The human foot is a masterpiece of engineering and a work of art.

Leonardo Da Vinci

HISTORICAL DIFFERENCIES

The foot is an organ found exclusively in primates, but it is only in humans that the foot has such a specific structure, allowing for continuous bipedal walking in an upright position without the need to assume a quadrupedal stance. The change in the human way of life, the conditions in which they lived, and the tasks they performed, required an evolution in the foot, the effects of which we benefit from today. It is the upright posture that influenced the current shape of the foot.
Unlike the anthropoid primates, humans no longer have an opposable big toe, which helps with movement in tree canopies (in anthropoid primates, the foot has a structure similar to the hand – it is capable of grasping). The reduction of the opposable toe in favor of the elongation of the first metatarsal bone allowed humans to stand and walk upright with ease and stability.

Gorilla foot vs human foot

ANATOMY

The foot is the distal part of the lower limb located just below the lateral malleolus and medial malleolus (distally, peripherally).
The basis of its structure and activity is:

  • at least 26 bones (1/4 of our body bones are in the one foot) - although there may be more (additional bones)
  • at least 33 joints
  • at least 107 tendons and ligaments, the movement of which causes the work of numerous muscles.

All the above-mentioned structural elements are contained within a single foot, which is relatively small in surface area. This makes its construction very complex. One could say that it is one of the most advanced structures of the human locomotor system.
The surface of the foot is covered by skin, which contains sweat glands (but lacks sebaceous glands), numerous nerve endings (there are over 200,000 in the sole of the foot), and small blood vessels. The tips of the toes are protected by keratinized nails, which safeguard them from injury.

TRIANGLE

Viewed from the sole, a properly shaped foot has a triangular shape: it is wide at the toes and narrow at the heel. This shape is typically maintained by children until they start wearing improper footwear.
Looking at the foot, the foot touches the ground at the calcaneus tuberosity and the heads of the second, third, and fourth metatarsal bones. This means that the concept of the transverse arch at the level of the metatarsal heads is not applicable when the foot is bearing the weight of the body. From the same perspective, moving towards the heel, at the level of the cuneiform bones and the cuboid bone, there is a transverse arch (orange line).
From the side view, a medial longitudinal arch forms along the medial side of the foot, running from the tuberosity of the calcaneus through the talus, navicular bone, cuneiform bones, and three medial rays (a ray is formed by the combination of a metatarsal bone and its corresponding phalanges), meaning the three metatarsals with their respective phalanges. On the lateral side, a lateral longitudinal arch forms, running from the calcaneus through the cuboid bone and two outer rays (the fourth and fifth metatarsals).
This "triangular" structure of the foot not only allows for stable standing but also enables the transfer of large loads and the absorption of shock during walking, running, and other activities.

SIGNIFICANT DIFFERENCES

At this point, it is important to distinguish between the development of the foot and its anatomy: the child’s foot vs. the adult foot. This is a crucial distinction, as the child’s foot differs from the adult’s foot not only in external appearance (which is obvious) but primarily in its internal structure. A child’s foot is not a miniature version of an adult’s foot.
A child’s foot is wider at the toes and narrower at the heel because it has not yet been shaped by improper shoes, body weight, and activity (or rather, the lack of it). Inside the foot, there are many cartilaginous structures because the bones do not ossify (turn into bone) quickly and evenly. The bones are mostly cartilaginous (made of cartilage tissue), meaning they are very soft and delicate, prone to deformation, and capable of adapting to various shapes that are not ideal for them (e.g., too small shoes). They also do not grow evenly, and the process of ossification takes several years. This unevenness can be observed, for example, in the shoes children wear when their foot rapidly "skips" sizes: for instance, a size 24 shoe may become too small after two months, and the child "skips" to a size 26 rather than to a size 25.

OSSIFICATION - WHAT IS IT?

It is the process of bone formation and mineralization involving the transformation of cartilage into bone tissue.

Tendons and ligaments in children often have a higher collagen content: they are very elastic and pliable, with a great capacity for adaptation to various conditions. The range of motion in the joints is also greater than that of an adult with a fully developed foot. However, tendons and ligaments are weaker and simultaneously more prone to injury.

The medial longitudinal arch and the entire sole of the foot are filled with a thick layer of adipose tissue. It may seem that the child does not have a longitudinal arch because they place the entire foot on the ground. Many parents mistakenly suspect flat feet in their children, which is unfounded. The thick layer of adipose tissue also acts as an excellent insulator: even though children run barefoot on various surfaces and the foot may seem "cold," it is actually protected from freezing by this "fat pad."

LONG-TERM FORMATION

From the prenatal period, a child's foot undergoes a series of incredible changes to ultimately fulfill its functions. These changes are most visible until the age of five, but of course, the fifth year of life is not the end of the transformation, as it continues to acquire its proper shape and characteristics for a long time after. The bones shape and harden, tendons, ligaments, and muscles strengthen, and the adipose tissue of the inner arch and sole gradually disappears. In general, the human foot is shaped around the age of 12-14, but it is finally "completed" between the ages of 17 and 18. It is important not to hinder the development of the feet—they are the foundation of our body.

The anatomy of the foot will be consciously discussed using the example of the adult human foot skeleton. This is because by this stage, the foot is well-formed: all the bones are "completed" in terms of their shape and are strong and hard. Tendons, ligaments, and muscles are also well-developed.

The traditional division divides the foot into 3 parts:

FOREFOOT

is formed by the phalanges and metatarsal bones (blue).

MIDFOOT

is formed by three cuneiform bones, navicular bone and cuboid bone (green).

HINDFOOT

is formed by talus, calcaneus (yellow).

The hindfoot and midfoot form the tarsus, and this section will focus on the discussion of this complex, as it is directly related to the deformity—clubfoot.

CALCANEUS

CALCANEUS (Latin calcaneus) or heel bone is the largest of the tarsal bones and the largest bone of the foot. It is located in its posterior lower part under the ankle bone. The calcaneus articulates on top with the ankle bone at the subtalar joint and on the front it articulates with the cuboid bone at the calcaneocuboid joint.

TALUS

TALUS (Latiun talus, astragalus) is a one of tarsus bone. It is located between the tibia (upside) and calcaneus (downside), betweent lateral and medial malleouls. Facing anteriorly, the head carries the articulate surface of the navicular bone, and the neck, the roughened area between the body and the head, has small vascular channels. Because of the connections between these bones, the ankle bone transfers all the weight-bearing of the body to the foot. No muscles attach to it.

NAVICULAR

NAVICULAR (Latin os naviculare) is a part of tarsus. On the medial surface, it has a prominent tuberosity (Latin tuberositas ossis navicularis) - a control point when examining the transverse tarsal joint. On the anterior surface, it has three fields for connection to the three cuneiform bones. The lateral surface has a non-permanent articular surface for the cuboid bone, while the posterior surface has a non-permanent articular surface for the ankle bone.

CUBOID

CUBOID (Latin os cuboideum) has an uneven cube shape and is placed anteriorly from the calcaneus on the lateral side of the tarsus. Its medial surface is longer than its lateral surface.

CUNEIFORM BONES

CUNEIFORM BONES/ CUNEIFORMS (Latin ossa cuneiformia) are located between the navicular bone and the first, second and third metatarsal bones and are medial to the cuboid bone. They are wedge-shaped. There are 3 cuneiform bones: medial, intermediate and lateral.

MULTIFUNCTIONALITY

The foot is one of the organs that play key roles in making our lives and functions easier.

LOCOMOTION

The foot is a locomotor organ.
It allows you to move wherever and however you need to: walk, run, jump.

SPAR OF YOUR BODY

It is the spar of your body.
Body weight - bones, muscles, organs, etc., is ultimately supported by the foot while standing, walking and running.

DO YOU KNOW...

While running, the foot takes a load at least twice as large as the body weight. You can find out about the very large adaptability of the foot by walking on the sand by the sea, where the variability of the terrain requires the foot to work in a multidimensional way, activating a number of muscles (not only the foot, but the entire leg, pelvis, spine, etc.) of tendons and ligaments. Similarly, walking on wet glass requires stabilization work from the foot.

SUPPORT

It is the support of the body.
This means that thanks to the three points of support mentioned earlier, i.e. the "triangle" stretched between the tuberosity of the calcaneus, the heads of the first (I) and fifth (V) metatarsal bones, and thanks to the complement of the triangle by ligaments, tendons and muscles between these points , specific "bridges" are formed. They allow you to stand steadily regardless of the surface.

SHOCK-ABSORBER

It is a shock-absorber.
Thanks to its advanced structure ("a masterpiece of engineering"), MOVEMENTS occurring in the joints of the foot allow for propulsion of the foot while walking, running, jumping, sliding, ... (enter any variations that come to your mind in connection with the foot here) during sudden, while allowing you to adapt to the terrain.
This is important because the foot works in various planes and its adaptive properties affect the stability of the body and the transfer of large and variable loads in order to protect the joints from excessive stress leading to injury and you from falling.

TRANSMITTER

It is a transmitter.
Thanks to your feet, you recognize the terrain - not only its shape but also its temperature and structure. This is thanks to numerous nerve endings of which there are over 200,000 in the sole of each foot and numerous blood vessels. It is the contact of the foot with the ground that helps us determine whether you are walking on wet grass or hot sand, whether the terrain is sloping or dipping. Such sensory experiences are extremely enriching in terms of overall human development and cannot be underestimated, especially in children.

DISCOVER!

Embark on a journey through your own home when it's quiet and dark inside. Take off your shoes and socks, close your eyes, and go where your feet take you. You will suddenly discover that your carpet is soft and your bathroom floor tiles are laid unevenly. Maybe you'll even bump into the corner of the bed-your little toe will definitely feel it... All of these sensations will reach your brain, giving it a picture of the terrain you're walking on, even if you think you know it well. A good training for children's feet (but also for adults) is to walk barefoot on different surfaces and textures: grass, sand, stones, wooden logs - not only do you teach your brain to determine the position of your body, but in this way your foot improves and becomes stronger and more resilient.

TAKE CARE!

The entire correct posture of the body begins with the foot. It is necessary to take good care of this locomotor organ to avoid complications in the future that you may not be aware of now. Many orthopaedic problems of children are connected with abnormal formation of the foot: bad shoes, too much body weight, lack of activity, forceful support of the development by not (or limiting) lying on the stomach, placing the child by the furniture when it is not ready, leading it "by the hands" and facilitating its functioning in many aspects: beds, rocking-toys, walkers, soft mats, giving toys. Such "support" does not bring the intended results. A child has to learn to use its feet because each stage of development is necessary for its little feet to be strong and healthy.

Nature has designed us wisely - do not disturb her, and she will manage!

MEDICAL RESEARCH & MEDICAL SOURCES
  1. Barisch-Fritz B., Mauch M.: „Foot development in childhood and adolescence.”
  2. Sarrafian S.K., Kelikian A.S.: „Development of the Foot and Ankle.”
  3. Daentzer D. et al.: „Observations concerning the transverse metatarsal arch.”
  4. Kanatli U. et al..: „Evaluation of the transverse metatarsal arch of the foot with gait analysis.
  5. Mosca V. et al.: „Understanding the foot’s functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept.”
  6. Luger E.J. et al.: „Patterns of weight distribution under the metatarsal heads.”
  7. Gwani A.S. et al.: „How the three arches of the foot intercorrelate.”
  8. Cavanagh P.R. et al.: „Pressure distribution under symptom-free feet during barefoot standing.”
  9. Metera K., Saran T.: „Erroneous theory of the transverse arch of the foot and its negative consequences.”
  10. Tschauner C., Kohlmaier W.: „Ultrasonographic evaluation of the transverse metatarsal arch.”
PHOTOS & GRAPHICS

In the order of appearance on the page:

  1. Lawrence F.: „The Application of Morton’s Observations to Contemporary Treatment of Foot Dysfunction – Clinics in Podiatric Medicine and Surgery.”
  2. Foot skeleton illustration from screenshots of the Essential Anatomy 3 application by 3D4Medical: own
  3. Graphics: own
  4. Photo: own