Symptoms of Foot Damage and Common Foot Problems

Symptoms of Foot Damage and Common Foot Problems
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Symptoms of Foot Damage and Common Foot Problems/Foot deformity is a disorder of the foot that can be congenital or acquired. Such deformities can include hammer toe, club foot, flat feet, pes cavus, etc. A foot deformity is a disorder of the foot that can be congenital or acquired. Such deformities can include hammer toe, club foot, flat feet, pes cavus, etc. In its normal form, the structure of the human foot allows us to walk in an upright position. Our feet consist of bones, joints, muscles, tendons, and ligaments, which also keep everything in place. This makes them stable and strong, while at the same time being flexible and adaptable. Feet can become deformed as a result of external factors, certain foot postures or diseases. Foot deformities may – but don’t always – cause problems, such as pain and walking difficulties. There are various types of foot deformities. Some are present at birth.

Most people have slightly deformed feet. This is completely normal and usually doesn’t lead to any problems. Hardly anyone has ideal feet.

Types of Foot Deformity


  • In splayfoot, the metatarsal bones spread out and the front end of the foot becomes wider. As a result, more pressure is put on the middle bones in the forefoot. This is usually painful and can make the skin hard and thick, leading to calluses. People with splayfeet are also more likely to develop bunions (hallux valgus). This is where the first metatarsal bone moves sideways (towards the other foot) and the big toe leans in towards the neighboring toes.
Illustration: Healthy foot and splayfoot – as described in the article
Illustration: Healthy foot and bunion – as described in the article

Fallen arch / flat foot

  • In people with fallen arches, the hollow arch under the foot is flatter than usual. When standing and walking, most of the foot – from the heel to the ball of the foot touches the floor. Fallen arches can become painful after a number of years, particularly when you put your weight on them.
  • More extreme cases of fallen arches are referred to as flat feet. This is where the entire sole of the foot touches the floor. Fallen arches and flat feet usually develop over time. People are rarely born with them. The possible causes of fallen arches include weak foot muscles, the abnormal strain on the foot, unsuitable footwear and joint inflammations.
Illustration: Healthy foot, fallen arch and flat foot – as described in the article

Pronated foot

  • In this foot deformity, the heel leans inward. Pronated feet already arise in childhood, often together with a fallen arch or flat foot. But they usually only start causing problems after several decades – at around the age of 30 or 40. In people who are overweight and/or knock-kneed, the foot often remains pronated.
  • Many parents look for medical advice because they think that their child might have a flat or pronated foot. It’s normal for the soles of children’s feet to be flatter than those of adults, though. The foot arch, midfoot and hindfoot only reach their actual normal position at around the age of ten. So “flat feet” usually don’t need to be treated in children.
Illustration: Healthy foot and pronated foot – as described in the article

High-arched feet

  • As the name suggests, people with this foot deformity have an unusually high foot arch, and the upper surface of the foot (the instep) is higher than normal too. Because of this, the ball of the foot has to carry more of the weight. This can lead to pain and calluses (areas of hard, thick skin). High-arched feet are often caused by nerve problems. They increase the likelihood of ankle injuries and claw toes.
Illustration: Healthy foot and high-arched foot – as described in the article

Equinus foot

  • In equinus foot, the footpoints down and the heel can’t be lowered onto the floor because the calf muscles are too short. People who have this deformity can only walk and stand on the front and middle part of the foot, and they can’t roll the foot in a smooth heel-to-toe movement. Equinus foot may arise following brain damage that affects the communication between nerves and muscles. It can also develop in people who are bedridden for a long period of time, or who have had an injury (e.g. an ankle injury).
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  • In this severe deformity, the foot points down and inwards. It’s often only possible to stand on the outer edge of the foot, or – in extreme cases – even only on the upper surface of the foot. The person has difficulties standing and walking, their foot hurts and eventually stiffens. People who have a clubfoot are usually born with it. In those children, certain muscles don’t develop properly during pregnancy. The reason for this is often not known. Genes and developmental problems in the mother’s womb are thought to play a role. Clubfoot is more common in boys. It can occur together with a developmental problem affecting the hip (hip dysplasia).

High Arch Foot or Pes Cavus

  • In a normal foot, the gait cycle (walking) begins with the arch in a flattened position, allowing the foot to be loose enough to adapt to the terrain. When the leg is perpendicular to the ground, the arch begins to rise to allow the foot to lock and support the weight of the body as it is propelled forward. In individuals with a flat foot (pes planus), the foot stays loose and unlocked.
  • In those with a high arch (pes cavus), the arch does not flatten with weight-bearing and the foot stays locked—the foot is not flexible and thus pounds the ground as the person walks. Neurologic conditions, such as cerebral palsy and Charcot-Marie-Tooth (CMT), can result in a structurally high arched foot.

Flat Foot or Pes Planus

  • The opposite of a high arched foot is a flat foot (pes planus), which, due to its structure, is “loose.” Flat foot is among the most common structural deformities of the foot, in which the medial arch is collapsed or begins to collapse at some point.[3] This deformity can be congenital or acquired if ligaments can no longer support the foot structure because they are injured (posterior tibial tendon dysfunction) or become mal-aligned later in life.
  • For a person with a congenital foot deformity of this nature, there are increased strains on ligaments and tendons, resulting in medial arch pain and overuse injuries (eg, tibial stress fractures). Treatment requires providing support to the foot in order to control the motion of the foot. These supports may include supportive shoes, inserts, or prescription orthotic devices. In severe cases, surgical interventions may also be necessary.

Hammer Toes and Claw Toes

  • Hammertoes (shown) and claw toes are also common foot deformities named for their appearance. In a normal lesser toe (toes not including the big toe), there are three phalanges connected by two joints. When the joint closest to the foot, the proximal joint, contracts, it is referred to as a hammertoe. If the joint closer to the nail, the distal joint, is contracted, the deformity is referred to as a claw toe. In addition, there may be a rotation of the toe, referred to as an adductor varus deformity, which is commonly seen in the fourth and fifth toes.

Hallux Limitus

  • In hallux limitus, changes occur to the top of the great toe joint (metatarsophalangeal [MTP] joint) (rather than to the side, as seen in a bunion), limiting its ability to bend backward. During normal walking and lifting of the heel off the ground, the great toe dorsiflexes and the MTP joint bends. If the great toe joint is compressed, there is a reduction in the range of motion (ROM), which results in increased pressure to the top of the joint.[10] Over time, osseous changes occur, which further reduces the ROM of the great toe joint. This process can continue and result in a fusion of the great toe joint (ie, stiff big toe or hallux rigidus).

Ingrown Toenail (Onychocryptosis, Unguis Incarnatus)

  • Ingrown nails (onychocryptosis, unguis incarnatus) are most commonly seen in children and young adults, as well as in the older population.[11] In young patients, ingrown nails are usually due to inconsistent growth of the toe structures, resulting in the nail border penetrating the skin; later in life, ingrown nails are commonly seen when the bone structure changes, resulting in nail deformity.
  • Other causes include cutting a nail too short along the lateral portion, such that the nail fold is irritated or penetrated, as well as external compression from shoes that are too tight.


  • Onychomycosis is a fungal infection of the nail that is caused by an interruption of the nail plate and nail bed, allowing the fungus to grow. This is commonly seen when an injury occurs to the nail, either from repetitive trauma through athletic activities or from direct trauma, such as dropping something heavy on a toe.
  • Common nail changes seen with onychomycosis include discoloration (yellow-brown), thickening of the nail, separation of the nail from the nail bed, and debris underneath the nail.
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Plantar Wart or Plantar Verruca

Verrucous skin growths on the plantar surface are caused by the human papillomavirus (HPV) and have a few common characteristics, as follows

  • Black dots within the wart referred to as capillary budding
  • Interruption of the skin lines, where the wart appears to be separating the skin from the wart as it grows
  • More painful when squeezed, compared to direct pressure
    Calluses are commonly misdiagnosed as warts, but calluses generally appear near bony prominences, such as joints, have skin lines that go through them, and are more painful with direct pressure.
  • Plantar verrucas are usually self-limiting and can resolve without treatment. However, there are countless treatment options, ranging from duct tape and surgery to freezing, laser, and topical acids[18,19]; all of these are designed to irritate the wart, allowing the body to react to the irritant and recognize the viral infection. This condition is prevalent in children, in whom treatments have a high success rate. However, once patients are beyond the teenage years, treatment success rates are lower, and this condition may require medical and/or surgical intervention.

Subungual Exostosis

  • A subungual exostosis is a benign tumor composed of bone and cartilage that can grow out from the distal phalanx. This growth, which usually occurs underneath the nail bed, can result in a deformity to the toe. The center of the nail may lift up, leading to a pincher toenail.
  • A more distal growth can push the nail bed out from beneath the nail, giving the appearance of a skin growth below the nail plate left). When this occurs, it is commonly mistaken for a wart, and a radiographic examination of the toe is necessary to confirm the diagnosis (right).
  • The only treatment for the excessive bone growth, besides observation, is surgical removal of the lesion and curettage of the underlying bone. Subungual exostoses are usually found in children and young adolescents, whose feet and toes are still growing.

Spongiotic Dermatitis

  • Inflammatory skin conditions, including eczema, are referred to as spongiotic dermatitis, in which intercellular edema within the epidermis (spongiosis) leads to widening of the intercellular spaces between keratinocytes and elongation of the intercellular bridges, which may progress to intraepidermal vesiculation.[22] The inflammatory process evolves over time, causing the skin to become erythematous, scaly, and pruritic. In more severe cases, pustules may form.
  • Because there are many causes of spongiotic dermatitis, it is sometimes difficult to determine the exact etiology. Most often, it results from a hypersensitivity reaction. The precipitating factor can be an external exposure, such as a contact allergen (eg, detergents, soaps, shoe material), or an internal exposure, such as those relating to food (food allergies) and medications. Other factors can include insect bites or a viral or bacterial infection.


When there is an interruption of blood flow to tissues (typically via infection, vascular dysfunction, or trauma), it causes tissue death or gangrene. The three main types of gangrene are dry gangrene, followed by two infectious types, wet gangrene and gas gangrene (a subtype of wet gangrene). The foot is a common location for the occurrence of gangrene.

  • Dry gangreneDry gangrene is usually noninfectious and occurs when blood flow to a digit or limb is disrupted or suddenly stopped for example, by an arterial clot or a hypothermic injury such as frostbite (shown). Initially, the area becomes a  dusky or purplish color. Over time, the necrotic or dead tissue separates from the viable or healthy tissue, at which time a well-demarcated line divides these two types of tissue; the necrotic tissue eventually peels away, similar to a healing scab.[43] Management includes the restoration of the blood supply to the affected area. Surgical intervention is sometimes, but not always, required.
  • Wet gangrene – Wet and gas gangrene constitute medical emergencies: These rapidly spreading infections require prompt diagnosis and almost always require emergent medical and/or surgical treatment. Wet gangrene involves aggressive infection (group A beta-hemolytic streptococci, other streptococcal species, staphylococcal species[41-43]) on the surface of the skin, whereas gas gangrene involves a deeper infection within muscle fibers, in which the organism (usually, but not always, Clostridium perfringens) produces gas bubbles within the limb. Management of wet gangrene includes infection control, surgical debridement and, potentially, amputation. Hyperbaric oxygen therapy may facilitate faster-wound healing.

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Follow Chart of Foot Deformity

Diagnosis and Treatment of Foot Deformities


  • Complete evaluation of feet, knees, hips, and spine
  • Flexible vs. resistant foot deformities
    • Evaluation of foot deformities, according to whether the deformity may be corrected with active (muscular contraction) or passive (manual correction by examining physician) manipulation.
      • Resistant deformity: difficult or impossible to correct → indicates a structural abnormality 
      • Flexible deformity: may be easily corrected → indicates a muscular imbalance
  • X-ray: evaluate skeletal deformities

Basic principles of treatment

  • Correctable foot deformities – foot orthotics and manipulative treatment with casting and splinting are usually successful 
  • Resistant foot deformitiessurgical correction is usually required to reposition structures or relieve muscle contractures

Prompt treatment of congenital foot deformities is vital! Surgery may often be avoided if the manipulation is implemented correctly and consistently! If muscular imbalances are not corrected at an early age, they may result in structural deformities and often require surgery!

Clubfoot (Talipes Equinovarus)

  • Definition: Clubfoot is a complex foot deformity that is comprised of five fixed deformities.
    • Hindfoot
      • Equinus foot position: short Achilles tendon fixes the foot in plantar flexion 
      • Varus position = supination of the calcaneus
    • Forefoot
      • Adductus (Pigeon toe, false clubfoot, metatarsus adductus): medial deviation of the toes (adduction of the forefoot)
      • Supinatus: inversion of the forefoot
    • Cavus (high arch): distinct arching of the foot
  • Epidemiology
    • One of the most common congenital anomalies (∼ 1/1000 births)
    • Bilateral involvement in ∼ 50% of cases
  • Etiology
    • Congenital: most common form
    • Acquired: rare (e.g., secondary to neurological conditions or trauma)
  • Pathogenesis
    • Dominant medial musculature; posterior tibial muscle is considered to be the muscle primarily responsible for the clubfoot (→ plantar flexion and supination, particularly of the hindfoot)
    • Medial deviation of the talar neck
    • Weak peroneus muscles
    • Shortened Achilles tendon
  • Diagnostics
    • Physical examination: See “Diagnosis and treatment of foot deformities” above.
    • X-ray: The long axes of the calcaneus and talus are parallel.
  • Differential diagnosispostural clubfoot 
  • Complications: pathological strain with ulceration and early onset of arthrosis
  • Treatment
    • Manipulative treatment: the Ponseti-method (manual correction with serial casting ) should be initiated within 24 hours of birth 
    • Achilles tenotomy: the equinus foot position may be corrected by surgically by lengthening the Achilles tendon with a Z-shaped suture


Symptoms of Foot Damage and Common Foot Problems

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