When we think about the arches of our feet, most people immediately picture the large arch running along the inside of the foot.
But there is another, much smaller arch at the front of the foot that we pay very close attention to during a biomechanical assessment at Dubai Podiatry Centre.
It is called the transverse arch.
What is the transverse arch?
The front part of your foot is called the forefoot. It includes the toes and the metatarsal bones, which are the long bones immediately behind your toes.
Across the forefoot, just behind the toes where they connect with the foot, is the transverse arch.
Rather than running from the heel towards the toes like the more familiar medial arch, the transverse arch runs across the foot from side to side.
It is a relatively small arch, but biomechanically it can be extremely important.
What happens when the transverse arch starts to drop?
Over time, the forefoot can begin to spread and the transverse arch can become lowered.
We sometimes describe this to patients as the metatarsal bones beginning to “avalanche” forwards and downwards.
Although this change is occurring in a relatively small area at the front of the foot, it can influence the way the rest of the foot functions.
The metatarsal bones do not work independently from the remainder of the foot. They form part of the interconnected structure of the foot and contribute to its stability and function during standing and walking.
As the forefoot begins to change position, we may also see changes occurring through the larger medial arch, the midfoot and eventually the mechanics around the ankle.
This is why we never look at the transverse arch in isolation.
Are you beginning to look hunched forwards?
One of the observations that can prompt us to investigate the forefoot is a change in a person’s stature.
Sometimes a patient, or their family, will say that they are beginning to “look hunchbacked” or that they appear to be leaning forwards.
The head may be sitting further forwards, the shoulders may appear more rounded and the person can develop an increasingly stooped appearance.
There are, of course, many different reasons why somebody may develop a forward head position or stooped posture. It should never automatically be assumed that it is coming from the feet.
However, it is one of the physical signs that makes us look more carefully at the person’s overall biomechanics.
We look at the person from the side and assess their stature. We look at the position of the head and shoulders. We observe how they stand and walk.
Then we investigate what is happening underneath them.
In particular, we examine the sole of the foot and the forefoot to see what has happened to the transverse arch.
If that small arch has dropped and the metatarsal bones have moved forwards and downwards, it may be contributing to a chain of biomechanical changes occurring further up the body.
Your feet form the foundation of your posture
The feet provide the foundation for the body when we stand and walk.
Changes in that foundation can sometimes contribute to compensations further up the biomechanical chain.
This is why a person’s posture can give us clues about what we should investigate in their feet.
A forward head, rounded shoulders, a stooped stance or a tendency to shuffle when walking does not diagnose a foot problem. However, these observations can be a reason to include the feet in the assessment rather than concentrating only on the upper body.
Sometimes the clue is visible at the shoulders and head, while part of the biomechanical problem may be much further down, at the sole of the foot.
Why we look for problems early
One of the reasons we pay such close attention to the transverse arch is that it can give us an opportunity to identify biomechanical changes relatively early.
If the transverse arch has started to lower but the remainder of the foot is still relatively well controlled, treatment can be much simpler.
Where appropriate, a custom corrective orthotic can be designed to support and lift the transverse arch and improve the mechanical stability of the forefoot.
The objective is not simply to put something soft underneath a painful area. It is to address the position and function of the forefoot as part of the mechanics of the entire foot.
What if the whole foot has already started to collapse?
More advanced biomechanical changes can also be managed. It simply requires a different approach.
If changes have progressed through the forefoot, midfoot and ankle, attempting to correct everything at once may not be appropriate or comfortable.
Instead, orthotic therapy may need to be carried out step by step and stage by stage.
We may initially need to address the forefoot and transverse arch. As the foot adapts, we can reassess the midfoot, medial arch, rearfoot, heel and ankle mechanics.
This process naturally takes longer than treating an early biomechanical change.
A small arch can give us a big clue
The transverse arch is a relatively small structure, but it can tell us a great deal about what is happening throughout the foot.
This is why we don’t assess feet simply by asking, “Where does it hurt?”
We look at the toes, forefoot, midfoot, heel and ankle. We look at how you stand. We look at the position of your shoulders and head. We watch how you walk.
If somebody tells you that you are beginning to look more hunched over, or you notice that your head is increasingly sitting forwards and your shoulders are becoming rounded, there can be many possible explanations.
But don’t forget to look down.
A biomechanical assessment of the feet, and particularly that small transverse arch underneath the forefoot, may provide another important piece of the puzzle.
The earlier we identify a change in foot biomechanics, the easier it may be to manage before it progresses further.
Dubai Podiatry Centre
Biomechanical Foot Assessment and Custom Orthotic Therapy
For more information or to book an appointment please call our clinic +971 4 3435390 or WhatsApp +971 50 3553024