Splayfoot is a common foot deformity in which the transverse arch in the forefoot flattens and the metatarsal bones spread apart. Typical symptoms of splayfoot include pain in the forefoot, pressure points, calluses, or corns on the sole of the foot. Many people affected notice the discomfort especially when standing for long periods or when wearing unsuitable shoes with high heels.
Splayfoot is often caused by being overweight, weak connective tissue, improper footwear, or deformities such as hallux valgus and hammertoes. The deformity places excessive strain on the metatarsal heads and metatarsophalangeal joints, which can lead to metatarsalgia and sharp, stabbing pain. In orthopedics, orthotically customized insoles, special insoles with pads, and conservative measures to relieve pressure on the arch of the foot are frequently used.
In addition, physical therapy, foot exercises, and walking barefoot help strengthen the foot muscles and improve mobility. In advanced cases, surgical treatment for splayfoot may be necessary to permanently correct the shape of the foot.
What symptoms does a splayfoot cause, and how does it develop?
As a rule, people with splayfoot are not even aware of it. This foot deformity remains completely asymptomatic for a long time. In advanced stages, however, pain in the midfoot may occasionally occur: the heads of the metatarsal bones can become painful when walking.
A characteristic feature of splayfoot is the spreading of the midfoot. This spreading develops primarily as a result of
- excess weight,
- shoes that are too tight, and
- shoes with very high heels.
Splayfoot occurs particularly frequently in conjunction with a “bunion” (hallux valgus). In hallux valgus, the big toe is increasingly turned inward. Here, too, the cause can be shoes that are too tight.
Generally speaking, however, the midfoot and forefoot of humans naturally exhibit a wide range of width variations.
In a splayfoot, the metatarsal bones deviate outward and the foot appears wider © Henrie | AdobeStock
Diagnosis of Spread Foot
The diagnosis of a splayfoot is based on the orthopedic presentation. Due to instability along the outer edges of the midfoot, the first and fifth toes become increasingly misaligned. As a result, the main weight-bearing load when walking shifts to the middle metatarsal bones, whose heads also undergo painful changes under this stress.
Below the toes, pronounced callus formation occurs in the metatarsal region, often accompanied by claw toes. An X-ray reveals a wider-than-normal spacing between the metatarsal bones—an additional indication of metatarsal splay.
How is a splayfoot treated?
Most patients with splayfoot experience no symptoms at all for a long time. Therefore, in many cases, specific treatment is not necessary at all. However, to prevent symptoms from developing later on, doctors recommend so-called splayfoot braces. These are designed to compress the forefoot area to prevent further spreading of the metatarsal bones.
If a splayfoot becomes symptomatic—that is, if pain occurs in the area of the metatarsal heads—special orthotics can help. Orthotics can also be used as a long-term treatment option.
Concomitant hallux valgus is often corrected surgically to stabilize the metatarsus along its outer edges as well. This allows the patient to bear more weight on the metatarsus again, thereby restoring physiological function as fully as possible.
Follow-up Care and Prognosis for Splayfoot
After treatment, the patient should have their foot checked regularly by their orthopedic surgeon. The surgeon will advise you on further treatment options, such as surgical correction of the splayfoot.
Overall, splayfoot is considered highly treatable. This applies both to treatment with orthotic insoles and to potential surgical correction.
Nevertheless, it is also important to ensure you wear the right footwear and maintain a stable, healthy weight. This relieves pressure on the midfoot and reduces the risk of developing splayfoot or its progression.
Where can patients find help for splayfoot?
Given the foot’s delicate bone and joint structure, it falls within the scope of orthopedic specialists. Some orthopedic surgeons specialize in the foot skeleton and its surgical correction.
Orthopedic centers for foot surgery are the right point of contact when a symptomatic splayfoot requires surgery. In addition to orthopedics and surgery, other (non-medical) specialties can be helpful for splayfoot, such as
- orthotic technicians for fitting insoles and orthopedic footwear, as well as
- functional (manual) therapists, and
- physical therapists.
They promote foot mobility and help prevent the splayfoot from worsening.
FAQ
What symptoms does a splayfoot cause?
Typical symptoms of a splayfoot include pain in the forefoot, calluses, pressure points, and sharp pains in the area of the metatarsal heads. Hallux valgus, hammertoes, or discomfort in the metatarsophalangeal joints also frequently occur. The foot appears wider, and many people with this condition complain of foot pain when standing or walking for long periods.
How does a splayfoot develop?
Splayfoot is usually caused by a flattened transverse arch and an altered angle between the metatarsal bones. Risk factors include being overweight, weak connective tissue, improper footwear, and high-heeled shoes. Congenital foot deformities or flat feet can also contribute to the condition.
How can a splayfoot be treated?
Treatment for splayfoot begins with conservative measures. Special insoles with pads, properly fitting shoes, physical therapy, and physical therapy exercises to stabilize the foot muscles often help. Conservative therapy and treatment are intended to relieve symptoms and reduce pressure on the forefoot.
When is surgery necessary for splayfoot?
Surgical treatment becomes necessary when conservative measures are not sufficiently effective or when severe deformities are present. Surgery may be advisable, particularly in cases of hallux valgus, hammertoes, or severe inflammatory pain in the forefoot area. The goal is to permanently correct the joint, toe, and foot shape.
How can you prevent a splayfoot?
Walking barefoot, foot exercises, and wearing orthopedically appropriate footwear can help prevent it. It is also important to wear properly fitting shoes with sufficient room in the forefoot area and to engage in regular exercise to strengthen the muscles. Anyone who wants to detect a splayfoot early should pay attention to typical symptoms and initial discomfort in the foot.
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