The front of your foot is critical for establishing a stable base of support for walking. So what happens when, instead, it’s a mushy mess? For example, if you have this issue, you may notice that your toes spread apart when walking. What happens is that the forces that your foot should absorb get transferred to your ankle, knee, and hip, and those joints start complaining. Let me explain.
The forefoot (or the distal portion of the foot, where the toes live) houses a band of tissue called the transverse metatarsal ligament. This ligament runs across the forefoot and not only connects the five metatarsal bones (the bones that form the toes at the end) but holds them nice and tight, providing just the right amount of firm flexibility to provide proper walking motion in the foot. When there is a problem with this ligament (e.g., the ligament has become lax, or loose) the forefoot can become unstable.
The foot, as you will see in my brief video above, angles a bit as you walk, so you need a firm foundation of support in the forefoot to allow that to happen. This also stores and releases energy, giving you “spring” in your step. This is why the transverse metatarsal ligaments (along with the supporting muscles) are so critical here.
Unfortunately, when the transverse metatarsal ligament in the foot becomes loose, this can not only disrupt walking and create more problems in the foot, it can also impact other musculoskeletal structures all the way up the entire lower limb, from the ankle to the knee to the hip. This happens because the energy that was supposed to be absorbed by the stable forefoot and tight metatarsal ligament instead get transferred up the kinetic chain (to the next joint or joints up). Similarly, if the forefoot is unstable, this can cause too much motion at the ankle, knee, and hip as the foot caves inward as it hits the ground.
One sign of this instability in the forefoot is toes that spread apart when walking as the ligament is no longer firm enough to hold the metatarsals tightly together. This is a sure sign of a “mushy” foot that can’t absorb forces or help stabilize the ankle, knee, and hip. Let’s take a look at the forefoot of one of my patients and compare his normal forefoot on one side to his abnormal one on the opposite side.
As I mentioned before, instability in the forefoot can create additional problems in the lower limb, and that was indeed the case for my patient who, in addition to the foot issue, also developed ankle and knee issues. Be sure to follow along with my video above as you will see actual video of my examination of this patient’s feet.
When I examine his normal forefoot, I look first at the lateral side, or outside of the foot, to see if there is any abnormality or play in the metatarsals. To do this, I’m stabilizing one part of the forefoot with one hand as I move one metatarsal bone against the other. As the video shows, I find no abnormal motion there. Next, I check the medial side, or inside, of the foot, for joint play in the metatarsals there. Again, no abnormal motion there.
Moving to the other foot, the story clearly is much different. First, note that on this foot, the patient does have a huge bone spur that you can see, but for our purposes, ignore that and just focus on the forefoot examination. When I examine the outside, the excessive motion between the metatarsal bones demonstrates this patient’s very loose transverse metatarsal ligament. I also examine the inside of this foot, and the result is the same. This patient has a completely unstable forefoot!
Do your toes spread apart when walking? Loose transverse metatarsal ligaments can be tightened without surgery, using very precise ultrasound-guided orthobiologic injections. It’s not something that can be done by your orthopedist, your podiatrist, or a nurse working at a chiropractic office and blindly injecting amniotic “stem cells.” It’s a pretty complex procedure that should only be performed by a physician certified in interventional orthopedics and trained specifically in these types of ligament injections. To find physicians with these skills, you can see our advanced provider network or find a physician who has mastered advanced skills through the IOF (a nonprofit dedicated to interventional orthopedics training).
The upshot? Understanding that your forefoot stability is critical for normal walking and for protecting all of the joints up the kinetic chain is critical. A mushy forefoot can thus cause many problems, like ankle arthritis or knee/hip pain. A simple test by your doctor can figure out if you have this problem. In the meantime, if you do, surgery isn’t usually the answer, but instead finding an advanced provider who can tighten the loose transverse metatarsal ligament through precise injections can usually fix the issue.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…