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Dropped met heads and "3 Arches of the Foot" !!

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kahuna, May 31, 2010.

  1. Kahuna

    Kahuna Active Member

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    Hi all

    I am preparing a podiatry seminar for 20 GP's in my local city (by special request!!)

    I want to talk about (amongst other things) why they should move on from referring patients with terminology such as "dropped metatarsal arches", "dropped transverse crest (!)" and/or 3 arches of the foot model.

    (This is still a very common opinion and model that new-and-old UK GPs work on - the three arches of the foot etc.):boxing:

    I have a presentation as a work in progress, but just wondered if I could appeal for any help in any references you have on the above paradigms being outmoded??

    I obviously want to present a robust argument with references they'll respect, so if you have any good teaching ideas / illustrations, anything would be welcome!!

    Thanks in advance all,

  2. Pete Look in this thread we discussed the transverse met arch myth from post 7 down. Admin put some links to other threads and I posted up 2 full text articles.

    ps there are 4 arches ............. apparently you will see in the thread I linked.

    Hope the info helps

    PS take a photo when you drop the boom about 10 seconds after you say there is no metatarsal arch and post it up !!! Good luck
  3. Kahuna

    Kahuna Active Member

    Thanks so much Michael,

    I'd done a search on pod-arena but not found that thread.

    I promise, the photo will be posted!!

    And yes, out of interest I know some osteopaths who work on the 4-arch model.... and these GPs work on the three arch model (medial, lateral and met)..... They all seem to love the 'logic' associated with pathological 'partial-dropping' and 'dropping' of the said arches.

    Thanks for quick reply too

  4. drsarbes

    drsarbes Well-Known Member

    Hi Kahuna:
    20 GPs. What is the purpose of the presentation?
    I've done a few of these over the years and they have changed quite a bit from what my initial presentation was many years ago.

    If I may give you some advice, take it or leave it.

    I realized the two main points of presentations to GPs were;

    1. Give them some usable information they can use right away to help their patients, such as how to access a patient with a foot or ankle complaint. (I always found that they appreciated advice on how to give a digital block with less pain.)

    2. Give them a quick education of what you do and what you treat so as to increase your referrals.

    Some of the GPs will be into orthopedics/podiatric medicine more than others. Just like some are more aware of neurological or dermatology more than others. It's the nature of being a general or family practitioner. They are fast learners and will use the terminology you use.

    Have fun and make them know that their patients are in good hands when they refer to you.

    My 2 cents

  5. Griff

    Griff Moderator

    Kahuna (and Mike),

    Here's another of the articles debunking the transverse arch


    Attached Files:

  6. efuller

    efuller MVP

    Steve's advice is good. If you take away the GP's explanation of what is wrong, you need to replace it with something. What are you seeing when you get a referral for dropped metatarsal or fallen arches?


  7. Bill Bird

    Bill Bird Active Member

    Thank you all for this and the related threads. For me this is where this site is a leader as an agent for CPD.

    You might be interested to know that in last design, the last being the solid form around which all footwear is made, the part of the last that gives shape to the insole of the shoe underneath the met heads is curved.

    I remember reading, and am thinking of reseaching again, a paper on last design. It begins by showing the ideal of the metatarsal arch such as proposed by Kapandji, then it shows the state of the average foot, which as the three 'myth' articles show, is flat. The paper then goes on to recomend that the last designer curves the bottom of the last at that point so that the first and fifth met heads have ground reaction forces brought up to them and the 2 - 4 met heads are off of the bottom of the shoe.

    I hope my description makes sense. The paper goes on to say that if the last designer doesn't put that feature in, many wearers will experience discomfort.

    In light of the present discussion, maybe what the last designer is doing is simply conforming the shape of the bottom of the shoe to the shape a healthy foot would make in soft ground.

    Any ideas?

    Bill Bird
  8. Good advice on several levels! You have to be a bit careful not to do the big I AM with this sort of thing, especially if they have been "getting good results" by propping up the medial arch.

    One I often use is to relate the "collapsed met arch" to the pattern of callus on 2-4 met heads. In my universe this lack of load on 1st MPJ is often associated with a loss of function in the windlass. What do we often use to help the windlass? 1st met cut out. What effect will a pre met dome have? Much as a 1st met cutout. So I can sell it as "you've been doing the right thing, heres WHY its working, but its not a structural arch" rather than telling people they're doing it wrong.

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