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Transverse Arch?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by sparkyclair, Jun 6, 2008.

  1. sparkyclair

    sparkyclair Active Member


    Members do not see these Ads. Sign Up.
    Hello everyone
    I am now slightly addicted to these forums! I was wondering if I could ask a question of you all. My father and I were talking (he is a podiatrists, I am a pod student) about fit flops. I have just acquired a pair and we were looking at the manufacturer's claims, both somewhat sceptically. My father pointed out that the area under the transverse arch was concave and that is his mind it should be convex so that the first and fifth mets are able to take the load, rather than the 2,3 and 4th mets as the shoe appears to be encouraging the foot to do.

    Having read a little around the subject, there seems to be nothing in the literature to support the existence of a transverse arch? Why then does the foot appear to sit in the well known three point structure, calc, 1st met and 5th met, the truss? And why do we put met bars in the shoes of patients with morton's neuroma? Would that be to spread the toes alone, or to raise the 2-4th mets?

    I am really interested in hearing from anyone who's got any knowledge on this, or even if you don't have knowledge but have an opinion, bring it on.

    kindest regards
    Clair, Southampton, UK
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Maybe you should look at thie thread, especially this post. There is NO transverse arch.
     
  3. sparkyclair

    sparkyclair Active Member

    Hi Craig
    Thank you so much for your very quick reply. I am getting used to searching for things on the forums so excuse me if I duplicate questions!!

    I will take a look now

    many thanks
    Clair
     
  4. perrypod

    perrypod Active Member

    Of course there is a transverse arch, I have such an arch in the myrtle hedge
    that bisects my lawn in the transverse plane!
     
  5. Bruce Williams

    Bruce Williams Well-Known Member

    Doesn't it depend on whether you are looking at the metatarsal heads or the base of the metatarsals?

    There is most certainly a transverse arch at the metatarsals base and cuneiforms.

    If Fit Flops have a built in accomodation sub 2-4 metaheads that doesn't really affect the supposed transverse metatarsal arch, but may potentially effect pressure under the metaheads.

    Bruce
     

  6. Good point, Bruce. The metatarsal heads are on a common plane so they display no evidence of a transverse arch. However, the more proximal metatarsals, cuneiforms and cuboid do show a plantar concavity within a frontal plane cross-section which has functional significance in allowing the peroneus longus and posterior tibial tendons to help stabilize the proximal transverse arch of the foot from collapsing.
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Yes, BUT, all the research I linked to above investigated if there was an anterior metatarsal arch under the met heads and there wasn't one.
     
  8. markjohconley

    markjohconley Well-Known Member

    Kevin, simplified does this mean "the arch's function is to provide a platform? to support itself"? Thanks, mark c
     
  9. Bruce Williams

    Bruce Williams Well-Known Member

    Craig;

    hence my post on where there is a metatarsal arch.:D

    Research is interesting, especially when it is done by non-podiatric trained personnel.:rolleyes:

    :drinks
    Bruce
     
  10. Mark:

    I don't think what you said is any simpler since I don't understand what you are talking about!

    Here is what I meant. If you were to take a frontal plane cross-section of the foot at the level of the metatarsal bases, you would find that the first and fifth metatarsals are the most plantarly-located metatarsals and the second, third and fourth metatarsals are the most dorsally-located metatarsals.* With this anatomical information in mind, one could say that there is a "transverse arch" at the level of the metatarsal bases that is not present at the metatarsal heads.

    Since segmented structures that are arched in shape are inherently more stable (i.e. more resistance to deformation from external loading forces) than segmented structures that are linear in shape, then this transverse arch of the metatarsal bases would tend to lend increased stability to the portion of the midfoot that is unsupported by ground reaction forces.

    That is what I meant by "the more proximal metatarsals, cuneiforms and cuboid do show a plantar concavity within a frontal plane cross-section which has functional significance ... to help stabilize the proximal transverse arch of the foot from collapsing."

    Hope this explains myself more "simply".:rolleyes:
     
  11. Smilingtoes

    Smilingtoes Active Member

    should the met dome then be in the middle of the foot; in line with the taral metatarsal joints? I believe it should. This is an important inclusion when making custom orthoses.
     
  12. markjohconley

    markjohconley Well-Known Member

    Much better phrased, before it read like you were interested in maintaining the 'arch' shape for 'arch sake' but in fact it was to stabilise the midfoot and an arch shape would facilitate this. ;)
     
  13. Sorry, Mark.....still striving for writing perfection.....
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The transverse forefoot arch demonstrated by a novel X-ray projection
    O. Simonsen, M. Vuust, B. Understrup, M. Højbjerre, S. Bøttcher and M. Voigt
    Foot and Ankle Surgery Volume 15, Issue 1, 2009, Pages 7-13
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Cut and pasted from thread linked above:

    Form and structure of the metatarsal head arch in adults. Ultrasonographic and podometric studies[Article in German]
    Hermann B.
    Orthopädische Universitätsklinik und Poliklinik Hamburg-Eppendorf.
    Z Orthop Ihre Grenzgeb. 1995 Jul-Aug;133(4):335-40.
    Patterns of weight distribution under the metatarsal heads
    E. J. Luger, M. Nissan, A. Karpf, E. L. Steinberg, and S. Dekel
    J Bone Joint Surg Br 1999 81-B: 199-202.
    Evaluation of the transverse metatarsal arch of the foot with gait analysis
    Ulunay Kanatli, Haluk Yetkin, Selcuk Bolukbasi
    Gazi University Medical Faculty, Orthopaedics and Traumatology Department
    Journal Archives of Orthopaedic and Trauma Surgery Volume 123, Number 4 / May, 2003
    Observations concerning the transverse metatarsal arch
    D. Daentzer, N. Wülker and U. Zimmermann
    Orthopaedic Department, Hannover Medical School, Hannover, Germany
    Foot and Ankle Surgery Volume 3, Issue 1, 1997, Pages 15-20
     
  16. Whats a novel x ray? Certainly a novel result!

    Was it non WB i wonder?

    The Transverse Arch as described by Kapandji (1970) existed under the metatarsal HEADS so that heads 2-4 were off the ground during stance phase so the foot rested on 3 points, heel, 1st and 5th. At heel lift the forefoot was said to expand causing all the mets to flatten and receive the load.

    Whilst there is obviously an arch shape at the proximal end of the mets this is not the arch defined in Kapandji's work as the metatarsal arch.



    Kind regards
    Robert Isaacs


    Kapandji LA. The physiology of the joints. Edinburgh & London: E & S Livingstone, 1970.
     
  17. efuller

    efuller MVP

    I was wondering if they dorsiflexed the first toe to get it out of the way of the x-ray projection. The first will plantarflex more with the toes dorsiflexed.

    Regards,
    Eric
     
  18. collinsaloha

    collinsaloha Welcome New Poster

  19. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  20. Bruce Williams

    Bruce Williams Well-Known Member

    I still hold that there is a functional and structural, for most patients, transverse metatarsal arch of the foot. I will not argue that many patients do not have reliable pressure sub 1st and 5th metatarsal heads. This does not mean that their metatarsals are not capabale of being plantar flexed when casted for an orthosis, or that the pressures will not increase with the use of a properly casted orthosis along with a well placed metatarsal pad and digital wedge.
    The goal is increasing the dorsiflexion stiffness when it is necessary. If you can position the transverse arch properly you will maximize your outcomes for dorsiflexion stiffness IMHO.
    cheers Craig!
    Bruce
     
  21. CraigT

    CraigT Well-Known Member

    Craig- I assume this is tongue in cheek! Others may not realise that Ian G wrote the article...

    Collins- Ian is a big contributor in Pod Arena and is behind the sportspodiatryinfo blog.
     
  22. Rob Kidd

    Rob Kidd Well-Known Member

    The pedal arches have been an enigma for years; much is said about them, yet rarely, if ever does one hear a definitive description of their function(s). Actually, "Arches" is perhaps not the best description as a "half dome" is nearer to the mark, but that still does not help us understand what they do. Notwithstanding, a side step into engineering, to look at how they would hold an arch of a bridge up, for instance, will reveal that all of their methods - key stones, tie beams, staples, suspensions etc, can be identified in the human foot. Just as an example - look at the manner in which tibialis aneriort and peroneus longus insert - spanning a joint, essentially rendering it imobile.

    A long time ago, 1992 I think, I wrote about the evolution of the arch of the foot, suggesting that the reason for the inablity to find a function of the arch was that it was not a function unit per se, but that the hind part evolved for one purpose, and the forepart another. For the hindpart: raising the anterior portion of the calcaneus, which in turn raised the subtalar axis, which in turn gave us a transverse plane component to st movement, which gave us torque conversion. Chimps etc do not really have this. I also hypothesied that the anterior portion of the arch arose as a side effect of talar neck angle and talar head torsional changes, mainly as a result of first ray realignment. Important here is to recognise that (I suggest) the first ray did not align to the rest of the foot - the rest of the foot realigned to the first ray. Put your hand on the table in front of you; keep your thumb still, and move your medial most four fingers towards your thumb: made an arch?

    I am no nearer supporting these hypotheses now than I was back in 1991, but they were published in referreed biological press, if anyone wants a copy, let me know. Rob
     
    Last edited: Nov 25, 2012
  23. Interesting. Now do the opposite, keep your lateral fingers still and draw the thumb in- still makes an arch, although not as high. Why the height differential achieved between the two methods?
     
  24. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    :drinks
     
  25. I read Ian Griffiths' article on the transverse metatarsal arch and also have responded earlier here on Podiatry Arena to Craig Payne's assertion that their is no transverse metatarsal arch. One must be very careful in saying that "there is no transverse metatarsal arch" without qualifying the fact that there certainly is a transverse metatarsal arch in the proximal aspect of the metatarsals, at the metatarsal bases.

    Careful anatomical study shows that, indeed, the proximal metatarsals have a transverse arch structure, at their bases, but that this transverse arch structure is not present in the distal metatarsals, at the plantar metatarsal head level. This is very clearly demonstrated in the illustrations below which are coronal plane MRI sections of various feet at the metatarsal base level.

    Therefore, those that claim that "there is no transverse metatarsal arch", are no more right or correct than those that claim that "there is a transverse metatarsal arch". Rather it would be more correct to claim that the dorsal and plantar transverse plane relationship of the proximal metatarsals have a variable arched structure and the plantar aspect of the metatarsal heads (including the sesamoids at the first metatarsal head) are in a common transverse plane during most weightbearing activities.

    This proximal transverse arch of the metatarsals is quite mechanically important especially considering the insertion of the peroneus longus and posterior tibial tendons into the plantar aspects of this transversely arched plantar metatarsal base structure. Therefore, please don't continue to argue that "there is no transverse metatarsal arch" unless you first specify which part of the metatarsals you are referring to. Without this transverse arch structure of the proximal metatarsals, the foot would not work as well as is does at supporting the loading forces it does during weightbearing activities.
     
  26. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    There is no ANTERIOR metatarsal arch. The evidence is clear on that.
     
  27. Bruce Williams

    Bruce Williams Well-Known Member

    Craig;

    now that we are clear on that, I will sleep much better!
    :drinks
    Bruce
     
  28. Craig:

    When you say "there is no anterior metatarsal arch", specifically are you referrring to the metatarsal heads, metatarsal necks, distal third or distal half of the metatarsals?

    Better to qualify to say that there is no transverse arch at the metatarsal heads, I would think, since there is a transverse metatarsal arch proximally at the metatarsal bases.
     
  29. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    All the metatarsal heads share in the weight bearing --> if there was an arch there, then all the research would have found one --> there isn't one.
     
  30. Rob Kidd

    Rob Kidd Well-Known Member

    I would have thought the answer was there in the observation (BTW, check medial & lateral).

    It was only a simple hypothesis - that has long neeed to be supported with further work

    Rob
     
  31. Whats an arch?

    I mean, there's things which are arch SHAPED. The dorsal Venous arch is arch shaped... although not relevant from an MSK point of view.

    So what are we defining as an arch?

    In which case, is the answer not, it depends?
     
  32. I agree that all the metatarsal heads share in the weightbearing of the forefoot and that there is no "transverse arch" at the metatarsal head level. This is due to the spring-like function of each individual metatarsal ray being able to dorsiflex a variable amount in response to a variable dorsiflexion loading force acting on each plantar metatarsal head so that all metatarsal heads may dorsiflex to a common weightbearing plane.

    The point that I do have a problem with is when people say "there is no transverse metatarsal arch", when, in fact, there is a transverse metatarsal arch at the proximal aspect of the metatarsals, which is most pronounced at the metatarsal bases.

    As an illustration of my point.......

    Which statement is most correct?

    1. There is no transverse metatarsal arch.
    2. The Achillles tendon does not insert into the foot.
    3. The foot has no digits.

    Answer: Statements #1-3 are equally incorrect.

    1. There is no transverse metatarsal arch in the anterior metatarsals, but there is a transverse metatarsal arch at the proximal metatarsals.
    2. The Achilles tendon does not insert into the forefoot, it inserts onto the rearfoot.
    3. There are no digits in the rearfoot, there are only digits in the forefoot.

    We must be careful in our statements and identify the specific anatomical structures, and specific parts of each anatomical structure, we are discussing in order to avoid confusion in our common goal to increase our understanding of foot and lower extremity biomechanics.
     
  33. efuller

    efuller MVP

    Above from wikipedia. The arch pictured in the MRI does not span a space as it supports a load. Also, it gets most of its arch shape from the fact that the medial cuneiform or 1st metatarsal is much bigger than the 2nd. So, yes it's arch shaped, but the transverse arch is not mechanically an arch.

    How many angels could dance on the transverse arch before it collapses?

    Eric
     
  34. Agreed.

    So, besides being arc shaped, are there other requirements to call something an arch? I mean if I hold my skeleton foot upside down, I see something Arch shaped between the tib, talus, navicular, cuniform and Metatarsal. Is this an arch? Or a claw toe, is that a digital arch?

    Does an arch have to be weight bearing at both ends? Fixed at both ends (or trustic)? Do the component parts have to be wedge shaped so that downward force is transmitted laterally? Does it require that their be weigh atop it?

    I'm just a bit unhappy describing whether an arch exists without a proper definition of what exactly one is!
     
  35. Cross posted with Eric. Thanks, that was what I was going for.
     
  36. Eric:

    Does the medial longitudinal arch "span a space"? If so, then how? It spans a space from the plantar calcaneus to the plantar aspect of the medial metatarsal heads. Right?

    Now, in moving from the medial aspect of the midfoot to the lateral aspect of the midfoot, wouldn't we also be able to also say that the metatarsal bases spans the space from the medial aspect of the midfoot to the lateral aspect of the midfoot?

    How does the proximal metatarsal bases "not span a space"?
     
  37. Robert:

    Here are the definitions for arch from an online dictionary: http://www.merriam-webster.com/dictionary/arch

    To me, if we can say that there is an arch in a cat's back, then we should also be able to say that there is a transverse arch at the proximal metatarsals. What we shouldn't say is "there is no transverse arch" in the foot.
     
  38. Eric:

    Please explain why the arched structure of both the dorsal and plantar aspects of the metatarsal bases within the transverse plane "is not mechanically an arch".
     
  39. Here is a reference, and illustration from that reference, that compares the transverse arch of the proximal metatarsals in homo sapiens, pan troglodytes and the StW 89 foot:

     
  40. Here is another reference discussing the transverse arch of the proximal metatarsals.

    Here is the figure legend for this reference's illustration below.

     
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