The hollow foot (lat. Pes excavatus) is a congenital or acquired foot deformation. Recognizable is the hollow foot, by a raised arch, which makes it the exact opposite of the flat foot.
What is a hollow foot?
Due to an elevation of the longitudinal arch of the foot, the pressure generated during walking and standing is not evenly distributed on the foot. Depending on whether the body load due to the high arch is more on the ball of the foot or on the heel, a distinction is made between high arch and high heel, with high heel occurring far less frequently. As a result, pressure points develop on the back of the foot, ball of the foot and toes, which manifest themselves as foot pain for those affected. Due to this foot pain in the hollow foot, there are restrictions in the movement of the foot and problems during walking. This results in an increased risk of falls and sprains. The deformity makes the foot feel rather stiff and awkward, as do the toes, which additionally appear curved. Another problem for people who suffer from a hollow foot is premature wear and tear of shoes influenced by the foot position.
Causes
There are several possible causes that can be decisive for a hollow foot. First possibility, and at the same time the most common, is a congenital hollow foot, which can be detected at birth. However, the foot deformity can also occur as a result of a disease. Possible causes are paralysis (especially in the small muscles of the foot), diseases of the nervous system, other nerve damage, muscle weakness, ligament weakness or spinal cord tumors. These diseases cause an excessive longitudinal arching of the foot, which puts unnatural stress on the foot. Another cause, especially in the case of weaker hollow feet, is wearing tight shoes with too high heels. However, it can also happen that the reason for the change in the shape of the foot cannot be determined. In this case, the condition is called idiopathic hollow foot (idiopathic = without an identifiable cause).
Symptoms, complaints, and signs
Schematic diagram showing the anatomy of the foot in comparison with a normal foot, flat foot and high arch. A hollow foot is manifested by a foot malposition, which can usually be seen from the outside. The longitudinal arch of the affected foot is greatly elevated, making the foot shorter and stockier. A hollow foot often occurs with an inward heel as well as hammertoes and claws. Due to the malposition of the foot, the foot’s appearance is also altered: The heel and forefoot bear the entire body load. This incorrect loading leads to the typical complaints of a hollow foot. The excessive stress on the foot causes severe pain and leads to the formation of calluses in the long term. Depending on the cause, a high arch can change over the years. The symptoms usually increase gradually and are often only noticed when the deformity is already far advanced. Complaints occur mainly when wearing shoes – then there are stabbing pains, feelings of pressure and gait disturbances. People with hollow feet show an unsteady gait and often twist their ankles, which repeatedly leads to injuries. If the hollow foot remains untreated, other health problems can develop from the avoidance behavior, such as premature joint wear, malpositioned ankles and nerve pain. As the deformity progresses, corns usually form on the toes as well.
Diagnosis and progression
Hollow foot is usually discovered during a physical examination, as it is already visible to the naked eye in a pronounced form. However, it can be determined with certainty on the basis of the footprint. The extent of a hollow foot is usually determined by doctors using X-rays. Characteristics to recognize a foot deformity are, for example, an unsteady gait, easier twisting, increased falls, sprains or corns on the toes. Due to the higher load on the forefoot and heel area, which is caused by standing and walking for a long time, pain can also occur in the metatarsus if splayfoot exists at the same time. Another indication can be pain in the heel. These usually come from inflammation, which can be caused by the deformed position of the hollow foot.
Complications
Hollow foot causes the patient to experience various discomforts and limitations that affect running and walking.In most cases, those affected suffer from a so-called hammer toe and corns. These complaints usually lead to severe pain, which occurs primarily when walking. This pain leads to considerable movement restrictions, which make everyday life even more difficult. The entire foot musculature is restricted and paralyzed by the hollow foot, so that no sporting activities are possible for the patient. Due to the permanent incorrect loading of the high arch, severe pain occurs, which can also occur in the form of pain at rest. The pain at rest can lead to sleep problems at night and cause depression. The diagnosis of high arch is usually relatively simple, so that early treatment can be initiated. In most cases, treatment takes place with the help of insoles and therapies. This can alleviate most of the symptoms and prevent further complications. In severe cases, surgical interventions can also be performed. Life expectancy is not affected by high arch.
When should you go to the doctor?
A mild hollow foot does not necessarily need to be treated as long as it does not cause any discomfort. However, if accompanying the deformity are pressure points, calluses or corns and the foot hurts regularly, it is best to see an orthopedist. An indication of a hollow foot can be a weakly developed or weakened foot musculature. In the case of a severely pronounced hollow foot, it is always advisable to have it examined by a specialist, preferably an orthopedist, because he or she can best decide which therapeutic measures are necessary to correct it and how the discomfort caused by the deformity can be most sensibly alleviated. In the case of an advanced deformity such as hammer toes and claw toes, physiotherapeutic measures are usually required, usually in the form of stretching exercises, so that the deformity does not worsen. If left untreated, a hollow foot usually worsens over the years, and discomfort sets in peu à peu, making it increasingly difficult to wear shoes. At this point at the latest, a visit to the orthopedist can usually no longer be avoided because of the pressure of suffering. However, it is better to see a doctor beforehand so that such complaints do not arise in the first place.
Treatment and therapy
Depending on the degree of deformity, there are different types of treatment for patients with a hollow foot. The degree to which the hollow foot is already pronounced is usually determined by X-rays. In lighter cases, modeled shoe inserts that support the foot are usually sufficient. This distributes the pressure and relieves the heavily stressed areas, such as the ball of the foot and the heel. In addition, it is advisable to wear a so-called night splint, which fixes and stabilizes the foot during the night. To maintain further stability and reduce the risk of twisting, it is recommended to wear shoes with a high shaft. It is also often necessary for people with hollow foot to have special orthopedic shoes made for them. If the deformation of the foot is already advanced, it is necessary to undergo physiotherapeutic treatment. Movement and stretching exercises under guidance often positively influence the course of the foot deformity. Gymnastics and appropriate exercises can perfectly complement orthopedic treatment. For patients with far advanced hollow foot, there is also the option of having the foot surgically straightened.
Outlook and prognosis
Hollow foot generally promises a good prognosis. If the necessary treatment steps are taken early, the deformity can often be corrected before permanent damage to the ankle and tendons has occurred. Early diagnosis and treatment is necessary to prevent further deterioration of the deformity. If the hollow foot is detected in time, it can be corrected by surgical, orthopedic and physiotherapeutic measures. Although a hollow foot can rarely be completely corrected, the discomfort is marginal and the prognosis is accordingly positive. However, if the deformity is not treated, it progresses and eventually leads to deformity of the toes and ankle. Then the movement restrictions and pain become more severe, which is always associated with a decrease in the quality of life.A congenital hollow foot must be treated immediately after birth to ensure a positive prognosis. An acquired high arch usually develops in conjunction with other deformities and physical ailments, which is why even early therapy cannot guarantee a symptom-free life. Patients usually have to perform physiotherapy exercises and take pain medication for the rest of their lives. In addition, the deformity can recur and cause discomfort that must be treated surgically.
Prevention
Because high arch is either congenital or a result of another condition, there is no way to prevent it. However, with early diagnosis and timely treatment, the course of the deformity can be positively influenced.
Aftercare
In most cases of high arch, the affected person has very few options for direct aftercare. In this regard, affected individuals are primarily dependent on early detection and treatment to prevent further complications or further worsening of symptoms. In general, early diagnosis has a very positive effect on the further course of the disease. Affected individuals should contact a physician at the first symptoms and signs of the disease. In most cases, a hollow foot is compensated by wearing and using shoe inserts. Affected persons should wear these insoles permanently and not skip them. Especially in the case of children, parents must control the wearing. Furthermore, the insoles must be adjusted to the foot as the child grows. Likewise, wearing special orthopedic shoes can also alleviate the symptoms of the disease. In many cases, sufferers of high arches are also dependent on physiotherapy measures. In this context, many of the exercises can also be performed in the patient’s own home, thus accelerating the treatment. As a rule, the life expectancy of those affected is not reduced by the hollow foot.
What you can do yourself
A hollow foot should definitely be presented to a specialist, preferably an orthopedist, even if it does not yet cause any symptoms. However, patients can also do their own part to prevent a high arch or halt the progression of the condition. In mild cases, it already helps if the affected person consistently wears special insoles that support and relieve the foot. The insoles distribute the pressure over the entire foot so that otherwise overly stressed areas such as the ball of the foot and heels are relieved. A sleep splint that stabilizes the foot during the night can further increase the positive effect of the insoles. Affected persons who tend to twist their ankles due to their hollow foot can reduce this risk by wearing boots or half-height shoes with an upper. Those who twist their ankles very frequently should also consider special orthopedic shoes, which can be adapted to the individual degree of the disorder and thus prevent this problem. Moreover, the progression of the deformity can be prevented or at least delayed by physiotherapeutic treatment started in time. In many cases, the special physiotherapeutic exercises can even help to reverse the deformity. However, this requires regular training under the guidance of a physiotherapist experienced in the therapy of the disorder. Blisters, pressure sores, fissures and other lesions should be treated promptly, which they can otherwise trigger additional foot pain.