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 arches of the foot and the function of the toes alter as the intrinsic muscles of the foot weaken as the toes lose the ability to hold themselves straight when gripping the surface. Due to this they start to bend or claw, and as this progresses the muscles which extend the toes can shorten in sympathy, drawing the toes up in a flexed position. This takes the pads of the toes away from any possible contact with the ground, obliging them to take force on the tips perhaps. Overall the foot becomes less functional and the arches decrease in height.
The main arch along the inside of the foot can suffer a loss of strength and height, sometimes brought on by the inward rolling of the foot in gait, causing a stretch to the ligaments underneath the joints of the arch. Stretch of these tissues over some time can produce aching and pain in the foot arch on standing and walking. The transverse foot arch, the less obvious arch across the front of the foot, can collapse down as the small muscles weaken, leading to the bodyweight being applied to the underside of the second metatarsal head.
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.
Another abnormality which might develop is a bunion, an enlarged and often unsightly joint between the big toe and the first metatarsal. This can be something which is familial to some degree as many patients report their relatives are similar to them. As the joint enlarges it can become painful and the big toe deviates gradually towards the outside. Along with the loss of the strength of the foot arches this turns the foot from a dynamic movement tool to a static platform which is difficult and often painful to use.
The relationship between the big toe joint and the first metatarsal is not the whole determinant of a bunion problem, as the first metatarsal is typically angled towards the inside and this makes the abnormality worse. Orthopaedic surgeons can approach these problems with a number of operations with differing goals, the first metatarsal osteotomy being a common intervention to restore the natural alignment between it and the big toe. Day case surgery has taken over from overnight admission or longer in cases where the patient can learn to mobilise quickly either weight bearing on the heel or hopping and if the pain can be well controlled.
Physiotherapists who specialise in the area of foot assessment and subsequent treatment manage many of the less severe foot disorders due to abnormal foot postures. This needs specific training in the assessment and the use of the large variety of pre-formed insoles, typically called orthotics, to correct the postures of the hind foot or to give support to the arches of the foot. Exercises are often prescribed at the same time to attempt to restore strength and function in the intrinsic muscles which maintain the foot arches.
The arches of the foot and the function of the toes alter as the intrinsic muscles of the foot weaken as the toes lose the ability to hold themselves straight when gripping the surface. Due to this they start to bend or claw, and as this progresses the muscles which extend the toes can shorten in sympathy, drawing the toes up in a flexed position. This takes the pads of the toes away from any possible contact with the ground, obliging them to take force on the tips perhaps. Overall the foot becomes less functional and the arches decrease in height.
The main arch along the inside of the foot can suffer a loss of strength and height, sometimes brought on by the inward rolling of the foot in gait, causing a stretch to the ligaments underneath the joints of the arch. Stretch of these tissues over some time can produce aching and pain in the foot arch on standing and walking. The transverse foot arch, the less obvious arch across the front of the foot, can collapse down as the small muscles weaken, leading to the bodyweight being applied to the underside of the second metatarsal head.
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.
Another abnormality which might develop is a bunion, an enlarged and often unsightly joint between the big toe and the first metatarsal. This can be something which is familial to some degree as many patients report their relatives are similar to them. As the joint enlarges it can become painful and the big toe deviates gradually towards the outside. Along with the loss of the strength of the foot arches this turns the foot from a dynamic movement tool to a static platform which is difficult and often painful to use.
The relationship between the big toe joint and the first metatarsal is not the whole determinant of a bunion problem, as the first metatarsal is typically angled towards the inside and this makes the abnormality worse. Orthopaedic surgeons can approach these problems with a number of operations with differing goals, the first metatarsal osteotomy being a common intervention to restore the natural alignment between it and the big toe. Day case surgery has taken over from overnight admission or longer in cases where the patient can learn to mobilise quickly either weight bearing on the heel or hopping and if the pain can be well controlled.
Physiotherapists who specialise in the area of foot assessment and subsequent treatment manage many of the less severe foot disorders due to abnormal foot postures. This needs specific training in the assessment and the use of the large variety of pre-formed insoles, typically called orthotics, to correct the postures of the hind foot or to give support to the arches of the foot. Exercises are often prescribed at the same time to attempt to restore strength and function in the intrinsic muscles which maintain the foot arches.
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