Just focusing on the structure of any arch, from an engineering perspective, you know it needs a stable anchoring point on each end. The other major fact, conveniently overlooked by podiatrists, is that the entire purpose of the arch design is to avoid the support in the middle. Yes, properly functioning arches, including your foot arches are designed to support themselves. "Functioning" is a broad term as the foot arch can suffer from multiple afflictions but in this blog post I'll focus on how the most common normal flexible arch works and how to make it work better.
When we look at the foot arch, we typically only see the arch formed by the inside (medial) bones of the feet from the inside heel to the base of the big toe (first metatarsal head), but the arch of the foot is unique in that it has a very different construction. Looking at your feet from the top you can see the arch consists of multiple longitudinal elements. In the heel, the arch rests on a single point while in the forefoot, the arch is essentially supported by five prongs at the end of the five metatarsal bones. What is also unique is that the first metatarsal, the major arch structure, referred to as the medial arch, has a strong thick bone while the other four metatarsal bones are thinner and designed to support less weight as you approach the fifth. Dr. Dudley Morton, after whom Morton’s foot Syndrome is named, professed that the first metatarsal should carry twice as much weight as any of the other metatarsals. So, if the strongest structural member of the arch for any reason is not properly anchored on the far (big toe) side, the arch and the whole foot will not function as intended.
Let's take a look at your feet. Unless you have structurally flat feet, when you are sitting with your bare feet resting on the floor, your non-weight bearing feet look like they have arches. At this point your visible (medial) arch is actually held up by your second metatarsal. The skin under your big toe joint may be touching the ground but it is not in full contact with the ground like the second is. Your arch is only anchored on the heel end. Once you stand up your ankles may drop forward and inward so the base of your big toes can become weight bearing. Although your medial arches became established by doing this, the big toe side of your arch travelled downward so far your feet may nearly look flat. You over-pronate, and you are told you have “Fallen Arches”.
The second possible outcome when you stand up is quite problematic for podiatrists. Instead of rolling in, your ankles roll slightly outward so you supinate. This is a source of confusion unless individual neuromuscular behavior is considered. Two people with exactly the same foot structure can, absolutely, experience entirely opposite responses. In podiatry terms, the first is told “You have Fallen Arches” and over-pronate and the second is told “You have high arches” and you supinate but both are prescribed custom arch support orthotics, the latter often with extra cushioning. Makes you a bit curious, doesn’t it? The self-assessment on mortonsfoot.com will demonstrate both the elevated first metatarsal and the resulting musculoskeletal response as evidenced by how your shoes are wearing on the bottom.
The elevated first metatarsal was the major discovery made by Dr. Brian Rothbart DPM, and anecdotally recognized by Dr. Janet Travell , the author of the original Trigger Point Therapy Manuals, in a letter to Dr. Rothbart as the “discovery of the third dimension of the Morton’s Foot Structure”. As you will learn throughout this series, Dr Rothbart’s discovery generally invalidated the concept of prescribing arch supports to correct flexible or flexible flat feet. Although Dr. Rothbart published his work in the early and mid-1990 the average podiatrist still today prescribes arch supports for most of their patients regardless of arch height.
The importance of this discovery hinges on something podiatrists hardly ever consider, namely the fact that the bottoms of your feet are loaded with thousands of pressure sensors that via your central nervous system control the muscles of your feet and calves. The design of the foot arch is ingenious because you have muscles that can preload the arch and bring the first metatarsal head (big toe side of the arch) firmly to the ground before you fully load it under the weight of your body. Then when you transfer your weight bearing to your forefoot as your heel rises, it is ready, and, just as cleverly, the "windlass effect" prevents your foot from elongating by tightening the arch. Without the big toe side of the arch on the ground, there is no "windlass effect".(Stiff- and rocker-toe shoes also impede the windlass effect)
Dr. Rothbart’s discovery led to a simple solution to stimulate the foot muscles to prepare and maintain the arch under the load of the body.
80% of the population have flexible or flexible flat feet which provide a dysfunctional, sagging foundation for the body, and is a major cause of chronic pain because of this simple and well understood principle: “As goes the foundation so goes the house.” Take a close look at your feet and your shoes. You may be looking at the source of your body pain from toe to jaw or the reason why you have never liked to participate in sports.
Gloves Off Series – We’ve had it with Podiatry dogma
After 20 years of working with people in pain and with responsible and caring professionals who care for people experiencing chronic musculoskeletal pain, we have had it with conventional thinking when it comes to your feet and your structural body. We may be risking the wrath of both the podiatry and footwear industries, but so be it. There simply is no rational reason for millions of people worldwide to suffer from chronic musculoskeletal pain. In this series we will cover better alternatives (not only shoes and insoles) to many ailments originating with malfunctioning of the feet. If you are interested in learning more from a clinically experienced engineer’s perspective on chronic pain in your feet and body, sign up for the blog at mortonsfoot.com and stay tuned.
About the Author:
Bjorn Svae is the owner of GRD BioTech, Inc. dba Posture Dynamics founded in 1998. Bjorn holds degrees in electrical engineering and business and has enjoyed a career in design, marketing and sales of diagnostic medical equipment as well as business consulting and entrepreneurship. In 1997, nine years after having undergone bilateral fractured meniscus knee surgery, he met Dr Rothbart and was fitted with an early edition of the forerunner to the ProKinetics Insoles. The pain which had reappeared in the left knee immediately went away and has never come back.