Foot Deformities

Foot deformities are changes in the shape or alignment of the foot and toes. The common ones in adults are bunions (hallux valgus), hammer and claw toes, flat foot, high arched (cavus) foot and a stiff arthritic big toe. In children the main ones are clubfoot and flexible flat feet.

Many deformities are harmless variations that need only sensible shoes. They matter when they cause pain, rubbing and skin breakdown, difficulty finding footwear, or instability, and especially in people with diabetes, where pressure points can lead to ulcers.

Symptome

• A bony bump at the base of the big toe, with the toe drifting towards the others
• Bent smaller toes with corns on top or at the tip
• Pain under the ball of the foot (metatarsalgia)
• Collapse of the arch with pain along the inner ankle
• A very high arch with ankle sprains and pain on the outer border of the foot
• Shoes wearing unevenly or no longer fitting
• Skin calluses or ulcers over pressure points

Ursachen und Risikofaktoren

Inherited foot shape is the largest factor in bunions and flat or high arches. Narrow, high heeled shoes do not cause bunions alone but speed them up and make them hurt. Adult acquired flat foot usually follows failure of the posterior tibial tendon, more often in women over 50 and with excess weight. A high arched foot, particularly if it is getting worse or differs between sides, can signal a nerve condition such as Charcot-Marie-Tooth disease. Rheumatoid arthritis, diabetes with nerve damage, old fractures and stroke also deform feet.

Wie es diagnostiziert wird

• Clinical examination: Standing alignment, flexibility of each deformity, tendon strength, skin, pulses and sensation.
• Weight bearing X-rays: Measure angles that guide the choice of operation; non weight bearing films understate deformity.
• MRI or ultrasound: For tendon tears such as the posterior tibial tendon.
• Weight bearing CT: Three dimensional assessment of complex hindfoot deformity, where available.
• Nerve conduction studies: When a high arched foot suggests a neurological cause.

Behandlungsmöglichkeiten

• Footwear changes: Wide, deep toe box and low heel; the first and often sufficient step.
• Insoles and orthoses: Arch supports, metatarsal pads and toe spacers relieve pressure but do not correct a bunion.
• Physiotherapy: Calf stretching and tendon strengthening for early flat foot.
• Bunion surgery: Bone cuts (osteotomy) or fusion at the base of the first metatarsal to realign the toe; chosen by severity.
• Lesser toe correction: Tendon release, joint fusion or shortening osteotomy.
• Flat foot reconstruction: Tendon transfer with a heel bone shift, or fusion for rigid arthritic deformity.
• Cavus foot reconstruction: Osteotomies and tendon balancing, tailored to the cause.

Wenn es dringend ist

A hot, red, swollen foot in a person with diabetes may be infection or Charcot foot and needs same day assessment locally. So do an open ulcer with spreading redness, sudden loss of the arch with inability to stand on tiptoe, or a foot that turns cold, pale or blue.

Reisen nach Türkiye zur Behandlung

Planned forefoot and hindfoot surgery is suitable for travel if you allow time. After bunion surgery most people walk in a stiff soled shoe straight away and can fly after about 7 to 10 days, but swelling lasts 3 to 6 months. Hindfoot reconstruction means 6 weeks or more without weight on the foot, so plan help at home and local follow-up X-rays. Cosmetic foot narrowing without pain is not advised.

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