Hollow foot: Causes, Symptoms, and Treatment

A hollow foot is a malposition of the foot. This can be congenital or acquired in the course of life. Depending on the degree of malpositioning, the it can be recognized as such from the outside. A change in the longitudinal arch of the foot causes an increased curvature of the foot towards the upper side, which creates a hollow space on the underside of the foot. This is caused by a dysbalance of the muscles of the foot and lower leg.

A hollow foot is noticed, depending on the time of its occurrence, by the symptoms caused or by the parents of the affected child. This diagnosis can be made by a doctor after a physical examination and an X-ray of the affected foot.

The most common other foot malpositions are the splayfoot, flat foot, and the splayfoot. Read more about this topic under Malpositions of the foot.

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The congenital hollow foot is relatively common among the various forms of the hollow foot and occurs more frequently in families. The causes of the congenital form have not yet been fully clarified. A hollow foot can also occur in the course of life. The underlying cause can be of neurological, orthopedic or neuromuscular origin. Often, however, no cause can be found, in which case we speak of a so-called idiopathic hollow foot.

A hollow foot, which occurs in the course of life, is caused by a dysbalance in the muscles of the foot and lower leg, which leads to a pathological change in the longitudinal arch of the foot on the underside of the foot. In general, both nerves and muscles and their interaction can be disturbed.

There are several diseases that are known to cause hollow feet in patients. Examples are neural muscular atrophy – the most common neuromuscular cause of hollow feet – or the so-called Friedrich’s ataxia, which is one of the neurological causes. In this disease, the destruction of parts of the central nervous system leads to the development of a hollow foot.

Muscle injuries caused by accidents can also cause a hollow foot.

Want to know more about Flatfeet: Causes, Symptoms, and Treatment?

Symptoms of a hollow foot

The symptoms of a hollow foot are relatively characteristic. Apart from the striking external change of the foot, in which the longitudinal arch of the foot on the underside of the foot has a strong upward curvature, severe pain is one of the main symptoms of a hollow foot.

The pain typically occurs during stress, for example, when walking, running, or standing for a long time. They are usually located on the inside and outside of the foot in the area of the metatarsal bones. Pain can also occur in the area of the tarsal.

Since the foot is particularly strained in some places due to malpositioning, changes in the skin of the foot are also frequent. Increased callus formation in the area of the inner and outer side of the metatarsus is, therefore, more frequent (see: callus on foot). Besides, increased tendon tension leads to an absolute immobility of certain joints of the foot.

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The therapy of a hollow foot depends on its severity and the cause of its development. If the cause is known, the underlying disease should be treated first.

In general, a distinction is made between conservative and operative therapy as well as symptomatic treatment:

Conservative therapy: The conservative therapy is the first step in the treatment of the hollow foot. Thus, it can be corrected to a certain degree with the help of specially made insoles. The insoles help to correct the imbalance between the muscle groups.

Surgical therapy of a hollow foot only takes place after the failure of conservative therapy. There are various procedures for the correction. In an osteotomy of the foot, bone parts are cut through and fixed in a displaced position. Arthrodesis, on the other hand, is intended to significantly reduce the discomfort caused by artificial stiffening of certain joints.

Symptomatic treatment: Painkillers can provide relief from the pain of high arches.


Special insoles are an essential part of the therapy of a hollow foot. Thus, conservative therapy is mainly based on wearing these insoles. The insoles can help to eliminate the imbalance between the muscle groups of the foot and lower leg, and thus the cause of the development of the hollow foot, thus reducing the discomfort. In addition to insoles, adapted night splints can also help to correct the position.

To achieve an optimal treatment goal, the insoles should be individually made and placed in the most frequently worn shoe. It is advisable to check regularly for any necessary re-fitting. There are several different materials and different types of insoles. The advice of an experienced orthopedic specialist, i.e., a specialist in the treatment of a hollow foot, as well as regular therapy checks, are essential for the success of the treatment.

Please check our article about Ledderhose disease: Causes, Symptoms, and Treatment

Surgery of a hollow foot

Surgery can be considered if conservative treatment methods have not been successful. There are different possibilities to treat this condition with the help of a surgical intervention.

A standard procedure used to treat a hollow foot is the so-called osteotomy (more precisely: calcaneus osteotomy). This involves cutting a bone of the tarsal, the calcaneus into two pieces, and fixing it in a displaced position. After the bone has healed, the hollow foot usually improves.

Another treatment option is the so-called arthrodesis, in which certain joints of the foot are artificially stiffened. Since this is a permanent stiffening of the joints, this operation is only considered in particularly severe cases.

Which operation is appropriate in each individual case depends on the underlying disease and the severity of the hollow foot and is discussed in detail with the treating physician.

You can also check other articles about Ankle Conditions: Types and Information


  1. Klammer G, Maquieira GJ, Spahn S, et al. Natural history of nonoperatively treated osteochondral lesions of the talus. Foot Ankle Int. 2015;36:24–31. [PubMed] [Google Scholar]
  2. Swenson DM, Collins CL, Fields SK, et al. Epidemiology of U.S. high school sports-related ligamentous ankle injuries, 2005/06-2010/11. Clin J Sport Med. 2013;23:190–196. [PMC free article] [PubMed] [Google Scholar]
  3. Marsh JL, Buckwalter J, Gelberman R, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am. 2002;84A:1259–1271. [PubMed] [Google Scholar]
  4. O’Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sport Med. 2010;38:392–404. [PubMed] [Google Scholar]
  5. Lynch SA, Renström PA. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med. 1999;27:61–71. [PubMed] [Google Scholar]
  6. Petersen W, Rembitzki IV, Koppenburg AG, et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg. 2013;133:1129–1141. [PMC free article] [PubMed] [Google Scholar]

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