterior Posterior

4. Arches of foot – Weight bearing areas Ball of the foot Carries about 40% of weight Heel of the foot Carries about 60% of weight

5. Architecture of an arch Arch is made up of Stones Parts of an arch Ends Pillars Rest over the ground (to support the arch) Summit Highest point of the arch Keystone V – shaped central stone

6. Factors maintaining the arches Tie beam Connecting the ends Prevents separation of the ends Shape of stones Stones are wedge shaped Staples Binding their lower edges together with metal staples Slings Suspending the arch from a cable above the level of the bridge

7. Medial longitudinal arch Most important Higher, more mobile, and resilient than the lateral 2/3 rd part of bones of foot participated

8. Medial longitudinal arch (formation) - Bones Calcaneum Talus Navicular 3 cuneiforms & 1 st 3 metatarsal bones

9. Anterior end is formed by Heads of the first second and third metatarsals Posterior end is formed by Medial tubercle of calcaneum Medial longitudinal arch - Ends

10. Anterior pillar Long & weak Formed by First three metatarsal bones Three cuneiform bones Navicular & Talus Posterior pillar Short and strong Formed by Medial part of the calcaneum Medial longitudinal arch - Pillars

11. Medial longitudinal arch Summit Superior articular surface of the body of the talus Keystone Talus (head) Main joint

12. Medial longitudinal arch - Factors maintaining Shape of bones Intersegmental ties or ligaments & muscles Tie Beams or bowstrings Sling

13. Medial longitudinal arch - Factors maintaining Staples (Intersegmental ties) Spring ligament Tibialis posterior Applied anatomy Stretch of Spring ligament Leads to flat foot

14. Medial longitudinal arch - Factors maintaining Tie beam Keep the anterior & posterior Ends of arch close together Help from flattening the arch Structures acting Plantar aponeurosis Abductor hallucis

15. Medial longitudinal arch - Factors maintaining Slings Summit is pulled up by Tibialis anterior Medial cuneiform (inferomedial) & base of first metatarsal Tibialis posterior Navicular tuberosity & all tarsal except talus Bases of 2 nd 3 rd & 4 th metatarsal

17. Lateral longitudinal arch Low, less mobile, less resilient Designed to transmit more weight & thrust to ground Bones involved Calcaneum, cuboid & 4 th, 5 th metatarsal bones (heads)

18. Ends Anterior End Heads of 4 th & 5 th metatarsal bones Posterior end Lateral tubercle of calcaneum Lateral longitudinal arch - Ends

19. Pillars Anterior Pillar Long & weak Formed by Cuboid bone & 4 th & 5 th metatarsal bones Posterior Pillar Strong & short Formed by Lateral side of calcaneum Lateral longitudinal arch - Pillars

20. Lateral longitudinal arch - Summit Subtalar joint (upper surface of calcaneum) Vulnerable part Calcaneocuboid joint

21. Lateral longitudinal arch - Factors maintaining Shape of bones Intersegmental ties or ligaments & muscles Tie Beams or bowstrings Sling

22. Staples (Intersegmental ties) Long plantar ligament Short plantar ligament Tie beam Plantar aponeurosis Abductor digiti minimi Lateral longitudinal arch - Factors maintaining

23. Slings Peroneus brevis Dorsal side of base of V metatarsal Peroneus tertius Lateral side of Dorsal aspect of base of V metatarsal Peroneus longus Runs in tunnel on cuboid Lateral aspect of base of I metatarsal & Medial cuneiform

24. Anterior Transverse Arch Formed by Heads of all 5 metatarsal bones A complete arch As heads of 1 st and 2 nd metatarsal bones come in contact of ground and form two ends

25. Formed by Cuboid & 3 cuneiforms An incomplete arch Only the lateral end comes in contact with the ground Each foot represents a half dome When medial borers of both feet are approximated a complete transverse arch Made of Bases of 5 metatarsal Posterior Transverse Arch

26. Transverse arch - Factors maintaining Shape of bones Wedge shaped Staples (Intersegmental ties) Deep transverse ligaments Strong plantar ligaments Metatarsal bones are held together by the interrosseous muscles

27. Transverse arch - Factors maintaining Tie beam Peroneus longus Tibialis posteri or

28. Transverse arch - Factors maintaining Sling Peroneus tertius Peroneus brevis Tibialis anterior

29. Flat foot/pes planus Medial longitudinal arch is depressed or collapsed So medial border will touch to the ground Causes Many Achillis tendon is short or muscle tone is poor – congenital Injury to spring ligament - acquired Person wears high-heeled shoes Distribution of weight changes so that the ball of the foot may carry up to 80% and the heel 20%

30. High arch foot/Pes cavus Exaggeration of the longitudinal arch May be hereditary or acquired Shortening of muscles or tendons of leg or sole Fixed plantar flexion deformity

31. Club foot Common congenital deformity Rotated internally at the ankle Ligaments and tendons of muscles are shorter than usual

32. Deformities Hallux vulgus Great toe adducted towards midline & first metatarsal abducted Talipes equinus Toes dorsiflexed & directed to ground Talipes calcaneus Heel remains on ground & toes are upturned