Non-bony Structures in the Foot

The soft tissues of the foot consist of ligaments, tendons and muscles. Ligaments are fibrous bands or sheets with limited elasticity which connect bones together. Ligaments both provide stability for the joint complexes and also allow movements to occur within their controlling restrictions. All the multiple joints of the foot have ligamentous capsules surrounding them, giving them stability and a base for the synovial membrane which secretes lubricating fluid. The largest ligament in the foot is the plantar ligament which connects the ball of the foot bones to the heel.

The arch is partly maintained by the plantar ligament which can store energy in certain phases of gait and use it later to contribute towards giving us the spring in our step. Any injuries to the plantar ligament can have affects on the support function of the whole foot as well as being very painful and sharp. The Achilles tendon, a large and powerful band of tendon, attaches at the posterior of the heel bone, being the extension of the major muscles of the calf, the gastrocnemius and soleus. The calf musculature is the provider of propulsive power in walking and running.

The complex nature of walking has been called controlled falling but is managed easily by the majority of humans. Gait is a repeating pattern of specific bodily movements and when we stand still our weight distribution is even between the front and back of the foot. The outside border of the rear of the heel strikes the ground first as the foot contacts the ground, with weight then transferring forwards and inwards towards the big toe and ball of foot. Absorption of some of the load occurs in the plantar ligament, with the arch flattening by some amount and the foot attaining the position of pronation.

Supination is the next posture the foot moves towards as the midfoot hits the ground and starts to bear weight, the foot rotating outwards until the walker starts to push off on their toes so they can take their foot off the surface. In gait problems these postural movements can become exaggerated. Overpronation occurs when the foot turns in excessively and throws exaggerated forces across to the great toe which typically suffers sixty percent of the load in gait. If the person tends to bear weight along the outer, lateral border of the foot as they walk forwards the foot is said to be underpronated.

Gait Problems

Changes which occur in one bodily area can have distant effects on other bodily regions due to the connected nature of body systems. A typical gait pathology is the antalgic gait, a gait where the body attempts to avoid a painful position or weight bearing posture. One of my neighbours attempts to minimise the forces which are being transmitted through his low back by gliding around smoothly, limiting spinal movement and using his legs almost exclusively to perform his gait. Pathologies can develop in other areas of the body as it attempts to limit forces by adopting an altered gait.

Foot pain does not typically occur in children and adolescents despite the many forceful activities they pursue. However, if a young person describes a pain problem with their feet it should be noted and action taken to solve a small initial problem as opposed to a later much more major one. In the twenties it is uncommon to report any problems with the feet apart from fungal infections and sport and activity related injuries.

It is uncommon for foot pain to occur in adolescents and children even though they stress their feet by being very active. If a pain problem presents itself then this should be taken seriously as treating a relatively minor initial problem is much preferable to having to take more vigorous measures for a more serious one later. People in their twenties rarely have significant problems with their feet except for injuries in activities such as sport and athlete’s foot.