arches of foot is explained in detailed manner.

1. ARCHES OF FOOT

2. INTRODUCTION
• The arches add elasticity and flexibility to the
foot by allowing the midfoot to spread and
close.
• They help the foot to absorb shock and
produce strength to push off and to adjust to
balance and walk.
• They also help distribute weight evenly
around the foot.

3. FUNCTIONS OF FOOT
Support body weight
Serves as a lever to propel the body forward
in walking & running

4. FUNCTIONS OF FOOT
IF THE FOOT POSSESSED A
SINGLE BONE
It cannot adapt itself to
uneven surfaces
Its propulsive action
depends entirely on
gastrocnemius &
plantaris
Gastrocnemius & plantaris

5. FUNCTIONS OF FOOT
IF THE FOOT IS FORMED
OF
SMALL BONES &
MANY JOINTS
It can adapt itself to
uneven surfaces
Long flexors & small
muscles of foot assist in
propulsive action

6. WHY THERE ARE ARCHES?
A segmented structure can hold up weight
only if it is built in the form of arches
Weight will be distributed on: 1) the heel
(behind) & 2) heads of metatarsal bones (in
front): pressure will be minimized on nerves
& vessels in sole
Forward propulsive action will be easier

7. FOOT DIVISION
• Hind-foot
• Mid-foot
• forefoot

8. CLASSIFICATION OF ARCHES
• A. Longitudinal
1. medial
2. lateral
• B. TRANSVERSE
1. ANTERIOR
2. POSTERIOR

9. ARCHES OF FOOT
• MEDIAL
LONGITUDINAL ARCH:
• Higher than lateral
arch
• Formed of:
calcaneum, talus (key
stone), navicular,
three cuneiform &
first three metatarsal
bones

10. ARCHES OF FOOT
LATERAL LONGITUDINAL
ARCH:
Lower than medial arch
Formed of: calcaneum,
cuboid (key stone), fourth
& fifth metatarsal bones

11. ARCHES OF FOOT
TRANSVERSE ARCH:
It is only half an arch
It is formed of: bases of
metatarsal bones,
cuboid & three
cuneiform bones

12. FACTORS MAINTAINING ARCHES OF
FOOT
Shape of bones
Strength of ligaments
Tone of muscles

13. MECHANISM OF ARCH SUPPORT
SHAPE OF
BONES
Bones are wedge-
shaped with the thin
edge lying inferiorly
This applies particularly
to the bone occupying
the center of the arch
“keystone”

14. MECHANISM OF ARCH SUPPORT
• INFERIOR EDGES OF
BONES ARE TIED
TOGETHER

15. MECHANISM OF ARCH SUPPORT
INFERIOR EDGES OF BONES ARE
TIED TOGETHER
Medial longtitudinal arch: plantar
calcaneonavicular ligament, tibialis posterior
Lateral longtitudinal arch: long & short
plantar ligaments
Transverse arch: deep transverse ligaments,
transverse head of adductor hallucis, dorsal
interossei

16. MECHANISM OF ARCH SUPPORT
• TYING THE ENDS OF
THE ARCH TOGETHER

17. MECHANISM OF ARCH SUPPORT
TYING THE ENDS OF THE ARCH TOGETHER
Medial longtitudinal arch: plantar
aponeurosis, medial part of flexor digitorum
longus & brevis, flexor hallucis longus, flexor
hallucis brevis, abductor hallucis
Lateral longtitudinal arch: plantar
aponeurosis, lateral part of flexor digitorum
longus & brevis, abductor digiti minimi, flexor
digiti minimi
Transverse arch: peroneus longus

18. MECHANISM OF ARCH SUPPORT
• SUSPENDING THE ARCH
FROM ABOVE

19. MECHANISM OF ARCH SUPPORT
SUSPENDING THE ARCH FROM ABOVE
Medial longtitudinal arch: tibialis anterior,
tibialis posterior, medial ligament of ankle
joint
Lateral longtitudinal arch: peroneus longus,
peroneus brevis
Transverse arch: peroneus longus

20. MEDIAL LONGITUDINAL ARCH
FACTORS STRUCTURES
BONES Sustentacular tali
LIGAMENTS Spring ligament, interosseus
ligament, talo calcaneus ligament-
Intersegmental ties
MUSCLES,
TENDONS
Tie beam- Plantar aponeurosis,
Abd. Hallucis, Fl. hallucis brevis
Slings- Tendon of TP,FHL,TA

21. LATERAL LONGITUDINAL ARCH
FACTORS STRUCTURES
BONES Distal calcaneus, proximal cuboid
LIGAMENTS Short and long plantar ligament
Intersegmental ties
MUSCLES,
TENDONS
Tie beam- plantar aponeurosis,
intrinsic muscles of foot
Slings- Tendon of PB,PT ,PL

23. TRANSVERSE ARCH
FACTORS STRUCTURES
BONES Most Tarsal and metatarsal
LIGAMENTS Small tarsal lig, sup,deep transverse metatarsal lig
MUSCLES,TENDONS Tie beam- Tendon of PL, TP
Slings- Tendon of PB,PT (Lat) TA (med)
Intersegmental ties- Dorsal Interossei

24. PES PLANUS (FLAT FOOT)
A condition in which the medial longitudinal
arch is depressed
The forefoot is everted
The head of talus is forced downward &
medially
The causes are both congenital and acquired

25. EFFECTS
• (a)The person usually has clumsy shuffling gait due to
the loss of spring in the foot.
• (b) Makes the foot more liable to trauma due to loss of
the shock absorbing function.
• (c) The compression of the nerves and vessels of the
sole is due to the loss of concavity of the sole.
• The compression of the communication between the
medial and lateral plantar nerves leads to neuralgic pain
in the forefoot (metatarsalgia).

28. Types of pes planus
• Flexible or fixed.
• Developmental, congenital or acquired.

29. FLAT FOOT
• Collapse of the medial longitudinal arch everts
the calcaneus in relation to the talus, so that
the foot pronates. Affected patients usually
also have:
• Valgus position of the heel and forefoot
(turned outwards); and
• Pronation (rolling inwards) of the midfoot,
usually referred to as 'hyperpronation'.

30. • Hyperpronation moves the transmission of force
medially as the weight is transferred forwards on to the
walking foot.
• Stretching of soft tissues behind the medial malleolus
(the posterior tibial tendon and posterior tibial nerve)
which can lead to tendinopathy and nerve entrapment.
• The collapsed arch can stretch the spring ligament and
plantar fascia, leading to plantar fasciitis.
• Compensatory abduction of the forefoot, together with
altered transmission of weight through the foot, can
lead to hallux valgus and metatarsalgia.

31. MANAGEMENT
• The arch may develop spontaneously in children aged
under 10 years with flexible pes planus and no other
relevant condition.
• In adults, pes planus which has been present a long
time, is flexible, bilateral, painless, and not progressing,
does not require treatment.
• Symptomatic and inflexible pes planus may require
treatment.
• Initial options include activity modification, footwear
and orthoses, exercises and medication (non-steroidal
anti-inflammatory drugs (NSAIDs)).

32. • Comorbidities should be identified and managed.
When treatment is required and non-surgical
treatment options have failed then surgery is
considered.
• Pes planus is fixed, new, asymmetrical or
progressing.
• Where there is foot pain.
• If the patient has another disease which may be
contributing (eg, neuropathy, inflammatory
arthritis).

33. CONSERVATIVE MANAGEMENT
• Orthotics (inserts or insoles, often custom-
made):
– These usually contain a heel wedge to correct
calcaneovalgus deformity, and an arch support.
– In patients with fixed pes planus or arthropathy,
customised insoles may help relieve symptoms.

34. SURGERY
• Soft tissue reconstructive procedures - eg:
– Achilles tendon lengthening.
– Reconstruction of the tibialis posterior tendon.
• Reconstructive osteotomies - rearfoot, midfoot or
forefoot, depending on alignment - eg, calcaneal
osteotomy, to re-align the hindfoot.
• Arthrodesis:
– Subtalar arthrodesis.
– Triple arthrodesis - usually a salvage for failed surgical
treatment.

35. PES CAVUS
• High arched foot (pes cavus): The exaggeration
of the longitudinal arch of the foot causes pes
cavus.
This usually occurs because of a contracture
(plantar flexion)at the transverse tarsal joint.
When the patient walks with a high arched foot
there is dorsiflexion of the metatarsophalangeal
joints and the plantar flexion of the interphalangeal
joints of the toes

36. CLUB FOOT
•

38. CTEV (Congenital talipus equino
varus)

39. Management
• Treatment options include:
• Stretching and casting (Ponseti method)
• Surgery
• Stretching and casting (Ponseti method)
• This is the most common treatment for clubfoot.
• Move baby's foot into a correct position and then place it in
a cast to hold it there
• Reposition and recast baby's foot once a week for several
months
• Perform a minor surgical procedure to lengthen the Achilles
tendon (percutaneous Achilles tenotomy) toward the end
of this process

40. MANAGEMENT CONTD.
• Doing stretching exercises
• Putting child in special shoes and braces
• Making sure child wears the shoes and braces
as long as needed — usually full time for three
months, and then at night and during naps for
up to three years

41. • Surgery
If baby's clubfoot is severe or doesn't respond to
nonsurgical treatments
More-invasive surgery may be needed.
An orthopedic surgeon can lengthen or reposition
tendons and ligaments to help ease the foot into a
better position.
After surgery, child will be in a cast for up to two
months, and then need to wear a brace for a year
or so to prevent the clubfoot from coming back.

42. THANK U