yogabook / pathologie / splayfoot

splayfoot (pes transversoplanus)

Definition

Progressive divergence of the bony rays of the metatarsus with a lowered medial transverse arch of the forefoot. Physiologically, the metatarsophalangeal joint area of the 2nd toe ray is the highest of the five. With a pronounced splayfoot, all five metatarsophalangeal joint areas bear weight. High heels can increase the forefoot load fivefold and thus significantly promote the development of splayfoot. In splayfoot, not only do rays 2-4 drop, but the first metatarsal bone also rotates, including its sesamoid bones, which thus move further towards the middle of the foot. The altered force conduction favors progression. The fat pads under the foot can become inflamed and later regress, which exacerbates the progression and pain. In addition to overloading, age-related degeneration and side effects of cortisone administration are the cause of the loss of the fat pads. If attempts are made to relieve the metatarsal heads in order to flex the toes, the plantar part of the capsule is often overstretched and chronic inflammation with corresponding pain occurs. Women are affected by splayfoot much more frequently than men.

ICD M21.6, Q66.8

Cause

1. inadequate footwear, especially with heels and shoes with too rigid soles
2. Genetic predisposition to weak connective tissue

Predisposing

1. Tibialis posterior syndrome
2. standing activity
3. Overweight

Diagnosis

1. laterally emphasized wear pattern of the footwear
2. Tests and signs: Grifka test, toe displacement test

Symptoms

1. Callus and callus formation under the metatarsal heads 2-4
2. widened forefoot
3. Load-dependent metatarsalgia, especially when standing and walking/running. Improvement at rest

Complications

1. Morton neuroma
2. Bursitis
3. Metatarsalgia
4. Plantar fasciitis
5. Heel spur
6. Hallux valgus
7. Claw toes
8. Hammer toes
9. Lisfranc osteoarthritis(osteoarthritis of the joints between the tarsus and the base of the metatarsal bones)
10. Tailor’s bunion (digitus quintus varus) with painful swelling at the base of the little toe, valgus position of the 5th ray, and possibly exostosis and varus position of the little toe, which presses on the 4th toe
11. Damage due to changes in gait to avoid pain, especially gait over the outer edge of the foot, as well as damage further cranially, such as back pain, scoliosis, disc damage

Therapy

1. Walking barefoot
2. Barefoot running
3. Pad