The splayfoot is the most common acquired foot deformity or malposition. It is almost always congenital and affects more women than men. In the course of the disease, the lowering of the transversal arch of the foot causes foot complaints with a widening of the forefoot, i.e., the entire forefoot comes into contact with the ground.
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Causes of the splayfoot
A splayfoot can develop as an aging process without any external influence.
With age, the fat pads under the 3 middle phalanges of the toes disappear. This increases the pressure on the underlying bones. The splayfoot is further favored by wearing shoes with high heels for many years. These constrict the foot at the tip and increase the pressure on the tip of the foot fivefold due to the changed weight distribution.
Women are often genetically predisposed to splayfoot because of the increased occurrence of connective tissue weakness. Long-term wearers of high heels are, therefore, the most significant risk group for the development of a splayfoot in old age.
The main symptom is load-dependent pain. These occur when walking and standing and subside in the resting position. The widening of the foot causes discomfort in the shoe.
Due to the changed positions of the metatarsophalangeal joints of the toes (hammertoes or claw toes), corns develop over the toes.
Another consequence is that the big toe pushes outwards while the small toe moves inwards. Due to the foot spreading further and further, the flexor tendons, in particular, become too short, and the toes are pushed into a claw position.
The result is the formation of hammer or claw toes.
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Splayfeet can cause very severe pain.
The reason for this is a profound change in the structures of the foot and the adjacent tendons.
The lowering of the arch of the foot causes the foot to widen. This widening requires – for example, in the shoe – much more space than usual.
However, the anatomical widening of the foot is not taken into account in standard footwear. Shoes that fit once now cause pressure pain on the outside, and even newly bought shoes are too tight for the splayfeet.
The constant pressure on the outer sides of the feet causes a so-called metatarsalgia in the long run. This is the name given to the occurrence of pain under the heads of the metatarsals. The metatarsal bones form the connecting piece between the toes and the metatarsal bones of the foot.
The middle three metatarsals are particularly affected. Patients then express the pain in the area of the front, the middle third of the foot, as well as increased callus formation.
Pain increases, especially under stress, because the bodyweight exerts additional pressure on the arch of the foot. An additional problem is now posed by the aforementioned tight shoes.
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Since tendons can be displaced due to the lateral constriction, the toes can be displaced. As extensions of the foot muscles, the tendons pull on the toes and, over time, bring them into an inclined position when they are displaced. After the toe bones have also been displaced, dislocations in the toe joints can occur. These are associated with extreme pain and must be treated orthopedically as soon as possible.
NSAIDs, i.e., painkillers that do not fall under the narcotics law, are usually prescribed for pain in splayfeet. These have relatively few side effects and can combat the pain well.
However, in addition to symptomatic therapy, a causal therapy must also be carried out, as a permanent intake of painkillers cannot be a solution. If taken over a more extended period of time, they can cause stomach damage and must therefore always be combined with stomach protection (e.g., Pantoprazole®). To alleviate the pain, it is also primarily recommended to avoid wearing tight shoes and to walk barefoot regularly. This should at least be possible at home.
In the end, however, freedom from pain can only be guaranteed by orthopedic treatment.
The diagnosis of splayfoot can be made from the symptoms and the physical examination.
Due to the described malpositioning, a pathological pattern of callosity occurs over the 2nd and 3rd metatarsal bones. The examination findings include:
Examination in standing position: A widening of the forefoot and a sinking of the transversal arch is observed.
Examination in a sitting position: On the sole, characteristic calluses and corns can be seen.
An X-ray can provide further information. Here, a changed angle between the 1st and 2nd metatarsal bone can be seen, as well as the fanning out of the metatarsus (splayfoot).
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A permanent erection of a sunken transverse arch can usually not be achieved with conservative or surgical measures. To treat the foot malposition, conservative measures are taken, while accompanying toe deformities are corrected surgically.
The different therapy concepts are:
- Avoidance of too tight and too high shoes
- Immobilization, alternating baths, medications for inflammation inhibition and pain relief
- Relief of pressure points via a retro capital splayfoot insert
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The foot muscles can be actively strengthened through specific exercises. The focus of splayfoot gymnastics is on building up the longitudinal and transverse arches. It is recommended to train barefoot! Of course, each exercise should only be practiced as long and intensively as the general constitution and state of health allow.
Several times a day, stand on your toes and slowly circle your feet. The heels must not touch the ground. In the beginning, you can start with 10 repetitions on both sides, but in the course of the training, an increase to at least 20 repetitions is desirable. It is not uncommon for the foot to ‘crack’ the first few times! This exercise is ideal for integrating it into your daily life in a time-saving way: For example, you can strengthen the foot muscles at the same time as you are telephoning or brushing your teeth!
An operation to correct splayfeet should only be arranged very cautiously! The operation is problematic in so far as the foot represents a functioning unit. All parts interact with each other, and every small bone has its exact place. If the position of the metatarsal or toe bones is corrected individually, the entire statics and mechanics of the foot can change.
In particularly stubborn and painful cases of splayfoot, surgery nevertheless offers the possibility of improvement. However, only if the conventional treatments (physiotherapy, splayfoot orthosis) have already been patiently applied over a long period of time without success. As a rule, this applies to stiffened (contractile) splayfeet, which is characterized by severe changes in the joints.
There are various surgical options, mostly parts of the metatarsal bones are selectively cut through. This procedure is also called an osteotomy.
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Often parts of the metatarsal bones are removed to lift the painful heads. However, the procedure is delicate: If the lifting is too strong, a very severe overload occurs! In technical jargon, the resulting pain is also known as ‘transfer pain.’
Furthermore, a so-called subcapital (below the head) osteotomy can be performed. Here the bone below the metatarsal head is cut through and fixed with small screws or wires so that the heads are moved backward.
In particularly severe cases, when the affected person can hardly walk, and the pain is unbearable, the last option is a complete removal (resection) of all metatarsal heads. All the heads are shortened at the same height so that a smooth line is created. In many cases, the pain decreases after the surgery, and patients can walk again without pain.
Malpositioning of the toes (deformities) is very common in splayfeet, e.g., in hammertoes or hallux vagus (deviation of the big toe to the side). Therefore, this part of the foot malpositioning should also be considered when choosing the surgical method.
Insoles can help to treat the splayfoot and relieve the pain. Insoles compensate for the shifted balance of forces in the arch of the foot. They serve to recreate the original anatomical position and thus restore a natural weight distribution.
However, insoles should always be fitted professionally and should not be purchased as a lump sum over the Internet. An insole must be 100% adapted to the foot. Otherwise, the problem will be aggravated, and even more significant pain and damage may result. Suitable insoles can be found in specialized shoe shops or shops for orthopedic needs.
Fitting and advice can also be provided there.
Orthopedic insoles, as used for splayfeet, are somewhat more expensive than conventional insoles. They are in the range of $40 to $170 per pair. However, several pairs should be purchased for hygienic reasons. The insoles can take away the pain and stop further deterioration, especially in the early stages. In very advanced stages, however, insoles alone are usually not enough; surgical therapy is usually necessary in these stages.
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