Effect of blockages in the small joints of the foot on the occurrence of functional disorders of the musculoskeletal system

Bones of the leg, or more specifically, ligaments, muscles and tendons in the area of the foot, instep and ankle have a specific shape (bone), direction of traction (ligaments, tendons) and standing surfaces of the joints with goal to form 2 longitudinal arches on outer side of the foot and 3 transverse arches on the inner side of the foot between the metatarsal bones.

These arches have a goal to dampen the impacts due to the heel hitting the ground during walking, and at the same time they enable the foot to “roll” up from the ground, which makes walking and running smooth and flexible. The impacts are dampened and are not transferred to higher levels of the body, to the knees, hips and through the pelvis to the spine.


If there is an occurrence of blockages in the metatarsal bones for example after injury of the lower limb, during an incorrect movement stereotype etc., and the soft tissues in the foot loose their function to dampen the impacts caused by the heel hitting the ground, it leads to a transfer of these impacts to ankle joint, knee, hips, spine and even head. Repeated impacts can cause damage to the cartilages, meniscus, intervertebral discs. But the bones alone can adapt as well. Osteophytes may form as well (bony spurs), usually occurring on the lumbar and cervical spine. Heel bone can be affected by calcar calcanei (heel spur). We also observe attachment pain in the Achilles tendon from excessive pressure, pain in the knees which was not diagnosed is later diagnosed with damaged ligaments of the menisci, there is a gradual arthrosis of the ankles, knees and hips, pain in the lumbar spine, back pain but also significant headaches.


In times when we were primates, the foot arches weren't formed yet, because there was no need for them. We didn't move in a straight posture. However what we have remained from the times when we were primates are the muscles in the foot whose function today also has a meaning. We were able to move the big toe enough to hold objects in our feet. This fact is still visible till this day by many apes, who climb up the trees and are able to position their big toes apart from the rest of the toes, and firmly hold themselves that way on the branch. Since the primates we have been left with adductor hallucis muscle (adductor of the big toe), which is not as strong today (during evolution there was also a change of the shape of the big toe joint). However, if this muscle isn't used sufficiently enough, it will get weaker, and it can lead to bunion (deflecting big toe), which can again lead to formation of functional blockages, which only results in a vicious cycle.

Foot Supportive points


The foot arch is by a born individual developing fairly late. The newborn baby has physiologically flat foot. The change of the foot and formation of mentioned foot arches appears gradually, under the effects of revealing the movement programs in the CNS results due to the maturation of the nervous system and activity of the muscles, which form by their contractions the joint surfaces. The first formation of arch development can be observed by children in age between 9 months up to 1,5 year. Basically in period when the foot gets in contact with the ground, and the child is able to do its first few steps. The foot arch should be developed by the third year of life (some literatures note 6 years). If the development of the foot is not perfect, problems such as blockages of the small foot joints can be expected in the future along with other problems connected to this issue.

Transverse and Longitudinal foot arch


Physiotherapist or doctor can recommend orthopedic insoles, which could support the transverse arch as well as the longitudinal arch, however passive support doesn't solve anything, not even orthopedic custom made insoles. Ligaments, tendons and muscles support the arches actively as well as passively. If the muscles “rely” on the passive support of the insole, they will only lose their own ability to hold the foot arch against the gravity of the earth, and they will only weaken down. Shoe insoles are great as a help for dampening the impacts while walking on a hard surface (asphalt, concrete, pavement…), or sports, where higher physical difficulty demands perfect dampening of the impacts during jumping, running, etc. (basketball, athletics, …). Insoles from soft materials such as gel, silicone, foam are therefore great.


We often meet with clients who are on the first therapy convinced about how a correct shoe should look like. They won't be convinced by a commercial, that a shoe that is “breathing” is a healthy shoe. Or they do not buy shoes that are shaped into a “perfect” tip of the shoe, because they know it is not healthy, but on our market are too much shoes with unideal space for the toes. Such shoes are unfortunately also located in specialized stores with medical shoes.

We recommend to focus on shoes whose outsole is made out of soft material for sufficient dampening of the impacts. For example german companies such as Birkenstock and Birkis use cork, and they produce high quality and representative shoes for either free time and work in an office or communication management field. The shoe should be flexible in the longitudinal axis because of the ability of lifting the foot from the ground and the width of the tip of the shoe should respond to the width of the instep and toes. The space in front of the toes should be even in the shoes for adults about 1 cm bigger. The free movement of the toes is very important, otherwise the toes are crooked, and they are stretching only in a specific phase of walking.

If you will pay attention to the quality of the shoes and take care of your feet, you will surely prevent the formation of blockages in the smaller joints of the foot, and that way you will prevent also problems of the musculoskeletal system, which is in a connected functional relation to it

Relieving the foot

Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

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