5O2 The Arches of the Foot 



no elasticity, and man would walk heavily, ungracefully, and with 

 discomfort. 



When in the erect position, the weight of the body is received and 

 transmitted by the inner tuberosity of the os calcis and by the heads 

 of the first and of the fifth metatarsal bones ; the plantar vessels, 

 nerves, muscles, and tendons occupy the intervening hollow, and are 

 there kept from pressure by the strong plantar fascia. 



The antero-posterior arch is best marked upon the inner side ; 

 it is formed by the point of the os calcis, the astragalus, and the 

 scaphoid, cuneiform, and the three inner metatarsal bones. Great 

 elasticity is obtained by this arrangement. Along the outer side of 

 the foot the antero-posterior arch has not so much spring, but it is 

 extremely strong. It is composed of the os calcis, the cuboid, and 

 the fourth and fifth metatarsal bones. 



The transverse arcfc is built up of the scaphoid, the internal 

 cuneiform, and the first metatarsal bones on the inner side, and of the 

 cuboid and the fourth and fifth metatarsals on the outer. 



The integrity of the antero-posterior and transverse arches is 

 maintained by the keystone arrangement of the bones, by the dorsal, 

 interosseous, and plantar ligaments, and by the tendons and fascia. 

 The oblique tendon of the peroneus longus gives valuable support to 

 both the antero-posterior and the transverse arch ; so also does the 

 widespread insertion of the tibialis posticus. 



Flat-foot. Those who are not strong enough for the task and 

 who carry about heavy burdens, who are wearied by too much walk- 

 ing or standing, complain of dull pains up the legs, and of aching 

 feet. This is due to the stretching of sensory nerve filaments, and to 

 the fatigue of muscles, which, like the tibials, are trying to support 

 the sinking foot. Sometimes these aches are mistaken for rheumatic or 

 for ' growing' pains. Even if the deformity be but slight, the subject 

 is not fit for active work ; he tires after a long walk, and is, therefore, 

 unfit for soldiering, and for hard physical work generally. 



In flat-foot the inferior calcaneo-scaphoid, the long and short 

 calcaneo-cuboid ligaments ; the plantar fascia ; the insertions of the 

 tibialis posticus and anticns, and of the peroneus longus, have all 

 yielded a little. The result is that the head of the astragalus rolls 

 downwards and inwards, whilst the tuberosity of the scaphoid, the 

 internal cuneiform, and the base of the first metatarsal bones sink to 

 the inner side of the sole. The condition may be treated by rest, 

 and by strengthening the tibial muscles, as by making the patient 

 walk on tiptoe and on the outer side of the feet. An ingenious 

 operation for flat-foot is that of opening the astragalo-scaphoid joint, 

 scraping away all the articular lamellae of cartilage and bone from its 

 interior, and, having arched the foot, inducing the raw surfaces of 

 astragalus and scaphoid to become ankylosed, in their tilted and im- 

 proved position. 



