Our Feet " Part Two"
Non-bony Structures in the Foot
The soft tissues of the foot consist of ligaments, tendons and muscles. Ligaments are fibrous bands or sheets with limited elasticity which connect bones together. Ligaments both provide stability for the joint complexes and also allow movements to occur within their controlling restrictions. All the multiple joints of the foot have ligamentous capsules surrounding them, giving them stability and a base for the synovial membrane which secretes lubricating fluid. The largest ligament in the foot is the plantar ligament which connects the ball of the foot bones to the heel.
The arch is partly maintained by the plantar ligament which can store energy in certain phases of gait and use it later to contribute towards giving us the spring in our step. Any injuries to the plantar ligament can have affects on the support function of the whole foot as well as being very painful and sharp. The Achilles tendon, a large and powerful band of tendon, attaches at the posterior of the heel bone, being the extension of the major muscles of the calf, the gastrocnemius and soleus. The calf musculature is the provider of propulsive power in walking and running.
Walking is a complex movement and often referred to as controlled falling. The gait cycle is the cycle we go through repeatedly with the same series of anatomical actions. The foot bears weight evenly on the front and rear on standing. In gait the foot hits the ground typically at the rear and outer border of the heel, the weight then passing forwards and towards the ball of the foot and the great toe. The plantar ligament stretches to some degree and absorbs some of the load. As the foot rolls inwards and the arch flattens to some amount, the foot moves into what is called pronation.
As the midfoot contacts the ground and weight is taken here the foot starts to supinate to some degree, turning outwards as the person begins to push up on their toes to take the foot off the ground. The typical movements can be exaggerated in many foot problems to do with gait. If the foot overpronates it turns inwards too much and forces increased pressure onto the big toe which normally takes about 60% of the weight load anyhow. Underpronation is the tendency for the weight to be born on the lateral, outside, border of the foot as the weight proceeds forwards.
Problems with Gait
Changes which occur in one bodily area can have distant effects on other bodily regions due to the connected nature of body systems. A typical gait pathology is the antalgic gait, a gait where the body attempts to avoid a painful position or weight bearing posture. One of my neighbours attempts to minimise the forces which are being transmitted through his low back by gliding around smoothly, limiting spinal movement and using his legs almost exclusively to perform his gait. Pathologies can develop in other areas of the body as it attempts to limit forces by adopting an altered gait.
Foot pain does not typically occur in children and adolescents despite the many forceful activities they pursue. However, if a young person describes a pain problem with their feet it should be noted and action taken to solve a small initial problem as opposed to a later much more major one. In the twenties it is uncommon to report any problems with the feet apart from fungal infections and sport and activity related injuries.
It is uncommon for foot pain to occur in adolescents and children even though they stress their feet by being very active. If a pain problem presents itself then this should be taken seriously as treating a relatively minor initial problem is much preferable to having to take more vigorous measures for a more serious one later. People in their twenties rarely have significant problems with their feet except for injuries in activities such as sport and athlete's foot.