Fallen arch or flatfeet causing over pronation or supination of the feet?

18 June 2019 by connor whittall in News

Fallen arch’s or flatfoot is known medically as pes planus. The foot loses the gently curving arch on the inner side of the sole, just in front of the heel. If this arch is flattened only when standing and returns when the foot is lifted off the ground, the condition is called flexible pes planus or flexible flatfoot. If the arch disappears in both foot positions — standing and elevated — the condition is called rigid pes planus or rigid flatfoot.
The foot has three arches: two longitudinal (medial and lateral) arches and one anterior transverse arch. They are formed by the tarsal and metatarsal bones and supported by ligaments and tendons in the foot. Their shape allows them to act in the same way as a spring, bearing the weight of the body and absorbing the shock produced during locomotion. The flexibility conferred to the foot by these arches facilitates functions such as walking and running.
MedialArch
The medial arch is the higher of the two longitudinal arches. These structures aid and support the arch;
Bones- It is formed by the calcaneus, talus, navicular, three cuneiforms and first three metatarsal bones.
Muscular support:
1. Tibialis anterior- The tibialis anterior functions as a dorsiflexor of the foot by pulling the top, or dorsum, of the foot towards the shin. Origin- along the lateral condyle and proximal body of the tibia, it runs down the shin just lateral to the tibia. Insertion-the medial cuneiform and first metatarsal bones of the foot.
2. Tibialis posterior- The tibialis posterior is the most central of all the leg muscles, and is located in the deep posterior compartment of the leg. It is the key stabilizing muscle of the lower leg. Origin- the inner posterior borders of the tibia and fibula. It is also attached to the interosseous membrane, which attaches to the tibia and fibula. Insertion- Navicular and medial cuneiform bone.
3. fibularis longus- The peroneus longus (also known as fibularis longus) is a superficial muscle in the lateral compartment of the leg, and acts to evert and plantarflex the ankle. Origin- Proximal part of lateral surface of shaft of fibula Insertion- First metatarsal, medial cuneiform.
4. flexor digitorum longus- The flexor digitorum longus is situated on the tibial side of the leg. Origin- Posterior surface of the body of the tibia Insertion- Plantar surface; base of the distal phalanges of the four lesser toes.
5. flexor hallucis- It bends the big toe downward. Helps you bend the foot downward and point your toes Origin- fibula, posterior aspect of middle 1/3 Insertion- Plantar surface; base of distal phalanx of hallux
Ligamentous support:
• plantar aponeurosis- The plantar fascia is the thick connective tissue (aponeurosis) which supports the arch on the bottom (plantar side) of the foot. It runs from the tuberosity of the calcaneus (heel bone) forward to the heads of the metatarsal bones (the bone between each toe and the bones of the mid-foot
• Deltoid ligament; The deltoid ligament (or medial ligament of talocrural joint) is a strong, flat, triangular band, attached, above, to the apex and anterior and posterior borders of the medial malleolus. The deltoid ligament is composed of 1. Anterior tibiotalar ligament 2. Tibiocalcaneal ligament 3. Posterior tibiotalar ligament 4. Tibionavicular ligament. It consists of two sets of fibers, superficial and deep.
• Talocalcaneal ligament -The interosseous talocalcaneal ligament forms the chief bond of union between the talus and calcaneus. It is a portion of the united capsules of the talocalcaneonavicular and the talocalcaneal joints, and consists of two partially united layers of fibers, one belonging to the former and the other to the latter joint.

Lateral longitudinal arch
The lateral arch is composed of the calcaneus, the cuboid, and the fourth and fifth metatarsal.

Muscular support:
1. fibularis longus- The peroneus longus (also known as fibularis longus) is a superficial muscle in the lateral compartment of the leg, and acts to evert and plantarflex the ankle. Origin- Proximal part of lateral surface of shaft of fibula Insertion- First metatarsal, medial cuneiform.

2. abductor digiti minimi- It arises, by a broad origin, from the lateral process of the tuberosity of the calcaneus, from the under surface of the calcaneus between the two processes of the tuberosity, from the forepart of the medial process, from the plantar aponeurosis, and from the intermuscular septum between it and the flexor digitorum brevis.
3. lateral half of flexor digitorum brevis- from the medial process of the tuberosity of the calcaneus, from the central part of the plantar aponeurosis, and from the intermuscular septa between it and the adjacent muscles. It passes forward, and divides into four tendons, one for each of the four lesser toes. Opposite the bases of the first phalanges, each tendon divides into two slips, to allow of the passage of the corresponding tendon of the flexor digitorum longus
4. fibularis tertius- The muscle arises from the lower third of the anterior surface of the fibula (anterior compartment of lower leg); from the lower part of the interosseous membrane; and from an intermuscular septum between it and the peroneus brevis muscle. Inserted into the dorsal surface of the base of the metatarsal bone of the fifth digit.

Ligament support:
1. plantar aponeurosis- The plantar fascia is the thick connective tissue (aponeurosis) which supports the arch on the bottom (plantar side) of the foot. It runs from the tuberosity of the calcaneus (heel bone) forward to the heads of the metatarsal bones (the bone between each toe and the bones of the mid-foot

2. plantar ligaments- Deltoid ligament; The deltoid ligament (or medial ligament of talocrural joint) is a strong, flat, triangular band, attached, above, to the apex and anterior and posterior borders of the medial malleolus. The deltoid ligament is composed of 1. #Anterior tibiotalar ligament 2. Tibiocalcaneal ligament 3. Posterior tibiotalar ligament 4. Tibionavicular ligament. It consists of two sets of fibers, superficial and deep.

Transverse arch

Bones: metatarsals I-V, cuboid and cuneiform bones

Muscles
1. fibularis longus- The peroneus longus (also known as fibularis longus) is a superficial muscle in the lateral compartment of the leg, and acts to evert and plantarflex the ankle. Origin- Proximal part of lateral surface of shaft of fibula Insertion- First metatarsal, medial cuneiform.

2. tibialis posterior- The tibialis posterior is the most central of all the leg muscles and is located in the deep posterior compartment of the leg. It is the key stabilizing muscle of the lower leg. Origin- the inner posterior borders of the tibia and fibula. It is also attached to the interosseous membrane, which attaches to the tibia and fibula. Insertion- Navicular and medial cuneiform bone.

Ligament support;
1. Ligaments: dorsal, plantar, interosseus ligaments;
• Dorsal – The dorsal ligaments consist of three transverse bands: one connects the first with the second cuneiform, another the second with the third cuneiform, and another the third cuneiform with the cuboid.

• Plantar- The plantar ligaments have a similar arrangement to the dorsal and are strengthened by slips from the tendon of the tibialis posterior.

• Interosseus-The interosseous ligaments consist of strong transverse fibers which pass between the rough non-articular portions of the adjacent surfaces of the bones.

Fallen arches are very common with the general population and if you know anyone who suffers with stiff or inflexible feet then they should research the signs and symptoms and visit their local physical therapist, physio or osteopath