Spreading feet are the most common orthopedic foot deformity in Germany and also the most commonly associated with pain. In many cases, spreading feet occur only in a slight degree without disease value. However, it can be painful to the foot, especially when people are prone to spreading feet or have already been diagnosed, without any treatment or avoidance of progression being initiated. Often the pain is due to improper stress and overwork, it can also be a rare neurological cause behind it.
The basic causes of the pain that can develop in the splayfoot are due to the particular position of the foot bones and also nerves. There is a ligament, tendon and muscle support in the foot that holds the metatarsal bones together, so that the load on walking and standing is borne by the 1st and 5th metatarsal bones. Spreading feet have a damaged transverse arch, causing the bones in the midfoot to spread, spread and sink. The big toe can also move outwards and form the so-called hallux valgus. Overall, the foot flattens and with every step, bones come into contact with the ground that are not normally involved in bearing the brunt - the metatarsal bones 2-4. Cornucopia causes unpleasant calluses, which cause pain, under the feet.
Causes of these processes are usually wrong and too tight shoes, especially high-heeled shoes are problematic in this regard. Also, congenital connective tissue weakness may increase the risk of spreading feet. The pain is then caused by chronic stress on normally unloaded regions. Especially the second and third metatarsal bones are thus overloaded and overloaded. Long standing also causes pain in the affected areas. In addition, there may be a neurological problem with spreading feet that causes further pain. This is the so-called Morton neuralgia. Between the toe bones run several nerves, which are exposed in normal foot posture with little or no stress when walking and standing. Due to the anatomical displacements of spreading feet, these nerves are narrowed and are further irritated and compressed with each step. This cause of pain in spreading feet is located mainly between the metatarsal bones 3 and 4.
The main symptom of pain shows some characteristics in spreading feet. The most important feature is that the pain is stress-dependent. They are noticeable when walking and running in the affected areas, which show calluses and can vary in their strength. At rest, the pain typical of splayed feet usually subsides.
If Morton neuralgia is the cause of the pain, it shows a characteristic neuropathic pain. Due to the direct irritation of the nerves, the pain occurs sharply at every step, sometimes accompanied by misperceptions. They can also move on to other areas of the foot, but the main location is the metatarsus. Pain in spreading feet are usually triggered by manual pressure.
In addition to the pain, spreading feet are still manifested by the obvious malposition of the toes and the calluses and corneal deposits under the foot. Furthermore, the onset pain results in an instinctive misalignment of the foot that attempts to prevent discomfort. Spreader feet can also cause problems in the ankle.
The diagnosis spreading feet can be easily made by a trained physician. At the beginning there is the exact inspection of the foot, with which the flattening of the arch of the foot as well as the deformity and broadening of the forefoot can be recognized. A large toe typical for spreading feet (Hallux valgus) also stands out. These examinations should be done standing up.
The examination is supplemented by imaging techniques, so in some cases, an X-ray of the feet is made. It is crucial to determine the extent of the spreading feet to adjust the therapy accordingly.
In addition, the pain is accurately queried. It is important to know when the pain occurs, how strong they are and what their character is (pointed, dull, piercing, tingling). Then the sole of the foot is scanned to detect and localize pressure pain. If it is suspected that the pain is caused by a Morton neuralgia, a magnetic resonance imaging (MRI) is made, with the constriction and thickening of nerves can be found.
Light spreading feet are in many cases subjected to no special therapy. However, if pain and severe limitations occur, treatment must be provided with a variety of methods.
The focus is on conservative measures. In addition to the conversion to suitable and wide footwear orthopedic insoles are useful. These support the arch of the foot from below and reduce pain and pressure sensations. They help to bring spreading feet back into a physiological position. Another important method to relieve the pain in spreading feet, are targeted exercises for strengthening the foot muscles in terms of foot exercises. Thus, under the guidance of a physiotherapist, a long-term improvement of the symptoms can be achieved, since deposits support, but not fight the cause. The simplest form of foot exercise, which helps against splayfoot and strengthens the muscles and vision, is barefoot running. However, if the pain is too strong and does not allow for activity, moist envelopes and rest help. Painkillers also relieve the pain. In some cases, it may be useful to have the corneal calluses removed by a podiatrist; in addition, weight reduction helps reduce the stress on the spreading feet.
Usually, these conservative measures are sufficient to get the pain under control. However, they do not completely eliminate the malposition. Therefore, in severe, uncontrollable cases, surgery must be performed. Sphincter surgery, which is called Weil Osteotomy, aims to straighten the length of the foot. This is achieved by shortening the involved metatarsal bones by a small amount and thus separating them spatially from the calluses that cause the pain when they appear. Also, a malposition of the big toe is corrected here. In the case of Morton neuralgia, the pain can be removed by relieving the nerves by removing tissue. The pain then goes back quickly. Whether a conservative or invasive therapy takes place, must always be weighed in individual cases.
The prognosis for spreading feet that cause pain is good in most cases. The above-mentioned treatment options can be of great help to the large number of patients without leaving pain behind. Untreated spreading feet can take a worse course, the calluses are larger and develop corns and so-called hammer toes. The ongoing pain then also lead to further orthopedic deformities on the foot.
The most important form of prophylaxis is appropriate footwear. It has to be pointed out that tight and above all high-heeled shoes with a large forefoot load are the main risk factors for spreading feet. People who have a disposition to spread feet, should pay particular attention to wear appropriate footwear. Frequent barefoot walking also significantly reduces the risk of spreading feet by strengthening the tissue on the foot. In addition, it is recommended to maintain a healthy body weight with a BMI below 25 to reduce the load on the foot.