Foot Deformity

Foot deformities affect millions of people worldwide, ranging from mild structural changes that cause no problems to severe conditions that make walking difficult and painful. Understanding these conditions and knowing when to seek help can make the difference between managing symptoms conservatively and requiring surgery.

Table of contents

• What Are Foot Deformities?
• Understanding Normal Foot Structure
• Common Types of Foot Deformities
• What Causes Foot Deformities?
• Signs and Symptoms
• How Foot Deformities Are Diagnosed
• Treatment Options
• When Surgery Is Needed
• Foot Deformities in Children

What Are Foot Deformities?

A foot deformity is an abnormal change in the shape, structure, or position of the foot. These conditions can affect bones, joints, tendons, or muscles, altering how the foot looks and functions^[1]. Foot deformities represent a broad group of conditions that include both congenital deformities (present at birth) and acquired deformities (developing over time)^[2].

Most people have slightly deformed feet, which is completely normal and usually doesn’t lead to any problems. Hardly anyone has “ideal” feet^[1]. The key distinction is whether the deformity causes pain, affects your ability to walk, or creates other health problems.

Understanding Normal Foot Structure

The human foot is remarkably complex, containing 26 bones, 33 joints, and more than 100 muscles and tendons^[20]. In its normal form, this structure allows us to walk upright, maintain balance, and adapt to different surfaces^[1]. The bones, joints, muscles, tendons, and ligaments work together to make feet both stable and strong, while also being flexible and adaptable.

The foot naturally has an arch that helps cushion the weight of each step and provides a “spring” when you push off the ground^[8]. When this structure changes due to injury, disease, or wear and tear, a deformity may develop.

Common Types of Foot Deformities

There are many different types of foot deformities, each affecting different parts of the foot in unique ways. Understanding the most common types can help you recognize potential problems early.

Clubfoot

Clubfoot is a complex congenital foot deformity where the foot points downward and inward^[4]. The condition affects both feet in 50% of cases^[4]. In clubfoot, the heel points down (equinus position) and turns inward (varus position), while the front of the foot also turns inward (adductus)^[4]. The Achilles tendon is shortened, and there is limited ability to move the foot upward^[4].

Flat Feet (Fallen Arches)

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^[1]. Fallen arches can become painful after a number of years, particularly when you put weight on them. More extreme cases are referred to as flat feet, where the entire sole of the foot touches the floor^[1].

Fallen arches and flat feet usually develop over time. People are rarely born with them^[1]. The possible causes include weak foot muscles, abnormal strain on the foot, unsuitable footwear, and joint inflammation.

High-Arched Feet (Cavus Foot)

People with this foot deformity have an unusually high foot arch, and the upper surface of the foot (the instep) is higher than normal^[1]. Because of this, the ball of the foot has to carry more of the weight, which can lead to pain and calluses (areas of hard, thick skin). High-arched feet are often caused by nerve problems and increase the likelihood of ankle injuries and claw toes^[1].

High arch feet cause the foot to bear weight abnormally on the ball and heel rather than distributing weight across the entire foot^[2]. This condition can be associated with neurological illnesses such as cerebral palsy, spina bifida, or muscular dystrophy^[2].

Splayfoot

In splayfoot, the metatarsal bones (the long bones in the middle part of the foot) 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^[1]. This is usually painful and can make the skin hard and thick, leading to calluses. People with splayfoot are also more likely to develop bunions.

Bunions (Hallux Valgus)

A bunion is a painful lump that forms at the base of the big toe on the inside of the foot^[2]. In this condition, the first metatarsal bone moves sideways toward the other foot, and the big toe leans in toward the neighboring toes^[1]. Standing for long periods and wearing narrow shoes worsens the pain from a bunion^[2].

Approximately 87 percent of American adults suffer from painful feet at some point in their life, and bunions are among the most common foot conditions^[2].

Hammertoes, Mallet Toes, and Claw Toes

These related conditions all feature toes that get “stuck” in a bent position at one or more of their joints^[8]. Hammertoes bend at the middle joint, making the toe curl downward like a hammer. At first, you can usually still move the toes with your fingers, but in time the digits become much more rigid and painful^[8].

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^[1]. They usually only start causing problems after several decades—at around the age of 30 or 40. In people who are overweight or have knock-knees, the foot often remains pronated.

Equinus Foot

In equinus foot, the foot points 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^[1]. Equinus foot may arise following brain damage.

Metatarsus Adductus

This condition involves the front of the foot turning inward. It is the most common cause of in-toeing in children under 1 year of age^[4]. The condition is associated with hip problems and may be flexible or rigid. In more than 95% of cases, metatarsus adductus resolves on its own within the first 18 months of life^[4].

Charcot Foot

Charcot foot is a very serious condition usually experienced by people with diabetes who have severe nerve damage. If you’ve experienced significant circulation reduction and nerve damage in your feet, your bones and joints may become very weak and brittle, and you may not be able to feel when they’ve broken^[8]. Over time, this can lead to severe collapse and deformity in one or both feet.

What Causes Foot Deformities?

Feet can become deformed as a result of external factors, certain foot postures, or diseases^[1]. Understanding the causes helps in both prevention and treatment.

Congenital Causes

Some deformities are present at birth and passed on through genes^[5]. Clubfoot and some cases of high arches or fused bones between toes are examples of congenital foot deformities.

Acquired Causes

Many foot deformities develop over time due to:

• Injuries: A broken toe or foot can lead to certain conditions, such as hammertoe^[5]
• Lifestyle factors: Ill-fitting footwear or gaining weight quickly can contribute to deformities^[5]
• Nerve damage: Conditions such as Charcot-Marie-Tooth disease can cause nerve damage which often leads to foot deformities such as hammertoes and high arches^[5]
• Weak foot muscles, abnormal strain on the foot, unsuitable footwear, and joint inflammation^[1]
• Wear and tear over time, particularly in conditions like bunions and fallen arches

Signs and Symptoms

Foot deformities may—but don’t always—cause problems, such as pain and walking difficulties^[1]. Some deformities are easy to spot through visible changes, while others cause symptoms that affect daily life.

Common signs and symptoms include:

• Foot pain or joint pain^[5]
• Limited mobility^[5]
• Visible misalignment of bones or joints
• Swelling or redness
• Difficulty wearing shoes or finding shoes that fit^[8]
• Difficulty walking^[5]
• Calluses or areas of hard, thick skin where pressure is concentrated^[1]
• Problems with balance
• Pain in the knees, hips, or back due to poor posture and alignment^[8]

How Foot Deformities Are Diagnosed

Diagnosis begins with a thorough examination by a healthcare professional. The process typically includes:

A complete evaluation of your feet, knees, hips, and spine to understand how the deformity affects your whole body^[4]. Your doctor will review your symptoms and medical history, examine your feet, and evaluate how you walk (gait analysis)^[6].

An important part of the examination is determining whether the deformity is flexible or resistant. A flexible deformity can be easily corrected with active muscle contraction or passive manual correction by the examining doctor, indicating a muscular imbalance. A resistant deformity is difficult or impossible to correct, indicating a structural abnormality^[4].

X-rays are commonly used to evaluate skeletal deformities and confirm the clinical diagnosis^[4]. Your healthcare provider may also request additional imaging tests to better understand your foot deformity.

For children, it’s important to note that it’s normal for the soles of children’s feet to be flatter than those of adults. The foot arch, midfoot, and hindfoot only reach their actual normal position at around the age of ten^[1]. So “flat feet” usually don’t need to be treated in children.

Treatment Options

The treatment for foot deformities depends on the type of deformity, its severity, what caused it, and how it affects your life. There are two basic approaches: non-surgical and surgical.

Non-Surgical Treatment

Healthcare providers prefer to manage foot deformities with conservative treatment methods whenever possible^[8]. These techniques are more likely to be effective if your condition is still relatively mild.

Conservative treatments won’t correct your deformity, but the main goal is restoring your ability to walk, play, and get through your day without pain or obstruction^[8]. Common non-surgical options include:

• Orthotics: Custom-made orthotic insoles provide support and alignment. These shoe inserts help distribute pressure more evenly across the foot, reducing strain and pain^[3]
• Physical therapy: Specific exercises can strengthen the muscles, tendons, and ligaments in the foot and ankle, improving mobility and function^[3]
• Changing footwear: Shoes that offer good arch support and adequate room for the toes can make a significant difference^[8]
• Padding, taping, strapping, or splinting to help realign toes or reduce pressure^[8]
• Over-the-counter pain relievers and anti-inflammatory medications to manage pain and reduce swelling^[1]
• Braces: Ankle-foot orthoses can help maintain proper foot position
• Activity modifications to reduce stress on the affected area

Manipulative Treatment for Congenital Deformities

For congenital foot deformities like clubfoot, manipulative treatment requires manual repositioning and serial casting (a series of casts applied over time)^[4]. This treatment should be initiated immediately after birth^[4]. The outcome depends primarily on whether the deformity responds well to manual repositioning.

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^[4].

When Surgery Is Needed

Almost all foot deformities are progressive conditions that slowly get worse over time. Ignoring them will not make the problem go away^[8]. If non-surgical care options don’t provide the necessary pain relief—or your deformity is so severe that they aren’t likely to work at all—surgical reconstruction may be necessary.

Indications for Surgery

Surgery may be recommended when:

• Pain persists despite conservative treatments for several months^[13]
• The deformity progressively worsens even with proper footwear and orthotic use^[13]
• Difficulty wearing any type of shoes becomes a significant problem^[13]
• Daily activities become limited due to foot pain^[13]
• Chronic inflammation or recurring ulcers develop in the affected area^[13]
• Arthritis develops in joints affected by the deformity^[13]
• The deformity affects your ability to walk or stand^[6]

Types of Surgical Procedures

The goal of reconstructive foot surgery is to restore proper alignment to the bones and joints of the foot in order to both relieve pain and achieve the highest level of function possible^[10]. Specific procedures may include:

• Osteotomy: Cutting and realigning bones^[3]
• Removing the enlarged portion of bone (as in bunion surgery)
• Releasing tight tendons or ligaments^[4]
• Tendon transfers: Moving tendons to help rebalance and supplement weakened muscles^[3]
• Arthrodesis: Fusing joints to permanently correct alignment^[10]
• Realigning joints and correcting bone angles

Physical hardware, such as plates, pins, or screws, may be necessary to fix the reconstructed foot in place during the healing process^[10].

Recovery from Surgery

Recovery from foot deformity surgery typically requires several weeks to months. You will likely need to:

• Keep your foot elevated as much as possible to reduce swelling
• Use crutches and avoid putting weight on your foot for several weeks^[14]
• Wear a cast, protective boot, or brace for a specific period^[14]
• Work with a physical therapist to regain muscle strength and learn to walk correctly^[14]
• Follow your doctor’s instructions carefully regarding proper foot care to help ensure healing

Although reconstructive surgeries do usually require a fair amount of recovery and rehabilitation time, this investment must be weighed against the alternative: continuing to live with a painful deformity for years or even decades^[10].

Foot Deformities in Children

Pediatric foot deformity is a term that includes a range of conditions that may affect the bones, tendons, and muscles of the foot^[3]. Treatment of foot deformities in children can vary significantly from that needed in adults.

Common Pediatric Deformities

Among the most frequently treated pediatric foot deformities are:

• Cavus foot (excessively high arch)
• Tarsal coalition (abnormal connection between bones in the foot)
• Clubfoot
• Accessory navicular (extra bone on the inside of the foot)
• Juvenile bunion

Special Considerations for Children

Pediatric orthopedists who specialize in foot deformities can bring to bear a range of non-operative and operative techniques specifically developed to address the distinctive needs of children^[3]. These include special attention to preserving the integrity of the growth plate (the area of developing tissue near the end of long bones), allowing continued growth and development of the foot.

How surgeons cut the bones and the ways in which they place pins and screws during surgery is different in children than in adults, since the foot must be allowed to grow^[3]. The special needs of children require a different approach than what would be used for adults.

When to Seek Help for Your Child

Many parents look for medical advice because they think their child might have a flat or pronated foot. However, it’s normal for the soles of children’s feet to be flatter than those of adults^[1]. 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.

If you notice any abnormalities in your child’s foot or ankle development, or if they complain of foot pain, schedule an appointment with a pediatric foot specialist. Early diagnosis and treatment can make a significant difference^[22].