A pointed foot is a deformity in the foot, either congenital or acquired in the course of life, in which there is an elevation of the heel which results in problems in the gait pattern and on the skeleton.
What is a pointed foot?
Pointed foot is a heel elevation so that only the ball of the foot touches the ground when walking. Pointed foot is in a permanent flexed position, which cannot be corrected even passively. The pointed foot is also called pes equinus (horse’s foot), because almost all quadrupeds walk with the ball or toe of the foot. In humans, however, the pointed foot is not physiological, since the body weight rests only on the forefoot and thus the stable stance cannot be guaranteed. Insecurity in the gait also occurs due to the non-existent rolling process.
Causes
The causes of a pointed foot can be very different. First, one can distinguish between congenital and acquired pointed foot. In the case of congenital pointed foot, for example, there is an underdevelopment of the lower leg or also a bad posture in the womb. In this case, the pointed foot is also called clubfoot. However, pointed foot usually develops after birth, for example due to polio, a disorder of the nervous system, after an injury to the ankle joint (resulting in a shortened Achilles tendon), or due to mechanical causes such as prolonged bedriddenness. Most often, however, there is impaired nerve function, so that the calf muscles are shortened or the nerves are paralyzed. Habitual pointed toe is when children walk too frequently on their toes while learning to walk.
Symptoms, complaints and signs
The elevation of the heel in a pointed foot is usually visible to the naked eye. Affected children walk predominantly or entirely on their toes and cannot roll their foot starting from the heel. The calf muscles may appear significantly shortened and it is not possible to press the heel to the ground while standing. Pointed toe often manifests in bedridden individuals. Just by the pressure of the bed cover on the toes and the forefoot, the foot is brought more and more into flexion. After some time, those affected can no longer actively bring the foot to a 90° angle to the lower leg. The calf muscles and the Achilles tendon visibly shorten. The discomfort is therefore most noticeable when walking and standing. Depending on the severity of the pointed foot, those affected can only walk with a toe gait, or can no longer walk due to the deformity. Calluses on the ball of the foot are also a clear sign of a pointed foot, since the entire body weight rests on this small area. With longer existing pointed foot, can be added by the changed gait pattern a curvature at the spine.
Diagnosis and progression
The diagnosis of a pointed foot is not very difficult, because the deformity is very noticeable even to a layman. The gait is also examined by the doctor during the examination, as well as the passive movement of the foot. However, to find the exact cause one needs diagnostic tools such as X-ray, electromyography or muscle biopsies (removal of tissue). Not only the foot, but also the other joints of the lower extremity and the spine are examined to determine the effects of a pointed foot. The course of Spitzfoot depends on the cause, for example, habitual Spitzfoot still has a good prognosis in childhood, it often regresses itself as it grows. However, in other types of pointed foot, the course is somewhat more extensive and longer; in most cases, it cannot be completely regressed. The result is problems in the knee, pelvis, and spine.
Complications
The gait pattern that is altered in Spitz foot can lead to further deformities. In the long term, this can lead to joint wear, arthritic diseases and other complications of the bones and joints. Often, visible calluses form on the feet due to the unusual gait. These are usually associated with severe pain and a feeling of pressure and can rarely develop into abscesses or serious inflammations. In the long term, the high load on the knee joint causes arthritic joint changes. In children, the spine may become curved in the lumbar region and the hip may become displaced. This results in functional poor posture. This is often accompanied by chronic pain.These also place a long-term psychological burden on the person affected and can trigger depression, for example. Surgical intervention can be associated with nerve damage, bleeding and inflammation. After the operation, there may be wound healing problems, secondary bleeding and excessive scarring. The use of pain medications can cause side effects, interactions and allergic reactions in some patients. If used incorrectly, orthopedic devices may also trigger complications in some circumstances, exacerbating the underlying condition in many cases.
When should you see a doctor?
A physician should be consulted as soon as there is any irregularity in locomotion. If children or adults can be observed walking only on tiptoe, clarification of the cause is advisable. Normally, the foot is placed with the heel during locomotion and then the foot is rolled over the heel to the toes. This is a natural movement. If the sequence of walking or running is different, it should be discussed with a medical professional. Permanent impairments of the skeletal system can occur and should be prevented. If muscular complaints, pain or malpositions occur, an examination and the preparation of a treatment plan should take place. If the spine is curved or the overall gait pattern is altered, the affected person needs medical help. If locomotion is difficult, costs the affected person a lot of strength, or if there is rapid fatigue, the observations should be discussed with a physician. If sporting activities cannot be carried out as usual due to the symptoms, a visit to the doctor is necessary. A decrease in physical resilience or psychological problems are also reasons for which a causal investigation should be carried out. In the case of joint problems, swelling in the feet or an unpleasant feeling of pressure in the calves, there is a need for action.
Treatment and therapy
Treatment for a pointed foot also depends on the cause and especially the severity. If there is no shortening of the calf muscles, simple but consistent active movements can alleviate the pointed foot. This is done through physical therapy. Often patients are given a lower leg standing cast, which stabilizes the foot and is designed to return the foot to its normal position over several weeks. Rarely is surgery performed for a pointed foot, only when the Achilles tendon needs to be lengthened due to excessive shortening. Mostly, this surgery is successful in children; in adults, joint fusion of the upper ankle is performed in the worst case, when the cartilage is already badly worn. In addition, pointed foot can be treated with orthopedic shoes.
Prevention
Pointed foot can be actively prevented in any case. For example, even if the patient is bedridden for a long time, the foot can be fixed in the normal position by sufficient positioning at the foot end. Physiotherapy is necessary to stretch the shortened muscles, both actively and passively. Except in case of Achilles tendon rupture, it is important that if the foot is injured, it should also be fixed in the neutral position to avoid pointed foot. After a rupture of the Achilles tendon, proper physical therapy is especially important to return the foot to the correct position and avoid getting a permanent pointed foot. Here, stretching the calf muscles is also the most important component.
Aftercare
After treatment of a pointed foot, comprehensive aftercare by a specialist is necessary, especially after surgery or prolonged physical therapy. Follow-up care includes a physical examination and a discussion with the patient. During the physical examination, the orthopedist checks to see if the foot is healing properly. If necessary, an x-ray is taken or another imaging procedure is used to accurately determine the health of the affected foot. After a surgical procedure, it is important to check the surgical wounds. If necessary, the prescribed painkillers and anti-inflammatory drugs must also be readjusted. Various medications must be phased out slowly. This should be monitored by the primary care physician to minimize side effects as much as possible. The pointed foot follow-up itself is usually carried out by the orthopedist who was already responsible for treating the deformity.If complications persist, other physicians may be involved in the treatment. Provided no complications or other abnormalities are noted, treatment is completed. The patient should consult the orthopedist once every six months to ensure that the pointed foot does not return and that no other complaints occur. In case of pain in the feet and other problems, the doctor in charge should be informed.
This is what you can do yourself
To avoid accidents or other complications, the feet and movements should be exercised daily. Especially when bedridden, it is particularly important to tense the muscles and perform movements. This can be done by anyone independently, no instructions or guidelines are needed. The joint activity is also to be used daily, so that impairments and disturbances can be avoided. It is especially important to pay attention to the organism’s instructions when moving. Hectic movements are to be avoided. In addition, it should be refrained from exposing the body to too strong physical loads. If locomotion is impaired following illness, a fall or an accident, special care should be taken during the healing process. Overstraining can lead to secondary diseases. If a physiotherapeutic treatment takes place, the techniques and training learned there can also be carried out independently outside the sessions. In addition, appropriate footwear should be worn. High heels are not advisable and the shoes should correspond to the size of the foot. Otherwise, the risk of accidents during locomotion increases. In order not to build up additional burdens for the organism, excess weight should be avoided. This has a very strong effect on the feet and leads to pain. As soon as the affected person notices disturbances in locomotion, he should take breaks in time.
