If the shoe does not fit the instep

hollow foot

What is that?

A hollow foot is a congenital or acquired deformity of the foot in which the plantar fascia and extensors contract. The plantar fascia and extensors are each a tendon and various muscles that are located on the bottom of the foot and provide support and stability. If these two components shorten, the bones of the foot are compressed upwards and the sole of the foot becomes arched. 

How does this manifest itself?

A hollow foot can remain undetected for a long time, especially in childhood when the feet grow rapidly. The first pain often only occurs when the shape of the foot has changed permanently. Young patients can initially compensate for this misalignment with their own muscle strength, but later they usually complain of pain in the balls of their feet. The pain points are mainly in the area of the big and little toes, as this is where the greatest strain is when walking. Patients develop a Metatarsalgia.

Patients with forefoot pain often experience increasing wear on the outer edges of their shoes. The patient tries to "avoid" the pain when walking and uses the outside of the foot more. 

Where does it come from?

The hollow foot develops during the growth phase. The various muscles and tendons on the bottom of the foot grow more slowly than on the top. Neurological disorders can also cause these symptoms because the nerves cannot properly control the tendons and muscles on the bottom of the foot. This severely limits the stabilization function. 

What happens if I don’t act here?

Common accompanying diseases of the hollow foot are inflammation of the Plantar fascia, overloading of the outer edge of the foot and pain in the forefoot area – the so-called Metatarsalgia In the case of a hollow foot, the plantar fascia is more tense than in a healthy foot due to the shape of the foot, which creates more tension at the attachment point - the heel bone. Since the main load when walking is on the heel and forefoot, inflammation of the metatarsal heads often occurs. 

Due to the high metatarsal bones, metatarsal arthrosis can develop in the long term.

How do I find out if I have something like this?

A simple self-test is, for example, to step on a smooth surface with wet feet. This allows you to see exactly whether the inner arch is filled or not. If the forefoot and heel are clearly visible in the print, but the middle of the foot is not, then this is an indication of a hollow foot. 

A clinical examination by a doctor provides reliable information. This examines what type of limitation is present and how advanced it is. The type of limitation, i.e. whether the deformation is fixed or flexible, can provide clues as to whether there is a muscular maldevelopment or an underlying neurological disease. An X-ray is often taken to better assess the progression of the deformation and to be able to adapt the therapy accordingly. 

How do you treat this?

The aim of treating hollow feet is to stretch the longitudinal arch, support the transverse arch of the forefoot and relieve the heel. Individually adapted insoles stretch the longitudinal arch. The forefoot and heel can be relieved using appropriate pads and cushions and, if necessary, a toe bar can reduce the tension on the Achilles tendon.

Additional stretching exercises and fascia treatments support the correction of the hollow foot.