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The Human Foot – Part Two

January 3rd, 2010

Our modern habit of confining our feet into the prisons of our shoes may be partly responsible for some of the problems we face. Our feet have evolved to manage the changing levels and types of surfaces as the toes grip the ground and reinforce the arches. With the universal use of shoes almost all of the time we have given our feet a much reduced role and they do not have to be able to manage the ground surface, being given a smooth firm plastic or leather one instead. The small intrinsic foot muscles weaken and lose function as they are deprived of their natural job, reducing the foot’s effectiveness.

The toes may even lose their ability to grip the ground at the front of the foot entirely if the weakness of the foot intrinsic muscles and the foot arches is allowed to progress. A clawing posture develops where the toes withdraw upwards in a bent position, leading to shortening of the extensor tendons and the use of abnormal weight bearing surfaces. The tips of toes may then suffer pressure and the upper surfaces of the joints can be compresses against the upper of the shoe. A weakness and reduction in the height of the foot arches will limit foot function further.

As the inside and long ways arch loses height, perhaps connected to the tendency to roll the foot inwards excessively in walking, the tissues under the arch become strained as they are put under tension stretch. This can cause pain and aching with time on the feet such as standing or walking for a while. The smaller front arch across the foot can also give problems if it loses some of its strength and tension. This allows the underneath of the head of the second metatarsal to contact the ground and take body weight pressure, a job it is not designed to do.

Having less padding under it, the second metatarsal is less equipped to manage the weight in standing, and people often feel like they are standing on a pebble under the ball of the foot. Hard skin areas known as calluses can develop over this area and are an indication that weight is being taken under the head. High heeled shoes can worsen this condition as the toes are typically crowded together as they are unable to push off in this position and the raised heel area moves the body weight forward over the forefoot.

Bunions are a common deformity of the forefoot, with the joint between the first metatarsal and the big toe enlarging and the big toe migrating towards the smaller toes. As people report their relatives may have this problem there is some likelihood of a family trait. The joint itself can develop pain and cause space problems within shoes due to its position and that of the toes. The foot can gradually change from the springy and responsive part to a static and non-dynamic support for the body weight with consequent functional loss.

The joint between the first toe and the first metatarsal is not wholly the cause of the bunion abnormality, as the first metatarsal can deviate medially towards the inside, accentuating the abnormality. There is a range of orthopaedic operations available to manage intractable foot pain due to deformity, with the first metatarsal commonly realigned to restore the joint relationship by an osteotomy of the this bone. It is typical for the more minor foot operations to be performed as day cases now, as long as the post operation pain can be controlled and the patient can get around hopping or bearing weight on the heel for an average six weeks.

The assessment and treatment of foot abnormalities is which are not severe enough for consideration of operation are often performed by specially trained physiotherapists. They can analyse foot problems and suggest a variety of already made orthotics such as supportive insoles, correcting hind foot posture and restoring normal alignment of the foot arches. Physiotherapists will also give exercise therapy to strengthen the foot intrinsic muscles and attempt to maintain the integrity of the foot arches.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Haywards Heath, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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