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Foot Talk

It’s all about communication. In this case, compartmental communication. There has not been alot on consensus about how many compartments the foot has, but it is known that all the compartments talk to one another. This study identified six compartments: dorsal, medial, lateral, superficial central, deep forefoot, and deep hindfoot. It goes on to say: Communication was evident between the deep hindfoot compartment and the superficial central and deep central forefoot compartments.

This should not be that surprising. In this case, the deep hindfoot intrinsic muscles would include the quadratus plantae (seen above attaching to the calcaneus), which augments the pull of the long the long flexor muscles and helps to keep the toes flat on the ground.

The superficial central compartment would include the short flexors (flexor digitorum brevis), another stance phase muscle that is also important in keeping the toes flat on the ground.

The deep central forefoot compartment would include the transverse head of the adductor hallucis. important in maintaining 1st ray stability and keeping the head of the 1st metatarsal on the ground and maintaining an adequate foot tripod.

Another point worth mentioning was this: In the hindfoot, the neurovascular bundles were located in separate tissue sheaths between the central hindfoot compartment and the medial compartment. In the forefoot, the medial and lateral bundles entered the deep central forefoot compartment.

This tells us that in the rearfoot, the important neurology is in the muscles which help to invert the rearfoot, and help create supination. In the central forefoot, information is fed from the lateral and medial aspects of the foot tripod to the transverse head of the adductor longus. this muscle, when biomechanics are appropriate and the head of the 1st metatarsal is anchored, assists in supination. It seems all roads leaad to assisting in supination and propelling us forward in the gravitational plane…

Communication. Not just for interpersonal relationships : )

The Gait Guys: communicating with you daily and keeping you current on all things feet.

Surg Radiol Anat. 2012 May 26. [Epub ahead of print] Compartments of the foot: topographic anatomy. Faymonville C, Andermahr J, Seidel U, Müller LP, Skouras E, Eysel P, Stein G. Source

Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany, christoph@faymonville.de.

Abstract

Recent publications have renewed the debate regarding the number of foot compartments. There is also no consensus regarding allocation of individual muscles and communication between compartments. The current study examines the anatomic topography of the foot compartments anew using 32 injections of epoxy-resin and subsequent sheet plastination in 12 cadaveric foot specimens. Six compartments were identified: dorsal, medial, lateral, superficial central, deep forefoot, and deep hindfoot compartments. Communication was evident between the deep hindfoot compartment and the superficial central and deep central forefoot compartments. In the hindfoot, the neurovascular bundles were located in separate tissue sheaths between the central hindfoot compartment and the medial compartment. In the forefoot, the medial and lateral bundles entered the deep central forefoot compartment. The deep central hindfoot compartment housed the quadratus plantae muscle, and after calcaneus fracture could develop an isolated compartment syndrome.

 Splay

Watch this video a few times through. Did you catch the subtle abduction moment of the Hallux (big toe) on impact? Did you see the collapse of the transverse metatarsal arch? No?  Watch it until you do.

What gives? We thought toes were supposed to be stable when they hit the ground (and in fact they are).  Read on…

Think of the adductor hallucis. It has 2 heads. The oblique head arises from the proximal shafts of metatarsals 2-4 and inserts on the MEDIAL aspect of the proximal phalynx of the hallux (along with medial fibers of the flexor hallucis brevis); the transverse head arises from the metatarsophalangeal ligaments of  digits 3-5, and the transverse metatarsal ligament and inserts blending with the oblique head on the proximal phalynx of the hallux.

The action of the adductor hallucis mirrors that of the abductor hallucis (which inserts on the LATERAL side of the proximal phalynx. Together, they act to keep the hallux straight and provide a compressive force which stabilizes the big toe WHEN IT IS ON THE GROUND.

The problem here, is that the base of the Hallux is NOT anchored to the ground. This person has a faulty tripod (most likely an uncompensated forefoot varus) and cannot anchor the big toe, there fore the adductor cannot do it’s job. Is is weak (from lack of use) and we see the result: an abducting big toe AND collapse of the transverse metatarsal arch (which the transverse head of the adductor, under normal conditions maintains).

Looks like this guy needs some exercises to descend the head of the 1st metatarsal and make an adequate tripod. Flexing the distal phalynx of the hallux while extending the metatarsophalangeal joint would be a good start. (see Dr Allen demonstrate this here: http://www.youtube.com/user/TheGaitGuys?feature=grec_index#p/u/11/TyRE9dReVTE )

The Gait Guys…promoting foot literacy here and everywhere.