The following information does not replace a physician’s diagnosis and advice under any circumstances whatsoever.
Skew and splayfoot with fallen arches
Skew and splayfoot with fallen arches: what’s that?
A combined malalignment of the footbones is described as a skew and splayfoot with fallen arches. This malalignment may result in early osteoarthritis, inflammatory predisposition and pain in the foot, knee and back regions.
Three-in-one: the skew and splayfoot with fallen arches
As the name already says, three malalignments of the foot are jointly incurred in cases of skew and splayfoot with fallen arches.
- Illustration of a healthy foot for comparison purposes:
- Skewfoot - heel bone bending outwards 1
- Fallen arches - lowered longitudinal arch of the foot under load 2
- Splayfoot - lowered transverse arch of the foot with a wide splayed metatarsal bone 3
In colloquial language, the technical medical term “skew and splayfoot with fallen arches” is often replaced with the somewhat imprecise name “flatfoot”. However, a flatfoot is a fully decompensated skew and splayfoot with fallen arches. On the other hand, the technical term describes the malalignment at all three levels: An outward bend, lowering of the longitudinal arch and lowering of the transverse arch.1
Where does a skew and splayfoot with fallen arches come from?
A very small number of people have the inborn genetic disposition for a skew and splayfoot with fallen arches. It is normally an acquired malalignment, for example caused subsequent to insufficient development of the arch of the foot during childhood. Equally, accidents, illnesses and a lack of exercise may cause a skew and splayfoot with fallen arches.
Amongst children, skewfoot with fallen arches is a normal component of the development of the body. Therefore, the baby’s “flatfeet” cushioned with fatty tissue and the temporary skewfeet of preschool children are generally really normal as the foot arch normally only becomes stabilised at an age of eight to ten years. However, the chronological variation range here is relatively widespread.2
Amongst youths and adults, the skew and splayfoot with fallen arches often arises subsequent to weakening of foot muscle, ligaments and tendons. This can be caused by lack of exercise or also inactivation of the function of the foot in inappropriate shoes. Moreover, such foot weakness can reinforce a foot malalignment disposition.
The causes or risk factors of skew and splayfoot with fallen arches may be:1
- Excess weight: each kilo too much is an additional burden for the arch of the foot
- Unsuitable shoes: high heels reinforce the load on the forefoot and facilitate the emergence of a splayfoot
- Overburdening due to carrying heavy items and/or standing for longer periods: a lasting elongation of the ligaments fosters the lowering of the arch of the foot (e.g. work in nursing care, in the retail trade or certain handicraft trades)
- Increasing age: age-caused reduced firmness of connective tissue and the ligaments foster foot malalignment
- Hereditary weakness of the connective tissue: e.g. diseases such as Marfahn syndrome3 or Ehlers-Danlos syndrome4
- Pregnancy: hormone-caused changes to the connective tissue or weakness
Further possible causes of skew and splayfoot with fallen arches include accidents or illnesses which influence the complex interplay of bones, tendons and muscles in the arch of the foot (e.g. torn ligaments, torn tendons, tarsal tunnel syndrome, rheumatism or the tibialis posterior syndrome, i.e. an inflammation of the tendon of the posterior tibial muscle which is connected to the tarsal).
Also, various medication can weaken the tendons in the arch of the foot, thus contributing to the emergence of a skew and splayfoot with fallen arches. Moreover, the skew and splayfoot with fallen arches is incurred more frequently amongst diabetics and high blood pressure patients.
What symptoms may occur in case of skew and splayfoot with fallen arches?
Generally, a skew and splayfoot with fallen arches may cause impairments when walking, in particular when going up stairs or when walking on uneven surfaces. Also, it may cause pain, not only in the feet themselves but also in the knee, hip joint and back regions. Even headaches, neck pain and giddiness may be the result of a chain of unequal load distribution originating from a skew and splayfoot with fallen arches.1
The skew and splayfoot with fallen arches results in unequal load distribution, which may cause the following symptoms:1
- Overstrain on the inside of the foot and the ankle, “burning soles of the feet” and fast fatigue under stress.
- Emergence of pressure sores, tyloma and corns
- Emergence of hallux valgus
- Emergence of calcaneal spur
- Facilitation of swellings and signs of wear (arthrosis)
- Imbalance of the entire musculoskeletal system including knee, hip and back pain
The skew and splayfoot with fallen arches influences the statics of the entire musculoskeletal system because it subjects all the joints located above the foot and also the spinal column to unequal load distribution. As the closest joint, the knee must compensate the malposition of the foot to the greatest extent, whereby the dampening function affected due to skew and splayfoot with fallen arches causes increased knee load at the same time. The skew and splayfoot with fallen arches may also result in misalignment of the lower leg: due to the resulting malposition of the knee joint: it in-turn is unevenly strained and the articular cartilage worn on one side (arthrosis). The consequence is knee pain. Also, scoliotic postures (hyperlordosis), muscle tension as well as neck pain and headaches can be caused by a skew and splayfoot with fallen arches. As moreover the shock absorption when walking is reduced by the sunken arch of the foot, problems with the intervertebral disc may also arise.1
How is a skew and splayfoot with fallen arches diagnosed?
A physician – normally an orthopaedic specialist – can already diagnose a skew and splayfoot with fallen arches when observing the foot position accurately. However, the typical signs of the skew and splayfoot with fallen arches can also be recognised by medical laypersons when observing the rear view of the foot and based on the footprint:
- When observing the rear view of the foot, it can be recognised that “skew and splayfoot with fallen arches” feet do not stand straight, but instead show an X-position with inner ankles twisted inwards and heels pressed outwards.
- When observing the footprint of a normal foot, you see an arched L-shape on the ground. Contrary to this, the skew and splayfoot with fallen arches shows an extensive footprint with a relatively straight inside of the foot, the L-shape is virtually or fully lifted. Frequently, a ball which protrudes inwards (hallux valgus) can also be recognised.
The functional impairment of the foot can be examined in further detail using dynamic foot pressure measurement. Using this, the strength and pressure distribution on the foot during the entire period of contact to the base, i.e. from setting the heel down to heel-to-ball motion of the toes can be measured effectively. The resulting image documents produced also enable follow-up and the analysis of therapeutic success. Also the gait and walking analysis can provide valuable information for diagnosis thanks to the recording of all motion sequences.1
Can you prevent a skew and splayfoot with fallen arches?
Generally, an upright posture ensures that all motion sequences and therefore also the position of the feet is/are ideal. In case of a tendency to skew and splayfeet with fallen arches, it may make sense to control standing and walking actively – in other words to take an anatomically correct foot position – and when walking to pay special attention to the natural rolling motion of the feet.1
Also, regular training of the muscles and ligaments in the region of the feet, such as targeted foot exercises according to the Spiraldynamic® principle or walking barefoot1 can prevent malalignment of the feet.
The selection of appropriate shoes also contributes to prevention. Therefore, you should favour shoes with sufficient space for the toes, flat heels and flexible shoe soles.1,2
Body weight is a further factor. In particular if you burden your musculoskeletal system by heavy lifting and/or long standing periods during everyday work, a healthy normal weight can prevent a skew and splayfoot with fallen arches.
What therapeutic options are available for a skew and splayfoot with fallen arches?
The respective therapy is geared towards the extent of complaints and the degree of foot malalignment. Thus, in case of minor foot malalignment, no therapy is required in as far as the malalignment doesn’t cause pain or other complaints. Preventive foot exercises are recommended in all cases, whereby these should not only be carried out rigidly, but also integrated into everyday life.
If, however foot complaints and pain are incurred repeatedly or persistently or additional back complaints exist, you should consult an orthopaedic specialist. The earlier you begin treatment, the easier and the more promising the therapy. Moreover, this enables you to prevent severe follow-up damages early. Normally, a skew and splayfoot with fallen arches can be treated successfully via Spiraldynamic® exercises as well as orthopaedic insoles and supports.
In certain cases, for example irreversible malalignment, an operation may make sense.1
- Larsen, C. Gut zu Fuß ein Leben lang. 2019 Trias Verlag in Georg Thieme Verlag
- Maier, E., Killmann, M. (2003): Kinderfuß und Kinderschuh – Entwicklung der kindlichen Beine und Füße und ihre Anforderungen an fußgerechte Schuhe, München, Neuer Merkur
- Marfan-Syndrom https://flexikon.doccheck.com/de/Marfan-Syndrom#Skelettsystem (last visited on 03.09.2021)
- Ehlers-Danlos Syndrom https://flexikon.doccheck.com/de/Ehlers-Danlos-Syndrom#Gelenke (last visited on 03.09.2021)