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Hollow Foot

Generality

The hollow foot is an anatomical malformation, in the presence of which a person's feet have a higher medial arch than the norm.

The presence of cavus implies a modification of the support on the ground and a different distribution of body weight on the feet.

Of congenital or acquired origin, the hollow foot can be considered the opposite condition to the so-called flat feet.

When present, the most common symptoms consist of: pain in the feet, pain in the ankles, instability of the ankles and the presence of hammer toes or hooked fingers.

For a correct diagnosis, physical examination and medical history are often sufficient.

Depending on the severity of the symptomatology, the treatment can be conservative or surgical.

A brief reference to what the medial arch is

As you can see from the image below, the feet of the human being have, on the inner edge, a raised area that is detached from the support with the ground. This raised area is called the medial arch or internal longitudinal arch .

The height of the medial arch - ie how far the raised area comes off the ground - varies from person to person.

What is the hollow foot?

The hollow foot is an anatomical deformity, in the presence of which an individual's feet have an excessively high arch.

The presence of a medial plantar arch higher than the norm modifies the support of the feet on the ground: if in people with feet without anomalies, the support affects the heel, the central external part and the front part (where the fingers reside ), in people with a hollow foot the support affects only the heel and the front area.

This anomaly of the support on the ground redistributes the body weight, which, instead of weighing on three parts (heel, external central part and front area), concentrates only on the areas resting on the ground, ie heel and front portion.

It is important to point out that the hollow foot is the result not only of an elevation of the internal anatomical structures that form the medial arch, but also of an accentuated downward bending of the front area of ​​the feet, in particular the area corresponding to the first finger (or big toe).

Furthermore, many people with hollow feet present problems at the level of the calf muscles and the two Achilles tendons (NB: the Achilles tendon is that important fibrous structure that connects the calf muscles to the calcaneus, ie the bone that constitutes the heel).

IT IS THE CONTRARY OF THE FLAT FEET

The hollow foot is the opposite condition to the flat foot (or flat feet ).

With the term flat foot, doctors identify an anatomical malformation for which an individual's feet have a lower than normal or completely absent medial arch.

In people with flat feet, therefore, the central inner part of the feet rests completely on the ground: this alters the distribution of body weight on the feet and predisposes the latter to painful and degenerative phenomena of the joints, muscles, bones and ligaments .

Causes

The hollow foot can be:

  • A congenital condition, transmitted by one of the parents as a somatic feature;
  • An adaptive condition, following the presence of certain favoring factors;
  • An idiopathic condition. In medicine, the term idiopathic, associated with the name of a pathology, indicates that the latter has arisen for unknown or unidentifiable reasons.

ADAPTIVE CABLE FOOT: THE CAUSES

The possible factors favoring the adaptive hollow foot include:

  • Some progressive neurological pathologies, such as Charcot-Marie-Tooth syndrome, Friedreich's ataxia, hereditary autonomic and sensory neuropathy, spinal tumors, brain tumors, spinal traumas, syringomyelia or muscular dystrophy;
  • Some neurological pathologies of a static nature, such as cerebral palsy, stroke, poliomyelitis, injuries to spinal nerve roots or lesions affecting the peroneal nerve;
  • Traumas in the feet or ankles;
  • Tendon injuries, such as achilles tendon rupture;
  • Rheumatoid arthritis;
  • Gout;
  • The persistent use of inadequate footwear.

EPIDEMIOLGIA

Hollow foot is a more common condition in the female population than in the male.

According to Anglo-Saxon research, one case of hollow foot out of 5 is idiopathic.

Symptoms and Complications

To learn more: Symptoms Hollow Foot

The presence of the hollow foot can be asymptomatic - therefore not involving any disturbance - or symptomatic.

When the hollow foot is symptomatic, the symptoms may consist of:

  • Pain or discomfort in the feet, especially on the sides or the metatarsal area;
  • Ankle pain;
  • Ankle instability. This predisposes to repeated distortions (of the ankles of course);
  • Sense of stiffness and / or insensitivity to the feet or ankles;
  • Difficulty standing up for many hours, walking for long stretches or running. In these situations, the difficulties are due to the painful, intensifying sensation;
  • Presence of hooked fingers or hammer toes;
  • Appearance of calluses in some specific areas of the feet, such as the heel, the outer edges or the metatarsal area.

COMPLICATIONS

In some unfortunate circumstances, flat feet can lead to complications.

The most common complications of the flat foot are: the so-called peroneal tendinitis (or peroneal tendinitis), problems with the Achilles tendon (eg: rupture), plantar fasciitis or the so-called ankle conflict syndrome .

It is also important to remember that progressive neurological diseases are often responsible for:

  • An increasing deterioration of the hollow foot e
  • The appearance of a particular painful sensation, known as neuropathic pain .

WHEN TO REFER TO THE DOCTOR?

An individual with a hound foot should contact their doctor when:

  • The feet or ankles are particularly painful;
  • Sprains in the ankles are very frequent;
  • Conditions such as the hooked finger or the hammer toe are present;
  • There are symptoms and / or signs of one of the aforementioned complications;
  • Feet and / or ankles give the feeling of being weak, stiff and numb;
  • Standing for many hours, walking for a long time or running is the cause of extreme pain.

Very often, it is also essential to consult a podiatra, ie a foot disease specialist, and an orthopedist, that is a doctor who specializes in the diagnosis, treatment and prevention of pathologies of the complex system of muscles, bones, tendons, ligaments and nerves, present in the human body.

Diagnosis

Physical examination and medical history are sufficient for a diagnosis of hollow foot.

In general, the use of further and more in-depth diagnostic tests takes place on two occasions: when doctors suspect that the hollow foot is due to a neurological pathology or when the symptomatology is very severe.

Among the diagnostic tests useful for an in-depth study, special mention should be made of: X-rays, nuclear magnetic resonance (NMR) of the brain and spinal cord and electromyography.

Accurate diagnosis of the hollow foot and its causes is essential for planning the most appropriate therapy.

OBJECTIVE AND ANAMNESIS EXAMINATION

The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of signs indicative of an abnormal condition. In the presence of a suspected cavus condition, the doctor observes the patient's feet from the front, from behind and during a walk.

The anamnesis is the collection and critical study of symptoms and facts of medical interest, reported by the patient or his family members (NB: family members are involved, above all, when the patient is very small).

X-RAY

X-rays on the feet produce images on the radiographic "plate" of bones and joints, present in the feet. They are very useful for identifying the precise skeletal anatomy of the feet and their health status.

The use of X-rays involves exposing the patient to a small amount of ionizing radiation that is harmful to human health. In all other respects, X-rays represent a painless test.

NUCLEAR MAGNETIC RESONANCE (RMN)

Through the execution of a nuclear magnetic resonance of the brain and spinal cord, doctors investigate the presence of neurological diseases or disorders, such as spina bifida, spinal tumors, brain tumors, etc.

Taking advantage of an instrument that creates magnetic fields, nuclear magnetic resonance provides detailed images of the soft tissues and hard tissues present in the human body.

In addition to being painless, it is also a completely non-invasive test: in fact, the magnetic fields, which are used to create the images, are completely without danger to the health of the human being.

ELECTROMYOGRAPHY

Electromyography is a diagnostic procedure aimed at assessing the state of health of the muscles and nerve cells that control the latter, or so-called motoneurons.

The use of an examination such as electromyography is useful when there is a neurological disorder or disorder at the origin of the cavus, which is reflected in the muscles.

A low-risk procedure with reduced adverse effects, electromyography is contraindicated for people with a pacemaker or an implantable cardiac defibrillator and for all those who suffer from lymphedema or haemophilia.

Treatment

Treatment of the hollow foot depends on at least three factors:

  • Favorable causes / factors. In some circumstances, treating the causes is essential to avoid a worsening of the hollow foot;
  • The severity of symptoms. The more severe the symptoms, the greater the likelihood of having to resort to invasive treatment;
  • The rapidity with which the condition of cavus has been established and induced the appearance of disorders. If the hollow foot appears suddenly, it is a source of concern and requires more attention from a therapeutic point of view.

Depending on what the causes are, the severity of the symptoms and the rapidity of onset of the condition, treating doctors can opt for a non-surgical (or conservative ) therapy or a surgical therapy .

If the hollow foot is asymptomatic, no treatment is foreseen.

NON-SURGICAL THERAPY (OR CONSERVATIVE)

Non-surgical (or conservative) therapy is a remedy to alleviate the symptoms and is not a cure for the hollow foot.

The most common conservative treatments, which can be used in case of hollow foot, consist of:

  • Use of plantar orthotics or lifts, to be included in footwear. Modeled on the patient's foot, foot orthoses and lifts guarantee a better impact with the ground, a better distribution of body weight on the feet and greater stability to the ankle joint. All this should reduce pain and the risk of distortions;
  • Stretching exercises (or muscle stretching) and strengthening for all leg muscles that refer to the Achilles tendon;
  • Use of shoes suitable for the condition of hollow foot . These shoes guarantee a better distribution of body weight on the feet, so the pain should be reduced;
  • The administration of pain - relieving drugs, to reduce the painful sensation;
  • Physiotherapy exercises for the improvement of walking technique and running technique. In general, doctors subject patients who practice sports - including, in particular, running, running, walking, etc. - to this type of treatment with a certain continuity;
  • A period of rest from all those activities that favor the appearance of pain (eg: running, long walks etc.). Alternatively, doctors recommend cycling or swimming.

SURGICAL THERAPY

Physicians consider surgery for the hollow foot when conservative therapy has proved ineffective (or has not provided the desired results) and the symptoms are very intense.

In general, the objectives of surgery are: to correct deformity as much as possible, to relieve the painful sensation, to preserve the ankle from (further) distortions and to improve the ground support of the feet.

There are three types of surgery:

  • Operations reserved for soft tissues . This type of procedure includes surgical elongation of the Achilles tendon, surgical distension of the plantar fascia and tendon transfers.
  • Osteotomy operations . They consist in the removal of bone portions, in order to reduce deformity. The bones on which the surgeon can act are, for example, the metatarsals or the calcaneus.
  • Arthrodesis operations, for joint stabilization. They are useful for all those patients who suffer from repeated ankle sprains.

The choice of the type of surgery is, of course, up to the attending surgeon and depends on the nature of the deformity.

If at the origin of the problem there is some progressive neurological pathology, a single operation of a hollow foot may not be sufficient.

Prevention

Practicing physical activity consistently (this safeguards against injuries) and wearing comfortable and well-made footwear (especially during exercise) are the main preventive measures against the hollow foot.

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