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The Awesome Arches of the Foot
Ross Hauser, M.D.
The figure below shows the
medial longitudinal, lateral longitudinal, and
transverse arches of the foot. The talus, cuboid,
and intermediate cuneiform bones function as
keystones to these arches. These bones have
joint surfaces that form a wedge to provide
support. Interlocking joint surfaces also
provide support.
Although skeletal structure is important to arch
support, without the
ligaments, the arches would
collapse. The plantar
ligaments (ligaments on
the bottom of the foot), which are stronger and
larger than dorsal ligaments (ligaments on top
of the foot), tie the inferior edges of the
bones together. The most important ligament in
the maintenance of the medial longitudinal arch
is the plantar calcaneonavicular, or spring
ligament.(1,2)
Insertion on the
calcaneus and navicular bones
allow s this ligament to function like a tie beam
in an arch. The long and short plantar ligaments
provide the main support for the lateral
longitudinal arch. The deep transverse ligaments
support the transverse arch.
It turns out that the ligaments are the most
important soft tissue supports for the foot and
the arches. A study to determine the role of
muscle activity in arch support found that men
standing on one foot could support loads of 200
pounds without any evidence of muscular activity
as measured by electromyography.3 These findings
suggest that the primary mechanism of arch
support is ligamentous and that muscle activity
provides support only when loads become
excessive.
When an athlete has pain on the bottom of the
foot or foot fatigue, it is typically because
one of these ligaments is weakened. If a
positive jump sign is elicited when the spring
ligaments, deep transverse ligaments, or plantar
ligaments are palpated, then
Prolotherapy is
performed to these structures. Prolotherapy is
extremely effective at stimulating the growth of
these ligaments, which aids in their ability to
support the arch.
There is another sports medicine myth we must
discuss here. A myth that is commonly
perpetuated is that flat feet are bad. At one
point, low-arched individuals were banned from
service in the U.S. Army.4 A collaborative study
of 248 Army trainees recently examined the risk
factors associated with training-related lower
extremity injuries. Foot morphology data were
collected from the new recruits before basic
training. The recruits with the lowest injury
rates had the lowest arch heights. High-arched
individuals had the highest training-related
foot injuries.5 This makes sense because the
ligaments would have more strain placed on them
in high-arched individuals. It is actually the
high-arched individuals who need arch supports,
not the flat-footed athletes. We will commonly
prescribe arch supports, in addition to
Prolotherapy, for those with pain in the arch
who have especially high arches.
1. Snell, R. Clinical Anatomy for Medical
Students. Second Edition. Little, Brown and
Company, Boston. pp. 543-570.
2. Foot morphology. NIKE Sports Research Review,
Beaverton, OR, August/November 1990.
3. Basmajian, J. Journal of Bone and Joint
Surgery. 1963; 31B:1184-1190.
4. Foot morphology. NIKE Sports Research Review,
Beaverton, OR, August/November 1990.
5. Cowan, D. Med. Sci. Sports and Exerc. 1989;
S60:2.
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