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All About The Fragile Foot 

It has been suggested that the foot is perfect! This is an interesting statement that can only be considered in the light of ever increasing incidence of foot pain in the population, and the evolutionary biology of this fascinating structure. The human foot started it’s journey from grasping appendage to bipedal support around 6 million years ago has we separated from our common ancestor with the chimpanzee (Pan troglodytes) and bonobo (Pan paniscus).  We are highly reliant on fossils to have an idea of the process of morphological change that has occurred. The problem is, despite the fact we have one of the most complete series of fossil of any mammal when it comes to humans, we still don’t have a great collection of foot bones. Yet we have enough of a tantalising glimpse to have pretty good ideas on the evolution of the foot.

A recent discovered specimen of an ape like creature included a few foot bones dated around 4.4 million years ago. Although we can’t prove this was a human ancestor, and it is very unlikely to be a direct ancestor, the specimen shows mixed early hominid features as well as ape. The foot is still more ape like and not a good bipedal structure. But by 3.4 million years the famous “Lucy” fossil, Australopithecus aferenis was fully bipedal. How do we know? Some very kindly Australopithecus walked over some volcanic ash leaving us fossil footprints, not unlike those of modern humans! However there was still a little final touch here and there required to make a much better bipedal device. By 2 million years ago with the arrival of Homo erectus, the human foot had largely finished its development. Little change has occurred since. The foot of Homo erectus is basically our modern foot and body, attached to the brain capacity of little more than a chimp. The last 2 million years have been spent on brain development, which means bipedialism seems to have in part, driven brain evolution rather than intelligence driving bipedalism.

We will probably never know why bipedalism started to develop, although there are several ideas. What it has led to is a rather unique morphology. Please remember that many species have shared this morphology, 1.7 million years ago at least 5 species existed who were using feet similar to us. Even as little as 30,000 years ago two species were still found in Europe, Homo sapiens and Homo neatherthalis. Feet work on an evolutionary scale! So why are they such a problem to us today.

What has to be remembered is that the foot has evolved from a grasping hand like structure, with an opposable hallux (big toe), and a flexible structure. To become bipedal we have had to lengthen the hind-foot, and shorten the mid-foot and toes. We have had to stiffen the structure of the hind and midfoot and raise the foot into a depressible and recoil-able dome like structure. To achieve this we have also had to weaken structures that are equivalent to those in the hand that stop your fingers bending back. This allows the toes to bend up wards when we walk, essential to roll off the foot during the final acceleration phase of walking and to a lesser extent, running. What is essential to keep this system working is the long and short flexor muscles of the foot and ankle.

Muscles affecting the function of the foot are classed as extrinsic and intrinsic. Extrinsic muscles are attached to the leg and pass into the foot with there tendons, whereas intrinsic actually sit fully in the foot. Only one muscle attaches to the top of the foot, and up to 3 muscle tendons (some people only have 2) run in to attach to the top of the foot. In comparison, over 20 muscles either lay under the foot or their tendons attach to the underside of the foot. Guess where we need the power? Yes under the foot to help hold up are arches and to help push us forward. What is clever about the foot is that the arch can drop as our body weight passes over it, stretching the muscles and tendons of the foot, then that stretch is released to help us accelerate. The result is increased mechanical efficiency!

So why with such a clever foot function are we so prone to foot pain? We can basically divide foot problems into five. These are traumatic, genetic, developmental, aging and environmental. Trauma is of course something we are all at risk off and although we try are best, can happen at any time. I know this too well having fractured an ankle very badly after a simple slip on a muddy bank. Without surgery I would have been crippled for life. Despite excellent internal fixation from the surgeon, and no matter how hard I keep up with the exercises I will get some osteoarthritis in my ankle. It is a sad fact. Any significant injury will leave us with a permanent weakness or abnormality of function. Injury is just a chance effect. However the other four cause of foot problems are very much linked together.

Genetic is a particularly interesting one. Humans are very interesting genetically because they seem to have the ability to alter genes much quicker than most species. In fact all apes are very adaptable genetically, but humans have produced far more genetic changes in the last 6 million years since our common ancestor than chimps and bonobos have. We get a glimpse of this by looking at the huge variation within the human populations of the world. One of the problems with having an amazing ability to alter your genetics about is that every time genes are shuffled, mistakes can occur. Sadly for some individuals it results in unpleasant genetic diseases, which are then inherited. There are some foot problems who’s origins are largely genetic, such as certain foot profiles which run in families, or our linked to genetic diseases such as motor-sensory neuropathies. Also humans have an over charged immune system, and certain inherited aspects of our immunity leave some of us prone to rheumatoid arthritis, or psoriatic arthritis, which can be very destructive to feet.

Most genetic linked foot problems are largely linked to development, aging and environment. Developmental problems concern how we grow as a fetus and then as children. For example the drug folidamide profoundly affected the development of many fetuses leading to absent or very deformed limbs, whereas club feet are thought to relate to abnormal fetus position in the womb. But the most interesting finding in genetic research is that our environment effects gene expression as we develop. That basically means that what our bodies, or our mothers body encounters as we develop will determine what sort of genes are switched on and for how long.  That of course means that genetics, development and environment all affect each other. We’ll come back to this.

Ageing is a sad consequence of evolution. Evolution is about passing on the genes. It is only interested in the individual while they are able to breed. After a period of breeding, the genes are already on their journey through time. You are an individual are now disposable. Once we reach around forty nature is trying to get rid of us. We start making far more errors in our cell divisions, as we repair tissues (a daily process for all of us). The more cell divisions we have made the more likely we are to make a mistake leading to cancer. Most of the time our immune system will catch these bad mutant cells, but when they are not we get cancer. However, a more insidious process occurs. Are musculoskeletal tissue is mainly made up of collagen, an amazing arrangement of protein fibers that can be arranged in different ways to cause different types of collagen. Most collagen we use for muscles and tendons is strong and stiff, but we also have one that is very elastic. Sadly the elastic one is slowly lost not only giving us wrinkles, but causing our tissues to sag, become stiffer and far more prone to injury. In time the stiffer collagen also deteriorates in its strength. What seems unfair is no everyone ages at the same rate. That is dependent on your genes and your environment working together.

Now environment is profoundly important to feet. Around 45,000 years ago some population of feet started to change shape and become less robust. It seems that the introduction of supportive footwear may be the cause. Interestingly European feet are generally less robust in the bones and higher arched than most other human populations. The reason is probably the longer and wider use of supportive footwear. There are other examples with length of time of cooking and jaw size. The ironic part of this is most scientific work on foot function has been done on European feet.   We have used an abnormal as normal. In the last 150 years many of us, and now over half the population of the worlds have become urbanized. That means we now spend an awful lot of time on concrete and other hard flat surfaces. When not on hard flat surfaces, we wear shoes, with there own hard flat surface. In the last 75 years it has become the norm to wear shoes based on fashion not function for daily use. These shoes are often very tight, unstable and high heeled. This is so far from what the foot evolved to walk on.

So what implication does this all have for foot problems today? Remember the foot needs strong muscles to support the arch. Those muscles are under assault daily on hard flat surfaces because there is little opportunity for your toes to grip down as they would when walking barefoot over rough ground. The important plantarflexor muscles of the feet weaken. When we wear a shoe with a heel we have to force our toes up towards us more, putting pressure on those anatomical structures we weakened to allow our toes to bend up. The higher the heel the more your toes are forced upwards.

Article written by Andrew Horwood -
Podiatry Clinics (Leeds)