The Foot Joints – Part Two

Some of the problems we have with our feet may be related to the fact that we keep them locked up in shoes all the time. Our feet are adapted for reacting to the surface of the ground and gripping and exercising the muscles as we cope with varying situations underfoot. Now we all wear shoes the foot has much less to do as it has an unvarying slab of leather or plastic underneath it and does not need to react greatly to the ground surface. If the small muscles of the feet are not exercised regularly by interacting with the surface and doing their job they will waste and become less effective.

With the increasing weakness of the intrinsic muscles of the foot comes a reduction in the function of the foot arches and the toes, which find themselves unable to grip the ground effectively. The toes adopt a bent posture known as clawing and this can progress to a complementary shortening of the toe extensors. This moves the pads away from any weight bearing situation in front of the foot and draws them up, pressing them against the top of a shoe or forcing them to bear weight on the tips. Accompanying arch height reduction reduces function further.

The medial longitudinal arch can lose some of its height, at times related to the person’s typical gait with rolling the foot inwards, stretching the joint ligaments of the arch as they are tensioned and stretched. If this occurs then any length of time spent walking or standing can bring on aching and pain. The less marked transverse arch at the front of the foot can also suffer a reduction in its structure and strength. If this occurs the second metatarsal is forced to take the weight of the body during walking and standing which it is not adapted for.

Because it has little fat padding underneath it, the second metatarsal is less well designed to cope with the weight of the body, with sufferers feeling when standing that they have a stone under their foot. Callused, hard skin areas develop and indicate that the area is taking weight that it should not be. Women wearing shoes with high heels can force their body weight forwards over the forefoot and the narrow front of the shoe can compress the toes together so their ability to push off is compromised.

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 physiotherapy, 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.