Are there 1,2 or 3 arches in the foot?
Lots of people are surprised to find out that there are 3 arches in the foot!
Two of these arches run lengthwise (longitudinal) from your heel and the third runs across the breadth of your foot (transverse).
Each of these arches is like a little arch of a bridge – let’s see what job they do and what happens if they collapse.
Medial Longitudinal Arch (MLA)
The MLA is the most known and visible arch of your foot and absorbs most of the shock when you walk or run. Chief Podiatrist Michelle Champlin describes it as looking a bot like a ‘cave’ running from the calcaneum (heel bone) forward through various bones of the middle of your foot (talus, navicular and cuneiforms) to the metatarsals of your 1st, 2nd and 3rd toes. You can see these bones in the picture below. Whilst the bones are like a jigsaw forming the arch, these bones are held in place by a number of muscles, tendons and ligaments. Underneath the talus bone is where this arch is the highest.
Although not a hard and fast rule, generally excessive pronation is associated with lowered MLAs, giving the appearance of ‘flat feet’ and very high MLA with the opposite, supination – too much weight through the outside of the foot and ankle.
Either of these biomechanical issues can cause foot and ankle pain, with over-pronation commonly in turn placing too much strain and inflammation on the plantar fascia (plantar fasciitis), shin splints, hallux valgus (bunions), inward rotation of the leg, thigh and hip and resultant inside knee pain, hip or lower back pain.
Supinators will exhibit a very high MLA, which forces too much weight to be placed forward onto the metatarsals – risking metatarsal stress fracture, bunions, clawed or hammer toes, outward rotation of the leg, thigh and hip with resultant outside knee pain, hip pain and risk of ankle injury.
Lateral Longitudinal Arch (LLA)
The ‘LLA’ is much flatter in comparison to the MLA – it is formed by less bones, although it still runs from the heel bone forward to the metatarsals – the 4th and 5th in this case – along the outside edge of your foot.
When you stand, all of your weight goes down through the talus bone in the middle of your foot and is spread almost evenly forwards to your metatarsals and backwards through your heel bone.
Issues that affect your lateral arch can involve the cuboid bone, which we have occasionally seen dislocated due to a sprain. We also see pain to the outside of the foot with peroneal tendonitis, notably in patients with high arched feet, or tight calf muscles.
Transverse Arch (TA)
This arch, running across the foot behind the metatarsals, provides flexibility and support to the foot. It is formed by the cuneiforms, cuboid and bases of the five metatarsals. The shape of these bones, particularly the ‘wedge’ shape of the cuneiforms, helps form the arch. This arch is flattened when weight bearing. The most common cause of excessive flattening of this arch is when the supporting ‘spring’ ligament of the bones becomes too lax, allowing the forefoot to splay out. This commonly occurs with over-pronation, when the sub-talar joint of the foot-ankle causing too much weight through the inside (medial) aspect of the foot. This can also cause the appearance of ‘flat feet’ with a lowering of the medial long arch.
When the forefoot splays, patients may report thick callous plaques and corns across their forefoot, particularly across the 2nd – 4th metatarsal heads, as the body tries to protect itself from too much weight onto these bones. There may also be pain to this forefoot area (metatarsalgia), higher risk of metatarsal stress fracture, bunions, bunionettes, Neuromas and Neuritis.
How Do You Know if any of Your Arches are Collapsed?
Visually, most people will only notice a lowered MLA, as they will appear as a ‘flat foot.’ Issues with any of your three arches will generally first show up with foot pain, persistent corn or callous pattern to telltale areas of your foot (i.e. inside heel or across your forefoot), corns at the forefoot where the skin ‘pinches’ or even noticing your foot size has grown in length or width. You may also have noticed a bunion / bunionettes starting to form.
Other telltale signs can be recurrent corn and thick callous, foot pain, a burning sensation or change in the shape of your foot and these signs should not be ignored.
Your Podiatrist is the right professional to seek assessment and diagnosis. At Dubai Podiatry Centre, we will work to carry out a full biomechanical assessment to identify, amongst a range of foot issues, if any of your arches have collapsed. There are different causes of collapsed arches, from untoned foot muscles and lax ligaments, to hereditary causes or injury (such as a previous sprained ankle).
Treatment – Children & Adults
Treatments vary according to cause and type of collapsed arch, from simple padding in your footwear to custom corrective orthotics to gradually tighten and tone the muscles, ligaments and tendons and pull the foot back into shape, to in some cases referral for specialist orthopaedic surgical intervention combined with post-surgical orthotics / splinting. Collapsed arches can affect how well your foot functions, causing pain, risk of injury and less efficient walking/running.
Over-the-counter insoles do not correct your foot posture and it is vital that a qualified Podiatrist fully assesses and measures the precise degree of collapse and designs and makes a prescriptive orthotic for your feet only. Wearing the incorrect prescription of rigid or semi-rigid insoles can cause long term damage.
Chief Podiatrist Michelle Champlin says “We recommend children’s arches being checked as they start school (5 years old), as this is the perfect time to correct any foot arch problems. We run annual school health checks in most schools, just as you start to check children’s teeth in the same way.”
Whether you’re concerned about your own or your child’s feet – contact the biomechanics podiatrists at Dubai Podiatry Centre on +971 4 3435390.