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ARCHES OF FOOT LEARNING OBJECTIVES • Understand the arches of foot and the factors responsible fo r th e i r m a i n te n a n c e • Recognize the injury when it occurs and be able to evaluate plantar fasciitis. • Learn about advices regarding the rehabilitation for plantar fasciitis. Anatomy of the foot As stated before, there are 26 bones, 33 joints, 106 ligaments, 19 foot muscles and 11 muscles in the lower leg. The foot enables us, through subtle movements, to walk and run up to 10,000 to 17,000 steps a day. During our lives our feet carry us between 65,000 and 115,000 miles. The arches of the foot function as shock absorbers, supporting the body and enabling stable ambulation. The Planter Fascia: The plantar fascia is a dense, fibrous membrane that spans the entire length of the foot It originates at the tubercle of the calcaneus and attaching at the proximal phalanges. The fascia protects the underside of the foot and helps support the arches. It consists of a thick central portion and thinner lateral and medial bands that provide flexibility and help maintain the longitudinal arch Division of the Foot The foot is composed of 26 bones Clinicians divide the foot in three regions Hindfoot Midfoot Forefoot Hindfoot This region includes The talus The calcaneus And their midtarsal articulations with the navicular and cuboid bones Midfoot This region includes The navicular The cuboid And the 3 cuneiform bones (numbered medial to lateral) Forefoot This region includes The metatarsals And the phalanges Not included in the 26 bones are the 2 sesamoid bones These are the floating bones at the base of the great toe. Arches of Foot Arches held by tendons & ligaments Allow foot to support weight of the body: Ball of foot – 40% weight. Heel – 60% weight Provide leverage for walking Crucially very important for maintaining the neurovascular status of the plantar aspect of foot Fully developed by age 13 METHODS OF MAINTAINING AN ARCH Shape of stones (bones) Staples Tie beam Slings All these methods are being used in maintaining foot arches ARCHES There are 2 arches in the foot Transverse arch Longitudinal arches Medial longitudinal Arch Lateral longitudnal Arch These are both held together by ligaments (static) and musculo-tendon units (dynamic). Medial Longitudinal Arch Consists of: Calcaneal tuberosity Talus Navicular Three cuneiforms 1st , 2nd, and 3rd metatarsals Maintained by: Tibialis anterior Tibialis posterior Flexor digitorum longus Flexor hallucis longus Abductor hallucis Flexor digitorum brevis The ligaments included are the long plantar fascia and the plantar calcaneo-navicular ligament. Ligament support • Plantar Calcaneonavicular ligament • Long Plantar Ligament • Deltoid ligament • Plantar fascia Lateral longitudinal arch Consists of: Calcaneus Cuboid 4th and 5th metatarsal bones Maintained by: Peroneus longus Peroneus brevis Peroneus tertius Abductor digiti minimi Flexor digitorum brevis muscles This arch is more stable and less adjustable than the Medial one. The ligaments included are the long and the short plantar ligaments TRANSVERSE ARCH Consists of Navicular Cuneiforms Cuboid Metatarsal bones Maintained by: Tibialis posterior Tibialis anterior Peroneus longus muscles Plantar fascia It is divided into 3 parts Tarsal Posterior metatarsal Anterior metatarsal A loss in the anterior metatarsal arch results in callus formation under the heads of the metatarsal bones. Plantar fascia It is a ligament that supports the longitudinal arch of the foot. It is a tough, fibrous band of connective tissue that runs from the heel bone to the ball of the foot. The plantar fascia is made up of predominantly longitudinally collagen fibers. In the ligament, there are three distinct structural components, the medial, central and the lateral component. The central component is the largest and most prominent. Plantar Fascitis An inflammation caused by excessive stretching of the plantar fascia. Results from repeated trauma to the tissue where it attaches to the calcaneus The result of the damage and inflammation is a dull, aching pain under the foot.
