Mathematician identifies new tricks for the old arch in our foot

Schematic of the foot skeleton showing the arches and typical loading pattern during locomotion

Press Release:

  • A stiff mid-foot is essential for withstanding excessive force when pushing off on the ground for walking and running
  • The arch along the length of the foot was believed to be responsible for mid-foot stiffness. Now, a research collaboration between the University of Warwick and two other universities has illustrated the greater importance of a lesser studied foot arch – the transverse arch.
  • Our research opens new ways to study the foot for future researchers on foot health. Even the definitions of flatfoot are based upon the longitudinal arch and do not consider the transverse arch. Our work throws these standard practices into question but more work is needed to know how to update them.

Walking and running subjects our feet to forces in excess of body weight. The longitudinal arch of the feet was thought to be the reason the feet do not deform under such load. However, researchers from the University of Warwick, Okinawa Institute of Science and Technology Graduate University in Japan and Yale University have illustrated that the transverse arch may be more important for this stiffness.

Past theories of the foot stiffness look at the longitudinal arch, however in the paper ‘Stiffness of the human foot and evolution of the transverse arch’ published today, the 26th of February in the journal Nature, researchers from the University of Warwick working in collaboration with Yale University and OIST Graduate University, propose the transverse arch may play an equally important role.

The collaboration found that the transverse arch is a bigger source of foot stiffness than what was found due to the longitudinal arch in previous work. They also discovered that the transverse arched evolved to become almost human-like over 3.5 million years ago.

This collaboration between Dr Shreyas Mandre, from the Department of Maths at the University of Warwick, Professor Mahesh Bandi, from the Nonlinear and Non-equilibrium Physics Unit at the Okinawa Institute of Science and Technology Graduate University (OIST) and Professor Madhusudhan Venkadesan, from Yale University was funded by a Young Investigator award by the Human Frontiers Science Program.

The authors say that this research motivates further work into the role of the transverse arches in the disciplines of podiatry and evolutionary anthropology. These insights could also inspire new designs for prosthetic and robotic feet.

The role of the transverse arch may be understood in simpler terms by looking at a thin paper sheet. When the short edge is held flat, the sheet is floppy and droops under a little weight. But curl the edge a little and even 100 times as much weight is not excessive.

“Flat thin objects like paper sheets bend easily, but are much difficult to stretch,” Dr. Mandre explains. “The transverse curvature of the sheet engages its transverse stretching when attempting to bend it. This coupling of bending and stretching due to curvature is the principle underlying the stiffening role of the transverse arch.”

But because the foot serves multiple mechanical functions, its structure is more complicated than the paper sheet. Therefore, “flattening” the foot to test the hypothesis of curvature-induced stiffening may have unidentified confounding variables. To overcome this difficulty, the researchers ingeniously disrupted the underlying principle while keeping the transverse arch intact.

“Understanding of the underlying principle enabled us to build mechanical mimics of the foot comprising springs that imitated the elastic tissue of the foot. Disrupting the transversely oriented springs in these mimics had the same effect as flattening them,” explains Ali Yawar, a co-author of the study.

“We disrupted the underlying principle of curvature-induced stiffening in human cadaveric feet by transecting the transverse tissue, which reduced the mid-foot stiffness by nearly half,” said Carolyn Eng, another co-author of the article. In comparison, experiments in the 1980’s on disrupting the stiffening mechanism due to the longitudinal arch only showed a reduction in stiffness by about 25%.

This research also injects new interpretation of the fossil record of human ancestral species, especially pertaining to the emergence of bipedalism. The researchers formulated a measure of the transverse arch to accounts for variations in the length and thickness of the feet. They used the measure to compare related species such as the great apes, human ancestral species and some distantly related primates.

“Our evidence suggests that a human-like transverse arch may have evolved over 3.5 million years ago, a whole 1.5 million years before the emergence of the genus Homo and was a key step in the evolution of modern humans,” explains Prof. Venkadesan. It also provides a hypothesis for how Australopithecus afarensis, the same species as the fossil Lucy, thought to not possess longitudinally arched feet, could generate footprints like humans that were discovered in Laetoli

Running research: Heel-toe or toe-heel?

Press Release:

New research from La Trobe University suggests there is no evidence that changing a runner’s strike pattern will help prevent injuries or give them a speed boost.

In a bid to avoid shin splints, sore knees and other injuries, many runners have adopted a toe-to-heel trend, running on the balls of their feet. This is often encouraged by coaches and health professionals.

However, in research out this week in Sports Medicine, La Trobe injury researcher and physiotherapist Dr Christian Barton found there is no evidence to suggest running on the front of your feet reduces injury risk or improves performance.

“We analysed 53 studies which looked at the impact of forefoot, rearfoot and flatfoot running patterns on injury, running economy and running biomechanics,” senior author of the study, Dr Barton said

“Our comprehensive review suggests that telling someone to run on the ball of their foot instead of their heel may make them less efficient, at least in the short term. Additionally, there is no evidence either way on whether running on the balls of your feet reduces injury.”

Dr Barton said switching your running style shifts the body’s loads but doesn’t make them disappear.

“Running toe-heel might help injuries at the knee, where loads are reduced. However, it may cause injuries to the feet and ankle, where loads are increased,” Dr Barton said.

“Put simply, when it comes to running style: If it ain’t broke, don’t fix it.”

Can the bunion correctors actually help correct bunions?

A simple search of Google will not give you the answer to the question as if bunion correctors work. You will see lots of posts and comments by podiatric and orthopedic surgeons saying that they do not work (they make their money by doing bunion surgery) and you see lots of posts and comments by people selling them say that they do work (they make their money by selling them).

So, who should you believe? Should you believe all the testimonials on the sites selling them. They can be fake. Lots of forum and social media posts ask if the work (eg here and here). Some podiatrists have tried to address the issue (eg here).

In these situations, you need to defer to what the unbiased published and peer reviewed scientific research says. Unfortunately there is not a lot to go on here as its not exactly a popular topic for researchers to look into!

There is one study that has looked at this and, yes it showed that bunion correctors do work at correcting bunions. However, it was only done over a 3 month period and its showed on average a 1 degree improvement per month in the angle of the hallux valgus. That is a reasonable outcome. What they study did not show is that if there is further improvement beyond the three months or if you need to keep wearing them to maintain the improvement. Maybe the improvement reverses when the corrector is no longer used.

There are lots of unanswered questions regarding the research on these, so unfortunately opinions is all that is left. There are opinions (eg here) that even if they do not actually correct the bunion or hallux valgus, they are still useful as a physical therapy type intervention to stretch and keep the joint mobile. This is a reasonable opinion and use of these bunion correctors.

Two different concentrations of benzoyl peroxide gel can be used to treat pitted keratolysis

Press Release:

Topical benzoyl peroxide gel 2.5% and 5% can both be used to treat pitted keratolysis according to study results presented at the American Academy of Dermatology virtual meeting in June, 2020.

Pitted keratolysis (PK), a common skin disease, is frequently accompanied by pitted lesions on the feet and malodor,” Charussri Leeyaphan, MD, of the department of dermatology, faculty of medicine at the Siriraj Hospital, Mahidol University in Bangkok, and colleagues wrote. “The over-the-counter drug topical benzoyl peroxide gel (BP) is used as a medication for PK. However, the appropriate dosage and duration of BP treatment of PK is controversial.”

Topical benzoyl peroxide gel 2.5% and 5% can both be used treat pitted keratolysis.
In a prospective randomized, controlled trial to assess the safety and effectiveness of topical 2.5% BP and 5% BP, 89 subjects diagnosed with PK were analyzed. Subjects were assigned either 2.5% or 5% BP and were asked to apply the topical medication once daily for 2 weeks. Safety and effectiveness were evaluated 2 weeks after treatment via clinical examinations and self-assessments.

Of the 42 subjects that were treated with 2.5% BP, self-evaluation of foot odor using a visual analog scale showed a significant decrease from 5.4 to 3.7 (P < .001). Of 47 subjects treated with 5% BP, the decrease was from 5.4 to 3.5 (P .001).

Pitted lesions were evaluated by treatment-blinded dermatologists, with a 69% improvement for the 2.5% BP group vs. a 63.8% improvement for the 5% BP group. Side effects were not statistically different between the groups, and moderate to high levels of satisfactions were reported from almost all subjects.

“This study demonstrated that either 2.5% or 5% BP can be used for the treatment of pitted keratolysis and foot malodor,” Leeyaphan and colleagues wrote. “Due to the similarities in their efficacies and side effects, the use of 2.5% BP may be preferable.”

New Balance Golf Shoes

Press release:

Boston, Mass., March 6, 2020 – New Balance Golf has added two new styles to its Fresh Foam LinksSL collection for spring.

New Balance’s Fresh Foam technology was first introduced in the company’s performance running shoes and is now used across almost all categories of New Balance footwear.

Fresh Foam Technology

CUSH+ – A molded insole for superior comfort and lateral stability.

FRESH FOAM – An innovative midsole with a data-driven design that identified zones in the midsole where altering levels of compression and resistance are aligned to provide ultra-soft cushioning and lateral stability.

SMART RUBBER OUTSOLE – The spikeless outsole on the Fresh Foam LinksSL has omni-directional traction lugs with pressure mapping colors to highlight key performance zones.

Fresh Foam LinksSL

The Fresh Foam LinksSL features a waterproof performance mesh upper and a spikeless smart rubber outsole. The smart rubber outsole has pressure mapping colors to highlight key performance zones during the swing. The suggested retail is $99.95. The green and white colorway is available March 15th and the red, white and blue colorway will be available May 1st.

About New Balance

New Balance, headquartered in Boston, MA has the following mission: Demonstrating responsible leadership, we build global brands that athletes are proud to wear, associates are proud to create and communities are proud to host. Manufactured in the U.S. for over 75 years and representing a limited portion of our U.S. sales, New Balance Made U.S. is a premium collection that contains a domestic value of 70% or greater. New Balance owns five factories in New England and one in Flimby, U.K. New Balance employs more than 6,000 associates around the globe, and in 2018 reported worldwide sales of $4.1 billion. To learn more about New Balance, please visit www.newbalance.com.

More on injuries in golf.

Paratrooper™ Plantar Plate System Receives 510(k) Clearance – 1st Dedicated System Allowing Surgeons to Repair the Plantar Plate Through Either a Dorsal or Plantar Approach

ENGLEWOOD, Colo., Feb. 7, 2020 /PRNewswire/ — The Paratrooper™ Plantar Plate Repair System was developed to allow surgeons to use a dorsal or plantar approach to the plantar plate repair procedure using a single, all-inclusive kit.

The Paratrooper™ Plantar Plate Repair System uses an all-suture anchor implant that can be fixed into bone or soft tissue. By using an all-suture implant, the surgeon can perform the plantar plate repair using a variety of fixation and approach techniques, while preserving surrounding bone and tissue. When the Paratrooper™ suture implant is inserted and tensioned, the implanted suture “sock” will contract and form into a low profile, flat anchor that will prevent the implant from pulling out of the site.

Surgeons face a variety of challenges and complications in plantar plate repair using the dorsal and plantar approach:

  • Exposure to the plantar plate from the dorsal approach
  • Difficulty implanting into bone or soft tissue
  • Step-heavy procedure with complicated instrumentation

The Paratrooper™ Plantar Plate Repair System was designed with these challenges in mind.

The system includes all instrumentation necessary to gain adequate exposure to the plantar plate from either the dorsal or plantar approach.  Paragon 28® designed the Paratrooper™ Plantar Plate implant and instruments to allow for simple insertion into tissue and bone through use of an innovative insertion tip, custom needle, and delivery method. Instrumentation is provided to directly address plantar plate deficiency and is included within one kit and is used to facilitate exposure, drilling, and implant placement within a small, limited vascularization environment.  The Paratrooper™ Plantar Plate Repair System was specifically designed to facilitate proper step execution and limit complications intraoperatively.

Paragon 28® is planning for full commercial launch of the Paratrooper™ Plantar Plating System in June 2020.