Splay Foot

Original Editor - HaniaElGibaly Top Contributors - Franca Ebomah, Kim Jackson and HaniaElGibaly

Introduction[edit | edit source]

Normal foot shape can be deviated by congenital or acquired foot deformities. If the cause of deformity is not treated, this could lead to impaired body statics. These foot instability can be significantly improved through strength, coordination and mobility training.[1]

splay foot

Definition[edit | edit source]

Splayfoot is a term used to describe the spreading of the metatarsal bones (forefoot), hence resulting in the disappearance of the transverse arch of the foot.[2] This is often accompanied by a painful callused protrusion that is tender under pressure. Due to this pain, the normal rolling mechanism of the foot is disturbed and patients instinctively wrongly position their foot, causing the shoe to become crooked and bend outwardly. This is the most common foot deformity.[2]

The mechanism of splayfoot results in intrinsic muscles weakness and intermetatarsal ligaments weakness. Splay foot usually accompanies a midtarsal strain.[3]

Mechanism of Injury[edit | edit source]

  • Splayfoot occurs majorly in women who wear high heels.
  • Too much weight on the midfoot leads to excessive dorsiflexion of the Lisfranc’s joint. Subsequently, the talus is pressed downwards, and the metatarsals experience an upwards pressure, leading to excessive horizontal play and the transverse arch flattening.
  • The resulting effects are: painful overstretching of the transverse interosseus ligament, increase in weight on the middle metatarsal heads, callus formations on the plantar surfaces of the heads and bruising of the plantar aspect of the capsule of the metatarsophalangeal joints i.e. chronic metatarsalgia. [3]

Often, the affected individual rolls over the outside edge of the foot while walking. The right way would be to ‘push off’ over the big toe. Poor footwear or hard surfaces are usually the reasons for an ‘incorrect rollover’. Stiff shoes greatly limit the foot’s freedom of movement. The foot musculature grows increasingly weaker as a result and one begins to compensate with an undesirable ‘rollover’ while walking. As a result, the foot keeps getting weaker, the transverse foot arch becomes insufficient and splayfoot develops.[4]

Symptoms[edit | edit source]

Some common symptoms that may signify splay foot include[5]:

1-Your shoes feel tighter and more uncomfortable

2-You can physically observe that your feet have become wider

3-Your foot pain is worse when you are walking or standing, and decreases when you are at rest

4-You find yourself walking on the outside edge of your feet rather than pushing off from your big toe while taking steps

5-Your shoes lean to one side when you place them on a flat surface or they wear down more quickly on the outside edge

6-You suddenly begin to develop calluses or pressure sores from walking with your weight distributed differently than usual

7-You start to develop deformities which can form when your weight distributions shifts to other parts of your foot and puts strain on different bones, joints and ligaments than usual

8-Faster fatigue of the feet due to incorrect loading, accompanied by severe pain, tingling, numbness and burning of the sole of the foot

Signs[edit | edit source]

  1. Hallux valgus (bunion) of the big toe
  2. Inward deviation of the little toe
  3. Malposition of the metatarso-phalangeal joints (claw foot, hammer toe)
  4. Painful callus formation on the sole of the foot[2]
  5. Abnormal posture which affects entire gait in more pronounced cases, and can cause problems such as knee pain or knee arthritis.[4]

Causes[edit | edit source]

  • Being overweight (often occurring in the second half of life, though children can also be affected)
  • Wearing uncomfortable footwear[2](wearing high-heeled pumps increases front-foot load by a factor of five.)
  • Connective tissue weakness (especially among women, who have a genetic predisposition) is another reason for increased width of the front of the foot.[1]
  • Previous injury or underlying genetic conditions such as: [6]
    • Rheumatism
    • Weakened ligament structures
    • Bone diseases (e.g. bone necrosis)
    • Injuries or trauma to the foot and adjacent ligaments and tendons
    • Paralysis caused by a damaged nervous system
    • A hollow foot  

Diagnosis[edit | edit source]

  • Subjective and Physical examination
  • X-ray: To estimate the degree of deviation between the metatarso-phalangeal bones[2]

Management[edit | edit source]

  • Orthopaedic insoles
  • Physiotherapy (foot exercises)
  • Medications (painkillers)[1]

Long-term consequences[edit | edit source]

Prolonged lack of management of splayfoot can results in pain in the feet and other joints.[1]

Orthopaedic insoles are often prescribed as they provide short-term foot relief but not recommended for long term use. This is because they only offer passive support to the foot thus exacerbating weakness of the muscles and pain over time.Insoles do not manage the underlying cause of the acquired foot malposition and also prevents the foot from moving freely resulting in the weakening of the foot muscles.

Common long-term consequences include:

  • Knee damage caused by incorrect force transmission while walking and standing[1]
  • The development of a painful heel spur, inter vertebral disc and back problems due to the disruption of movement patterns and inadequate dampening of impact because the arch of the foot has sagged.
  • Hallux rigidus (arthrosis of the big toe)[6]
  • Tarsal arthrosis (Lisfranc arthrosis)
  • Morton's neuroma (thickening of the tissue around the nerve on an irritated or damaged foot)

Physiotherapy Management[edit | edit source]

  1. Mobilisation of the metatarsus and activation of small foot muscles[6]
  2. Strengthening the small foot muscles
  3. Strengthening the shin muscle (M. tibialis posterior): Posterior tibialis muscle is essential in maintaining the transverse arch when walking and standing. Strong calf muscles help support your feet while lowering your risks of muscle fatigue, weakness and cramping
  4. Training of the lateral calf muscle (M. fibularis longus)
  5. Improving balance and foot stability
  6. Loosening muscles and tissues

Foot Strengthening Exercises include [5]:

  • Toe Pick Ups: Commonly used to help relieve pain. It consists of picking up small objects such as pebbles, marbles or tiny toys with your toes and depositing them in another container.
  • Arch Strengthening Caterpillar: To perform this exercise, begin by lying on your back with your knees bent and your feet flat on the floor about two feet from your glutes. Lift both foot arches and pull your toes back toward your heels. Relax your arches and slide your feet slightly back toward your butt. Repeat the process, allowing your feet to inch closer and closer to your glutes in a caterpillar motion. Once your feet are nearly touching your butt, repeat the sequence in reverse, slowly moving your feet away from your butt in the same caterpillar motion.
  • Arch Raises: Sit in a chair with your back straight, your knees bent in a 90 degree angle and your feet flat on the floor. Raise the arch of one foot off the floor without curling your toes or lifting your heel.
  • Alphabet Writing: This involves imagining a pencil in between your toes, pointing the toes outward and “writing” the alphabet in the air.
  • Walking Barefoot: Walking on natural surfaces like sand, smooth pebbles and grass can help strengthen your feet and legs and assist the body in returning to its natural gait.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Kybun Switzerland. Foot malpositions; flat valgus foot, splayfoot, flatfoot, hollow foot. Available from: https://www.kybun.com/advisor/health-conditions-does-kybun-help/foot-malpositions-flat-valgus-foot-splayfoot-flatfoot-hollow-foot.html (Accessed on 26/01/2022)
  2. 2.0 2.1 2.2 2.3 2.4 Schneider T. Splay Foot. Available from: https://www.joint-surgeon.com/orthopedic-service/foot-and-ankle-surgeon/splay-feet.html (Accessed on 26/01/2022)
  3. 3.0 3.1 ClinicalGate. Disorders of the forefeet and toes. Available from: https://clinicalgate.com/of-the-forefoot-and-toes/ (Accessed on 26/01/2022)
  4. 4.0 4.1 Sioux. Splay-foot. Available from: https://www.sioux-shop.co.uk/cms/keeping-your-feet-healthy/the-10-most-common-foot-ailments-and-what-you-can-dot-to-get-rid-of-them/splay-foot/. (Accessed on 26/01/2022)
  5. 5.0 5.1 Footfiles. Splay Foot Symptoms And Treatment Exercises. Available from: https://www.footfiles.com/health/orthopaedics/article/splay-foot-symptoms-and-treatment-exercises. (Accessed on 26/01/2022)
  6. 6.0 6.1 6.2 UxGO. The 7 most effective splayfoot exercises.2019. Available from: https://www.uxgo.de/en/guide/splayfoot-exercises/. (Accessed on 26/01/2022)