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"Vault" of the foot

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Aug 30, 2010.

  1. Members do not see these Ads. Sign Up.
    I came across this text which refers to the vault of the foot: http://books.google.co.uk/books?id=...&resnum=1&ved=0CBgQ6AEwAA#v=onepage&q&f=false

    Can anyone tell me which structures make up the vault of the foot and whether this terminology is valid ? The text I linked to suggests 'vault' is an invalid term and that the foot acts more like a truss, can anyone provide evidence as to why the foot should be considered as a vault and or series of vaults? Who is the father of the the term "vault' when applied to the foot? Kapandji seems to suggest that this term was already questionable when his book was published- when was this?
  2. Re: vault of the foot

    Nah, it a vault....

    Provided the first met is nailed to the floor.

    Seriously, If the foot truly behaved as a vault, there would surely be no tension in the plantar fascia. There rather obviously IS.

    So if the foot IS a vault, what is the plantar plantar fascia for?

    I think Kapanji physiology of the joints was 1971.
  3. drsha

    drsha Banned

    Re: vault of the foot

    In developing my work, I found no references to describe the area under the hollow of the foot and there was a great debate on the existence of the transverse arches (s) of the foot which I wished to squash since it never led me anywhere and always seemed like a red herring. As I investigated and organized Bioarchitecture when it comes to the foot and posture, "The Vault of The Foot" satisfied my search and was immediately accepted as a teaching term.

    The Vault of The Foot is a bioarchitectural term that I use educationally to explain the foot architecture to students, patients, DPM's and the foot and postural suffering public.

    In architecture, when two walls or arches are connected by a roof, that is a Vault, In fact, the foot is probably closest osseously to a Joint Vault with its rear pillars being narrower than the fore pillars.

    If we eliminate the phalanges of the toes, The Vault of The Foot is composed of all of the other bones, The MLA, The LLA and all of the transverse osseous arches that exisit above the hollow formed by them and the foundational pillars.

    The functional concept of "Vaulting" in an educational sense is the need to fill up the hollow under the osseous vault in order to prevent collapse of the foot and this can be broken down even further utilizing the independent tests of functional foot typing to the rear and fore pillars.

    In a Bioengineering sense, the architecture of the foot, functionally, relates best to a truss system with a flexible tie beam as Robert pointed out.

    I use this concept educationally to explain the tissue stress failure of the tie beam structures and realate that foot type specific to the rigid, stable, flexible and flat types of the rearfoot and forefoot as a great starting point to explain custom care from a professional perspective when it comes to designing a shell and the prescription for custom foot orthotics.

    When you build arches or vaults in architecture, one method is to construct a centrum or centring as a model for the voissours to lie on and for me, the centring is placed under The Vault of the Foot to supply the support needed to allow a lifetime of efficient function and to train the soft tissue structures to perform more efficiently. So I am a functional foot typer dispensing foot centrings and not a biomechanist dispensing orthotics (or is it orthoses? another red herring).

    Finally, the concept of working with The Vault of The Foot takes the focus of where to support the foot biomechanically to the transverse and sagital planes and away from frontal plane and subtalar joint treatment and in addition, away from the MLA and/or LLA to The Vault, where I believe it belongs (#4).

    I have always maintained that Root et al have had 30 years to explain biomechanics and orthotics to the foot suffering public and the medical community and both words are misspellings in windows word spellcheck. The use of Bioarchitectural language offers a simple, commonly understood language for this purpose even though it is not "scientifically" accurate when scrutinized to uphold Newtons Laws since it has no real research value.

    Robert is correct when he states that TSP and Foot Centering Paradigm (FCP) are apples and oranges. What he fails to mention is that the tissue stress and/or phyical stress theories are their common threads and they are interchangable.

    Dr Sha
  4. Re: vault of the foot

    Hey Dennis

    Could you elucidate on the support of the foot in the transverse plane? Are we talking about medial flanges to affect navicular drift?

    I sort of think I follow you here. What you are saying is that describing the foot as a vault is an easy way to understand it, but that is not actually accurate.

    A vault is essentially an arch (as per the dictionary definition. We were thinking in terms of supporting the arch 50 years ago, pre root, pre Kapanji. Kapanji introduced the concept of an arch (vault) in the frontal plane (the transverse metatarsal arch). Is not returning to this, whether in terms of how we as professionals think of what we do

    or how we explain things to patients

    not simply a retrograde step?

    The fact is, as you say, that the MLA functions closer to a truss system than a structural arch. That being the case I don't understand the merit of treating it as an arch when considering treatment.

    As to the concept of moving away from the concept of treating the sub talar joint and towards treating the arch, for me that depends on what I'm treating. For EG when I see a presentation of DCIS I am thinking very much in terms of the behaviour of the MTJ, and the apex of the arch and my ideas for prescription start there (although they will also include and consider what the STJ is doing). Whereas if I am treating a Tib post or deltoid ligament problem, my thoughts will be focussed around the behaviour of the STJ because that is the joint about which these muscles primarily work.

    Kind regards
  5. Re: vault of the foot

    I'm not sure who is more deserving of the Well's Termination Button - Simon for starting the thread or Dennis for more UTI discharge..... time for a holiday methinks..
  6. Graham

    Graham RIP

    Re: vault of the foot

    The use of "MY" = Narcissism

    The use of "I" = Narcissim

    Last time I was at St Pauls Cathedral I looked for the Fascial structure holding up the vault. I had to leave in a hurry coz it had obviously broken and I was scared the stone vaulted ceiling was going to fall! Phew!
  7. drsha

    drsha Banned

    Re: vault of the foot

    Jeff's Rules#2 changing the subject, #7 unqualified expert opinion, #10 cult of personality.

    Why are you so angry and hateful of me? What is your motive?
    You've made your point over and over and over. I'm not going away.

    I really don't want to go here but you are being chased by your Narcissistic father-in law and his son and me and possibly Dr's Root and Kirby and I don't how many other Narcissists. Maybe you are in need of a self exam? #4, #7.
    Dr Sha
  8. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot


    The Classic Collector’s Edition of Gray’s Anatomy (page 213):
    In addition to this longitudinal arch the foot presents a transverse arch, at the anterior part of the tarsus and hinder part of the metatarsus. This however, can scarcely be described as a true arch, but presents more the character of a half-dome. The inner border of the central portion of the longitudinal arch is elevated from the ground, and from this point the bones arch over to the outer border, which is in contact with the ground, and, assisted by the longitudinal arch, produce a sort of rounded niche on the inner side of the foot, which gives the appearance of a transverse arch as well as a longitudinal arch.

    Bob Smith, orphan
  9. Graham

    Graham RIP

    Re: vault of the foot

    Dr. Sha,

    Please believe me when I say I do not hate anyone. What I can't understand is the singular defence of a theory that has absolutely no biomechanical reasoning and no scientific process or rational. This then becomes a spitting match rather than a scientific debate.

    You offer little in professional/scientific discussion and much to YOUR opinion that your opinion is not worth listening to.

  10. drsha

    drsha Banned

    Re: vault of the foot


    I took this form Ian Grffith's Podiatry website as it seems to reflect the opposite point of view from your's in this recurring debate:

    It is often stated that the human foot has 3 arches; two longitudinal arches and the transverse arch (sometimes also referred to as the metatarsal arch).1 Whereas the presence of longitudinal arches are unanimously accepted, the transverse metatarsal arch of the foot is considered to be quite controversial. Believe it or not its existence has been debated since last century. But what is the transverse metatarsal arch? And what does the research actually tell us about it?

    The existence of a transverse arch at the metatarsal region would require the pressure to be greatest at the areas beneath the 1st and 5th metatarsal heads, and the area of the 2nd, 3rd and 4th metatarsal heads to be elevated relative to this. This gives us the ‘tripod’ like weight distribution of the foot which was first described by Kapandji in 1970.2 However, the first descriptions of the transverse metatarsal arch date back as far as 100 years prior to Kapandji’s work3 and several papers published in Germany between 1882 and 1927 actually concluded that no transverse arch of the foot was usually present.4-7 Much of the research produced following Kapandji’s work concurs with these conclusions regarding the transverse metatarsal arch being a misnomer.

    Both ends form the debate I refered to but my question is to what end is this debate? Red herring or something to be learned?
    Dr Sha
  11. Re: vault of the foot

    Depends which end of the metatarsal you are referring to, proximal or distal in the attached diagram, figure a shows a proximal view of the cuboid and cuneiforms, b shows the corresponding articular surfaces of the metatarsals. Looks like an arch to me.

    Attached Files:

    • arch.jpg
      File size:
      15.3 KB
  12. Graham

    Graham RIP

    Re: vault of the foot

    Interesting e-mail sent to me by Dr.Sha,

    Comments welcome - my reply is included also.

    And Dr.Sha! Ask Kevin if I haven't been as or more critical of some of his posts than yours. However, having a deep respect for Kevin and his work these criticisms are based on observations based on the disclosed theories, and Kevin has always been gracious enough to clarify or defend his position in a professional and educated manner.

    My Reply:

  13. Re: vault of the foot

    Further, if we took a foot and applied an independent yet equal load to each metatarsal head and noted the deformation under load of each metatarsal, I suggest that we should see an inverted arch, with the 2nd metatarsal deforming least under load. So if we were walking on a compliant surface, would all of the metatarsal heads lie on the same plane?
  14. Re: vault of the foot

    "Why aren’t you calling him a Narcissist or interrupting the flow of his posts?"

    My round: pint of bitter?:drinks
    P.S. how does someone interrupt the flow of your posts? Or, is it some kind of pelvic floor exercise where you stop yourself mid-stream?
  15. drsha

    drsha Banned

    Re: vault of the foot


    Looking at this slice of the foot, the bones form The Vault, the space underneath would be the hollow under the vault.

    The sum of all the cuts would add up to being The Vault.

    Attached Files:

    • arch.jpg
      File size:
      16.1 KB
  16. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot

    It's important to distinguish whether you're talking about the osseous structure of the foot or the plantar surface of the foot. However, in both cases, we are talking about an averaging or generalization of the shape of both structures, not an absolute description their more complex and exact shape or contour. These description are used for modeling purposes. The plantar surface of the foot is a complex shape that is best described by complex algebraic formulas which change with motion (i.e. relative position) of the foot. The issue at hand is what term(s) are most appropriate for describing the general shape in question at any given point in time.

    When you look at the foot with respect to the cardinal planes of the body, you are looking at a section in two planes only. It is not a 3-D object. Hence, the media longitudinal arch of the foot and the transverse arch of the foot at the apex of the arch can be used to describe the shape of two cross sections of the foot at one moment in time. The plantar contour of the foot is a 3-D object. Very different issue, but its shape is direclty influenced by the 2-D relationship of each 2-D section.

    None of the description provided are technically correct, since none of them represent the convex, concave, and planar nature of the actual plantar contour of the foot. Hence, they are all wrong. So which model is best depends on what aspect of the structure you’re referring to and whether you are describing it in two or three planes. The problem occurs when the sagittal and transverse arches are taken out of their anatomical context to represent something else.

    Bob Smith, orphan
  17. Re: vault of the foot

    Makes me chuckle, every time I read it.
  18. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot

    I would have to say based on my own observations, the plantar contour of most feet have a sagittal plane arch (arc) to them but in the frontal plane the mid foot is often an inverted, convex shape with the apex medially.

    Bob Smith, orphan
  19. drsha

    drsha Banned

    Re: vault of the foot

    Sorry but I have to preface by asking if anyone is old enough to know who"Buffalo" Bob Smith is from The Howdy Doody Show. It makes me chuckle every time he uses it.

    If as in a CAT scan, we combine all the 2-D slices together to form a foot that can be represented in 3-D and then we limit the motion of the foot so that it does not change as much, especially in a pathological correction (such as collapse or navicular sag) by bracing the area underneath the bony contours, would that possibly have some positive effect clinically? #4 ---big time---

    Dr Sha
  20. Re: vault of the foot

    Not if by limiting motion we raise stress in the tissues, raise this beyond their zones of optimal stress and induce pathology. no. 2 ---big time--- (like a baby's arm)
  21. Griff

    Griff Moderator

    Re: vault of the foot

    Wow, I've made it. My humble little blog getting cited by drsha ;)
  22. drsha

    drsha Banned

    Re: vault of the foot

    Simon, are you saying that in many feet, perhaps more than many, collapse on any or all of the cardinal planes, especially transverse and saggital, would not raise tissue stress and that reversal or correction of that collapse would not be of benefit?

    Dr Sha
    Last edited: Sep 1, 2010
  23. Re: vault of the foot

    Don't put yourself down, Fruitbat. I've got it bookmarked.
  24. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot

    You could, in theory, induce pathology from over control or restricting necessary motion. I have seen situations where patients were treated with orthoses and suddenly developed plantar fibromas along the medial slip of the plantar fascia. We had to accommodate them or lower the medial arch of the orthosis to reduce pressure (force) in the arch.

    Bob Smith, orphan
    p.s. My friends just call me BS
  25. Re: vault of the foot

    I'm saying that you can block motion and this may cause pathology. I'm saying that neither position nor motion cause pathology, it is the forces that are key. So by whacking in an "arch support" which blocks motion, and as such MUST raise moments about the foots joints, you might do more harm than good. Think of it like this Dennis, you go to kick me in the shins, so you pull your leg back and swing it forward, but I block your motion by putting my foot up sooner so that your shin impacts against the toe of my boot- you limp away crying. Newton's no. 3
  26. drsha

    drsha Banned

    Re: vault of the foot

    Are you in agreement with my statement then that most feet would benefit from restricting adult collapse?

    Dr Sha
  27. Re: vault of the foot

    What is adult collapse? Is that when you've grown up, but you suffer the temptation of takeaways, cheap supermarket alcohol and cable TV advertising? I just purchased a youth regenerator from sellmesome****tv.
  28. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot

    Based on the structure of the average foot, I would say it is more likely over time that there will be a reduction in the calcaneal inclination angle, increased talar adduction and plantarflexion, the height of the medial arch will lower, the foot will elongate but the digits will become contracted so the overall length of the foot may or may not increase, the hallux will abduct, the plantar fat pad will become less dense, etc. Gravity tends to act to lower the osseous structure of the foot. Most types of orthoses act to provide some level of support or maintenance of the structure of the foot based on the fact that their contour somewhat mimics the contour of the foot.

    As a rule, I don’t see where supporting the foot is contraindicated and based on average age related adaptations, it seems to make some sense to support the natural contour of the foot. That said, there are a percentage of elderly adults who are asymptomatic and have no significant lifestyle limitations who have never worn orthoses. Since we can not ignore the cost of orthoses and the other financial implications of treatment, we are left with the question of when and when not to treat. The dental profession has done a much better job of providing evidence for the benefit of preventive care or treatment than podiatry, and probably for good reason. It is easier to link dental pathology with lack of care. Foot pathology can be the result of abuse or lack of care (obesity, ETOH abuse, etc.), but the direct correlation is less obvious. Foot pathology can also be related to maintenance of health, such as running or walking for exercise. While not abuse, it can result in heath problems.

    Interesting that normal ontogeny is almost the opposite of the age related process in terms of foot structure (arch) development. So would I advocate putting all children in orthoses to assist in this normal process, absolutely not. So to directly answer your question, I don’t know exactly what percentage of adults might benefit from orthoses, so I can’t specifically say that “most” (ie over 50 percent) would benefit from resisting changes related to aging.


  29. drsha

    drsha Banned

    Re: vault of the foot

    So as I cannot summarize your thoughts #7, I get the feeling that you are explaining why it is so difficult to get any valid evidence that is worth incorporating into EBP. I think we can come up with many more.

    It must be so frustrating being on the side of Newton requiring proof and evidence when it is so hard to prove very much biomechanically that has clinical significance. #2

    The only thing left to do is fire all your weapons at those with opposing viewpoints proving that they have no evidence either. It must be draining and frustrating.

    Waiting for TS to produce the pathologies you knowing that it will for most people in your communities and then using your hit and miss protocols that your peers can't agree on without concensus year after year justifying them with Newton's Laws.


    remember, you always have rule #5 to bail out with, do something diufferent if the TSP doesn't work or produces compensatory failures. #4

    Pee Wee
  30. Jeff Root

    Jeff Root Well-Known Member

    Re: vault of the foot

    Fortunately the vast majority of my time is spent running a company that manufactures real orthoses for real patients with real problems for real conditions that respond favorably to mechanically based, logically designed orthoses. The only real frustration in my life comes from being tricked into becoming involved into futile discussions by intellectually dishonest people who are bent on wasting other people’s valuable time with rambling postings on this forum. I don’t believe I have ever started a thread on this forum. So who is on the attack, and who is being defensive about the paradigm (or lack of any real one) that underpins the focus of their daily activities? EBM has become such an overused term it is rapidly losing all real significance here because it is used as a marketing ploy and not as at tool to advance the quality of healthcare.


    Bob’s New Rule: Just because someone says it’s EBM, doesn’t make it EBM! Therefore, a lack of sufficient evidence (E) removes this component of the acronym from the equation and this turns the remainder into just another BM, and we all know what that stands for!
  31. efuller

    efuller MVP

    Re: vault of the foot

    Dennis, I think that it is incorrect to use the term vault in terms of the anatomy of the foot. From wikipedia
    The foot is not used to provide a space. It is used to support a load. Within the definition above of vault it describes an arch. An arch is used to bear a load including its own weight. In an arch the components of an arch are mainly under compression. When an arch crosses a river the embankment prevents the ends of the arch from moving farther apart. Whenever you have an arch, or use an arch as an analogy, you have to understand what compresses the arch together. One type of arch is the tied arch where a tie rod holds the end of the arch together. The windlass mechanism of the foot most closely resembles a tied arch.

    Whether or not you want to use physics, it is true that an arch must have its ends held together to keep standing. Dennis, are you willing to concede that the foot, as it functions, is not a vault. If you are not willing to concede this point would you defend the premise that a foot is a vault.

    Yes, when you build a vault, or an arch, you should use a centering to support the material that makes up the arch until that material can support itself. The problem with the premise as an orthotic as a centering that supports the arch is that the centering does not directly contact the solid structures of the arch. There is a whole lot of anatomy between the plantar skin and the bones of the foot. This anatomy includes the plantar fascia and compressible material like muscle. The idea of the orthotic as a centering doesn't work because the whole concept ignores the soft tissues of the plantar surface of the foot.

    Dennis this is why I think that your paradigm should be rejected. Do you find any fault with my logic?

    Dennis, again there is a problem with your logic. Above you say that vault is made up of the bones of the foot excluding the phalanges. The bones of the foot include the talus and calcaneus and hence the subtalar joint. Therefore, if the foot is a vault it would have to include the subtalar joint.

    There is further lack of logic in the following areas. How can you divide support across the planes. It's a three dimensional object. Support happens in 3 dimensions.

    For the above reasons, I feel confident that foot centerings as a concept can be rejected as a logical paradigm. Dennis, if you disagree with me, show me the flaws in my logic. I do thank you for expanding on your theory enough to point where I can feel confident in rejecting it. Dennis, this is not bias. I have explained my reasoning. You are welcome to try and refute my reasoning.

  32. drsha

    drsha Banned

    Re: vault of the foot

  33. Jeff Root

    Jeff Root Well-Known Member

    Centering is a temporary falsework (structure) used to create an arch or vault during construction. An orthosis is not a temporary device used to construct an arch of the foot. Unlike a centering, when an orthosis is removed the arch is not self supporting in the position in which the foot was held by the orthosis.

    The foot and some manmade structures that rely on tension members for support are significantly different from arches and vaults. If the tension members are cut, the foot will change shape and become flatter due to the loss of compression force created by the tension members. That said, the term arch support is commonly used to describe orthoses.

    Hence, we could say that an arch support or orthosis is a device that spans a space while supporting weight. We leave the device in the shoe to provided continuous support and do not remove it like a centering. Therefore the concept of an orthosis being like a centering is a poor example and false model of what an orthosis actually does.

    Bob Smith, orphan

    New rule #28: Anyone who uses rule #27 is a putz.
  34. Jeff Root

    Jeff Root Well-Known Member

    A foot orthotic shell is a one piece device. In the sagittal plane, it spans the space between the lowest point of the heel and the lowest point of the forefoot (met heads). By nature of its design, it will yield under a certain amount load. A centering transfers load to the supporting surface directly under the arch and is specifically designed not to yield or flex under load. An orthosis is a sprung arch in that its ends are free to float which allows the apex of the arch to become lower under load.

    An orthosis must be rigid enough to provide a necessary element of support and sufficiently flexible to yield under certain load bearing conditions. If an orthosis were totally rigid, it would typically be uncomfortable because the arch of the foot (osseous relationship) is dynamic. A dynamic arch is different than a static arch. A vault is not a dynamic structure and a centering is only designed to support a static structure. Can anyone present a reasonable argument to the contrary?

    Bob Smith, orphan
  35. drsha

    drsha Banned

    Re: vault of the foot



  36. drsha

    drsha Banned

    We're back to the recurrent false logic that ensues when you apply Newton's Laws biologically or Architecture biologically (#5).
    You are taking definitions from a text or dictionary of Architecture (or Newton, or Engineering or Mechanics) and saying they either do or don't work biologically.

    In this case, The Vault of the Foot is a dynamic vault, just like the arches of the foot of which it is made up of . This means that our Centrings, like your orthotics can flex to yield as well.

    BioMechanics, BioNewtonian, BioEngineering, BioArchitecture do not follow the laws of physics, they imitate them. The bird can fly and defy gravity. The foot behaves like a truss with flexible tie beams, it is not one or it would not fail as easily or in as many locations as it does.

    Dr Sha
  37. Jeff Root

    Jeff Root Well-Known Member

    So, your contention as clearly stated above is that:
    1. Vault of the foot = arhces of the foot
    2. Centerings = orthoses

    So what have we gained other than to substitute one set of terms for another. How is that an improvement?

    If the laws of physics don't apply to biological structures, then how can you explain a blister without the concept of friction? The laws do apply. Your contention that attempting to apply the laws of physics to living entities is not practical is not accepted by the general scientific community. Therefore, your argument is not valid.

    The laws of physics also apply to birds:

  38. drsha

    drsha Banned

    Re: vault of the foot

    Thank you for posting your rejection of my work (#4).
    It is quite a relief.
    Now I can respond to your postings and not be accused of trying to convince you of anything as motive (#3).

    I need not respond to your reasoning since they are your own, expert opinion (#7) and have no more value than mine or those of any one else.

    If I can sum up the import of your rejection of my work, that and a token will get me on a NYC Subway.

    In opposition, I believe the foundations of your work, the tissue stress theory (micro)and the physical stress theory (macro) will serve as the foundation for future research and treatment of pathology, but as far as your tissue stress paradigm, I reject it as it adds nothing to my body of biomechanical knowledge and I have made no changes in practice after having inspected it.

    As a matter of fact, coming from a 40 year EBP where prevention and performance and quality of life improvement have been part of my goal set, it serves as a major deterrent of its continued growth.

    As I will not wait for occlusive vascular disease to fester, wounds to develop upon insensate patients, irreversible neuropathic changes to grow from neglect, DJD to advance or cancer to harvest without trying to prevent them, I will not idly wait for mechanical pathology to develop.

    I teach and believe that there should be a fitness and reduced stress component to any medical practice in addition to the treatment of pathology, whether it be tissue related, metabolic or emotional or mechanical(#7).

    Your paradigm is predicated on complaints of pain and/or suffering to exist in order to begin care! I reject that philosophy.

    Time will tell what portions, if any, of our paradigms has validity and applicability.

    That said,
    I am so devastated, crushed and drained by your rejection that I need a few days just to gather strength, save face and recover so I will not be posting until Tuesday (#5).

    Oh wait, here at home, it’s our Labor Day Holiday and it’s going to be 5:00 somewhere.
    Dr Sha
  39. Jeff:

    As I told Robert Isaacs earlier, you are wasting your breath arguing with this man. You will only get frustrated and annoyed with this futile process. He will only continue with his marketing approach to foot biomechanics, making up new non-meaningful terms, trademarking them, putting testimonials on his website, and then telling you that Newton's Laws shouldn't apply to the foot.

    Please ask yourself this question: do I want to continue wasting my time trying to debate this man in a logical manner? My suggestion? Ignore him. He isn't worth it. You are a much better man and are much smarter than he is.

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