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Hello everyone
I am now slightly addicted to these forums! I was wondering if I could ask a question of you all. My father and I were talking (he is a podiatrists, I am a pod student) about fit flops. I have just acquired a pair and we were looking at the manufacturer's claims, both somewhat sceptically. My father pointed out that the area under the transverse arch was concave and that is his mind it should be convex so that the first and fifth mets are able to take the load, rather than the 2,3 and 4th mets as the shoe appears to be encouraging the foot to do.
Having read a little around the subject, there seems to be nothing in the literature to support the existence of a transverse arch? Why then does the foot appear to sit in the well known three point structure, calc, 1st met and 5th met, the truss? And why do we put met bars in the shoes of patients with morton's neuroma? Would that be to spread the toes alone, or to raise the 2-4th mets?
I am really interested in hearing from anyone who's got any knowledge on this, or even if you don't have knowledge but have an opinion, bring it on.
Maybe you should look at thie thread, especially this post. There is NO transverse arch.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Maybe you should look at thie thread, especially this post. There is NO transverse arch.
Doesn't it depend on whether you are looking at the metatarsal heads or the base of the metatarsals?
There is most certainly a transverse arch at the metatarsals base and cuneiforms.
If Fit Flops have a built in accomodation sub 2-4 metaheads that doesn't really affect the supposed transverse metatarsal arch, but may potentially effect pressure under the metaheads.
Doesn't it depend on whether you are looking at the metatarsal heads or the base of the metatarsals?
There is most certainly a transverse arch at the metatarsals base and cuneiforms.
If Fit Flops have a built in accomodation sub 2-4 metaheads that doesn't really affect the supposed transverse metatarsal arch, but may potentially effect pressure under the metaheads.
Bruce
Good point, Bruce. The metatarsal heads are on a common plane so they display no evidence of a transverse arch. However, the more proximal metatarsals, cuneiforms and cuboid do show a plantar concavity within a frontal plane cross-section which has functional significance in allowing the peroneus longus and posterior tibial tendons to help stabilize the proximal transverse arch of the foot from collapsing.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Doesn't it depend on whether you are looking at the metatarsal heads or the base of the metatarsals?
There is most certainly a transverse arch at the metatarsals base and cuneiforms.
Yes, BUT, all the research I linked to above investigated if there was an anterior metatarsal arch under the met heads and there wasn't one.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
... the more proximal metatarsals, cuneiforms and cuboid do show a plantar concavity within a frontal plane cross-section which has functional significance ... to help stabilize the proximal transverse arch of the foot from collapsing.
Kevin, simplified does this mean "the arch's function is to provide a platform? to support itself"? Thanks, mark c
Kevin, simplified does this mean "the arch's function is to provide a platform? to support itself"? Thanks, mark c
Mark:
I don't think what you said is any simpler since I don't understand what you are talking about!
Here is what I meant. If you were to take a frontal plane cross-section of the foot at the level of the metatarsal bases, you would find that the first and fifth metatarsals are the most plantarly-located metatarsals and the second, third and fourth metatarsals are the most dorsally-located metatarsals.* With this anatomical information in mind, one could say that there is a "transverse arch" at the level of the metatarsal bases that is not present at the metatarsal heads.
Since segmented structures that are arched in shape are inherently more stable (i.e. more resistance to deformation from external loading forces) than segmented structures that are linear in shape, then this transverse arch of the metatarsal bases would tend to lend increased stability to the portion of the midfoot that is unsupported by ground reaction forces.
That is what I meant by "the more proximal metatarsals, cuneiforms and cuboid do show a plantar concavity within a frontal plane cross-section which has functional significance ... to help stabilize the proximal transverse arch of the foot from collapsing."
Hope this explains myself more "simply".
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
should the met dome then be in the middle of the foot; in line with the taral metatarsal joints? I believe it should. This is an important inclusion when making custom orthoses.
Since segmented structures that are arched in shape are inherently more stable (i.e. more resistance to deformation from external loading forces) than segmented structures that are linear in shape, then this transverse arch of the metatarsal bases would tend to lend increased stability TO THE PORTION OF THE MIDFOOT that is unsupported by ground reaction forces.
Much better phrased, before it read like you were interested in maintaining the 'arch' shape for 'arch sake' but in fact it was to stabilise the midfoot and an arch shape would facilitate this.
Much better phrased, before it read like you were interested in maintaining the 'arch' shape for 'arch sake' but in fact it was to stabilise the midfoot and an arch shape would facilitate this.
Sorry, Mark.....still striving for writing perfection.....
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Objective
Metatarsalgia is often treated by metatarsal osteotomy. Exact knowledge of the normal anatomy of the forefoot is essential for pre-operative planning. The objective of this study was to investigate the forefoot arch during maximal loading in a randomly selected population sample.
Methods
Two hundred subjects randomly selected from a municipality representative of Denmark were invited to interview and forefoot X-ray examination, including a novel horizontal X-ray projection by which the height of each metatarsal from the floor can be measured under maximal loading.
Results
One hundred and thirty-four subjects (79%) presented themselves for interview and X-ray examination. The study group was representative of the randomly selected population sample in terms of age, sex and incidence of metatarsalgia. The study verified that the interrelated geometry of the metatarsal heads in the AP plane corresponds to a parabola as suggested previously (Le Lièvre's parabola). Also in the horizontal plane, the metatarsal heads generally form an arch, the transverse forefoot arch (TFA). Mean height was 3.91 mm (S.E. = 0.10). The individual height of the TFA varied from −1 to 10 mm and was dependent on the width of the forefoot. The relative height of the arch (arch height divided by forefoot width) was independent of age and sex. A non-significant tendency towards a lower arch among subjects with metatarsalgia was observed.
Conclusion
This population study demonstrated that the metatarsal heads constitute arches in both planes (Le Lièvre's parabola in the AP plane and the transverse forefoot arch in the horizontal plane). This knowledge is essential for pre-operative planning in metatarsal osteotomy for metatarsalgia. Formulae for calculating the individual location of each metatarsal head were obtained.
Form and structure of the metatarsal head arch in adults. Ultrasonographic and podometric studies[Article in German]
Hermann B.
Orthopädische Universitätsklinik und Poliklinik Hamburg-Eppendorf. Z Orthop Ihre Grenzgeb. 1995 Jul-Aug;133(4):335-40.
Quote:
Ultrasonic measurements (n = 172) and plantar pressure investigations (n = 119) are performed on the forefeet of healthy adults, in order to constitute a correlation between shape and function of the anterior metatarsal arch. The thickness of the sole of the foot has its maximum beneath the 2nd metatarsal head and its minimum beneath the 1st and 5th ray. The highest pressure values are found at the 2nd and 3rd metatarsal head. It is concluded that despite the arch like configuration of the forefoot there is no structural arch function. The biological principle of adequate padding of pressure points results-depending on the load-in a different thickness of the soft tissues of the sole of the foot. The higher pressure under the central metatarsal heads is accompanied by thicker soft tissue pads and a more dorsal position of these rays.
Patterns of weight distribution under the metatarsal heads
E. J. Luger, M. Nissan, A. Karpf, E. L. Steinberg, and S. Dekel J Bone Joint Surg Br 1999 81-B: 199-202.
Quote:
The longitudinal arch between the heel and the forefoot and the transverse arch between the first and fifth metatarsal heads, absorb shock, energy and force. A device to measure plantar pressure was used in 66 normal healthy subjects and in 294 patients with various types of foot disorder. Only 22 (3%) of a total of 720 feet, had a dynamic metatarsal arch during the stance phase of walking, and all had known abnormality.
Our findings show that there is no distal transverse metatarsal arch during the stance phase. This is important for the classification and description of disorders of the foot.
Background. The existence of the transverse metatarsal arch (TMA) of the foot is a point of controversy. According to Kapandji, TMA of the foot elevates the 2nd to 4th metatarsal heads. Some authors suggest the existence of TMA, while others suggest that there is no functional metatarsal arch of the foot. In this study, we evaluated the existence of TMA of the foot and weight distribution on the metatarsal heads with the EMED-SF (Novel H, Munich, Germany) plantar pressure analysis system.
Methods. The test was performed with 16 volunteers. According to the three functional columns of the foot, the metatarsal region of pressure picture obtained from the EMED-SF system was divided into three regions called 'masks'. Mean pressures in the masks were calculated at the mid-stance phase.
Results. The highest mean pressure recorded was located at the 2nd to 3rd metatarsal heads (7.96 N/cm2), and the second highest pressure was at the heel (6.55 N/cm2). The pressures of the 1st metatarsal and 4th-5th metatarsal heads were 4.86 and 6.26 N/cm2, respectively. The difference between the pressure distributions under metatarsal heads was statistically significant (p=0.000).
Conclusion. According to our results, TMA of the foot does not exist as described by Kapandji.
The existence of a transverse arch of the foot has been disputed in the past. In the present study, the alignment of the metatarsal heads was investigated by ultrasonography in 100 feet of healthy volunteers. In addition, plantar pressure measurements were performed with a capacitance sensor force plate. Ultrasonographic measurements in the weightbearing position showed the 2nd to 4th metatarsal heads in a more plantar position, compared to the 1st and 5th, which confirms there is not a transverse arch in the forefoot. Plantar pressure measurements revealed the maximum pressure during one gait cycle in the mid-forefoot, at the site of the 3rd metatarsal head. Significantly lower pressures were measured under the 2nd and 4th metatarsal heads, the lowest pressures occurred under the 1st and 5th metatarsal heads. In the present study, no anatomically or functionally relevant transverse arch was found. ‘Anterior flat foot’ is not a pathological condition and does not in itself require treatment.
The transverse forefoot arch demonstrated by a novel X-ray projection
O. Simonsen, M. Vuust, B. Understrup, M. Højbjerre, S. Bøttcher and M. Voigt
Foot and Ankle Surgery Volume 15, Issue 1, 2009, Pages 7-13
Whats a novel x ray? Certainly a novel result!
Was it non WB i wonder?
The Transverse Arch as described by Kapandji (1970) existed under the metatarsal HEADS so that heads 2-4 were off the ground during stance phase so the foot rested on 3 points, heel, 1st and 5th. At heel lift the forefoot was said to expand causing all the mets to flatten and receive the load.
Whilst there is obviously an arch shape at the proximal end of the mets this is not the arch defined in Kapandji's work as the metatarsal arch.
Kind regards
Robert Isaacs
Kapandji LA. The physiology of the joints. Edinburgh & London: E & S Livingstone, 1970.
I was wondering if they dorsiflexed the first toe to get it out of the way of the x-ray projection. The first will plantarflex more with the toes dorsiflexed.
Transverse Arch?
Linear Mode
