Arch Strain Foot: Arch Pain | Symptoms, Causes & Treatment by Sydney Heel Pain

13.09.202215.07.2023 by alexxlab

What are the symptoms of arch pain? What causes arch pain? How can arch pain be treated? Get the answers to these questions and more in this comprehensive article.

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Arch Pain: Symptoms, Causes, and Treatment

Arch pain can be a debilitating condition that affects many individuals, particularly those who are carrying extra body weight or who wear unsupportive footwear. In this article, we will explore the symptoms, causes, and effective treatments for arch pain, with a focus on the case of Mrs. X, a 44-year-old woman who sought help for her arch pain.

Symptoms of Arch Pain

According to the case study, Mrs. X experienced a variety of symptoms associated with her arch pain. These included:

A burning sensation under the sole of her foot
A sharp, pulling sensation in the arch
Extreme, stabbing pain that would cause her to stop mid-stride and stand still
Fatigue in her foot muscles
Tightening and occasional cramping in her calf muscles, particularly in the evenings

These symptoms are typical of a condition known as Plantar Fasciitis, which is a common cause of arch pain.

Causes of Arch Pain

The case study identifies several factors that contributed to Mrs. X’s arch pain:

Increase in body weight: Mrs. X had gained 14 kilos in the 6 months leading up to the onset of her arch pain. The extra weight added stress and strain to her feet, leading to inflammation and micro-tearing of the Plantar Fascia.
Lack of physical activity: Due to a stressful period at work, Mrs. X had stopped visiting the gym, which led to a decline in her overall fitness and muscle tone.
Unsupportive footwear: Mrs. X primarily wore flat and flexible shoes, such as ballet flats, which lacked the necessary arch and midsole support to properly support her feet during daily activities.

The combination of increased body weight, decreased physical activity, and inadequate footwear support all contributed to the development of Mrs. X’s arch pain.

Diagnosing Arch Pain

In Mrs. X’s case, the diagnosis of Plantar Fasciitis was confirmed through an ultrasound scan of her painful foot. The scan revealed inflammation of the Plantar Fascia, which is a common finding in individuals with arch pain.

The physical examination also revealed typical Plantar Fasciitis findings, including pain on palpation of the Plantar Fascia, an inability to perform a single-leg heel raise without pain, and an absence of heel pain.

Treating Arch Pain

According to the case study, the Sports Podiatrist reassured Mrs. X that Plantar Fasciitis is a treatable condition and that she should expect a full recovery within 1-2 months with the appropriate treatment. The treatment plan likely included a combination of the following interventions:

Transition to more supportive and cushioned footwear, such as the Asics running shoes that Mrs. X had mentioned
Stretching and strengthening exercises for the Plantar Fascia and calf muscles
Anti-inflammatory medication or other pain management strategies
Soft tissue massage or mobilization techniques to address the tightness and stiffness in the calf muscles
Gradual increase in physical activity and weight management to address the underlying factors contributing to the arch pain

Preventing Arch Pain

The case of Mrs. X highlights the importance of addressing the underlying factors that can contribute to the development of arch pain, such as weight gain, physical inactivity, and the use of unsupportive footwear. By maintaining a healthy weight, engaging in regular physical activity, and wearing appropriate, supportive shoes, individuals can significantly reduce their risk of developing arch pain and other foot-related issues.

Conclusion

Arch pain can be a debilitating condition, but it is often treatable with the right interventions. By understanding the symptoms, causes, and appropriate treatment strategies, individuals can take steps to address their arch pain and regain their active, pain-free lifestyle. The case of Mrs. X provides a valuable example of how a comprehensive approach to addressing the underlying factors can lead to a successful recovery from arch pain.

Arch Pain | Symptoms, Causes & Treatment by Sydney Heel Pain

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HISTORY – ARCH PAIN

A 44-year-old lady presents to the clinic with arch pain in her right foot which came on gradually. She reports an increase in body weight, gaining 14 kilo’s in approximately 6 months. The arch pain started 3months ago, around the time she was starting to feel her body weight was becoming a problem. Mrs X had been through an extremely stressful period at work and this meant she stopped visiting the gym. Her eating habits also became an issue and this compounded the weight gain problem. As her body weight increased she became aware of a mild arch pain and some general fatigue in her foot muscles. She would release the stiffness in her feet with a spiky ball at home and this provided temporary relief. In addition to the onset of arch pain and fatigue, she felt her calf muscles tightening and she would occasionally experience cramps, particularly in the evenings. Mrs X described the pain as a burning sensation under the sole of her foot and a sharp pulling sensation. She would often stop mid stride, and stand still, as the stabbing pain was extreme and she felt like her arch was tearing. One week ago, she went to see her regular physiotherapist who applied some rigid sports tape to her foot, and this provided short term relief.

HER ARCH PAIN WAS WORSE IN FLAT SHOES

Mrs X brought a large selection of shoes to her consultation and wondered if her arch pain and general foot fatigue was due to her choice of footwear. Amongst the collection were 3 pairs of ballet flats, a pair of Merrell street shoes, and some flat and flexible office shoes. Not one pair of her shoes had mid sole support or a small heel. The uppers were soft and flexible and also lacked support.

Mrs X did have a pair of Asics sports shoes too, although she did not bring these along to the consultation, as she had not worn them for some 6 months at the gym. On the odd occasion that she did wear the Asics running shoes she explained that her arch pain would subside and she could spend longer on her feet. This allowed her to carry out some household chores and go for an occasional walk without too much discomfort.

HER ARCH PAIN WAS DUE TO PLANTAR FASCIITIS

Mrs X was referred to the imaging centre for an Ultra sound scan of her painful foot. She was relieved when the report explained the cause of her arch pain, describing inflamed Plantar Fascia – a condition commonly known as Plantar Fasciitis. Plantar Fasciitis can cause pain in the heel and the arch of the foot and is common in people carrying extra body weight. The Sports Podiatrist reassured Mrs X that Plantar Fasciitis was a common condition that was treatable, and that she would make a full recovery within a month or 2, once treatment commenced.

PHYSICAL EXAMINATION OF ARCH PAIN

The medical report from the imaging centre had already described Plantar Fasciitis as the cause of this lady’s arch pain and the physical examination revealed typical findings. There was pain on palpation of the Plantar Fascia, distal to the heel and along the medial slip. Her peroneal tendons were unremarkable and there was no heel pain. Mrs X was able to walk in her bare feet without limping, but was unable to perform a single leg heel raise without pain. This is typical in patients with arch pain as the exercise loads the Plantar Fascia and pulls through the arch.

FACTORS CAUSING THE ARCH PAIN IN MRS X

The increase in body weight was clearly a contributing factor in the onset of Mrs X’s arch pain. The weight gain adds load to the feet and causes stress and strain on muscles and tendons. When the weight gain occurs quickly, the feet don’t always cope with the extra stress and the Plantar Fascia can become overloaded. This leads to the micro tearing and inflammation of the Plantar Fascial fibres.

In addition to this, the extra body weight leads to an increase in calf muscle bulk and tightness. This muscle group works harder during stance and push-off in heavier patient’s. The stiffness in these muscles, which are attached to the back of the heel, causes a stronger pulling action on the back of the foot. This in turn causes a stronger pull through the sole of the foot, which can lead to strain in the Plantar Fascia and result in arch pain.

There’s a fairly good case that would suggest Mrs X would not have developed this acute arch pain had she worn more supportive shoes. Ballet flats, and any shoes that are flat and flexible are likely to cause problems in heavier patient’s, if used for longer periods.

TREATMENT OF MRS X ARCH PAIN

It was explained to Mrs X that she needed to lose weight in order to help her fatigued feet and reduce this chronic and acute arch pain. She was already aware of this and explained she can’t walk for exercise, to burn the calories. She was advised to swim and perform resistance training for her upper body. Mrs X enquired about the use of prescription orthotics. She felt her feet were more unstable since gaining weight. The Sports Podiatrist
explained to Mrs X that the orthotics were a valid treatment option, and that the Carbon Fibre material would be the preferred choice. These are a firm material but are streamlined and less bulky, and so fit into more shoes more easily. They would have slow release poron to provide cushioning and the support from these orthotics would reduce the strain on the whole foot, particularly the arch. This would allow the arch pain to resolve over time, as the micro tears and inflammation subsided.

FOOTWEAR CHANGES

A comprehensive list of appropriate shoes that would offer support and accommodate the orthotics was given to Mrs X. These were tailored to her foot type and body weight. Work shoes, casual shoes and trainers were all recommended.
OTHER

As a temporary measure, rigid sports tape was applied to both feet and this would be used until the orthotics were ready for fitting. Calf massage was also recommended and a comprehensive stretching programme was applied.

2 WEEKS ON

After 2 weeks, Mrs X returned to be fitted with her orthotics. Her pain level had not changed when the arches were palpated. However, she did feel more stable and slightly more comfortable with the strapping in place, and the new shoes on her feet.

6 WEEKS ON

Calf range had improved and pain had reduced by 40%. Mrs X was compliant with stretching but was not applying ice packs to her feet on a daily basis. Her orthotics were very comfortable and were helping. She wore them every day. She had lost 2.5 Ks in weight, partly due to dietary changes and partly due to swimming.

10 WEEKS ON – MINIMAL ARCH PAIN

Mrs X reported that her arch pain had virtually gone. There was some mild discomfort if she was standing still, without walking, for extended periods, as she had recently done at a work conference. However, she was very comfortable and free from pain at all other times. When palpating her arches, she did not flinch and reported mild tenderness but to pain.

Mrs X was asked to continue her change in eating habits but to now introduce walking. 3 k’s to commence and only twice a week. Her stretching must continue and her training programme would be modified in due course, increasing gradually.

PLEASE NOTE: The information in this case study is specific to one individual patient and should not be taken as general advice. If you have arch pain or a condition causing discomfort in your feet, you should seek the help of a Sports Podiatrist.

For more information, click here: Plantar Fasciitis

Written by Karl Lockett

A online treatment plan by Dr. Karl Lockett from Sydney Heel Pain Clinic

Learn how to treat Plantar fasciitis and heel pain with a treatment plan that allows you to take home Karl’s clinical experience and resolve this condition in the comfort of your own home.

Course Outline

U1. Introduction / condition overview
U2. Causes of Plantar Fasciitis
U3. The big red flags

U3.1. Widespread misinformation
U3.2. Why certain exercises prolong the condition
U3.3. Self treatments to avoid
U4. Treatment and clinical advice
U4.1. Unloading the Plantar Fascia
U4.1.1. Dr. Karl’s favourite strapping technique
U4.1.2. Selecting the perfect shoe
U4.2. The Super Stretch (Release the heel)
U4.3. Reduce irritation / accelerate healing
U5. Final steps
U5.1. How to prevent a recurrence
U5.2. Ongoing heel care

Disclaimer: The clinical advice in this video provides the fundamentals and the foundations of all plantar fasciitis treatment plans, recommended by Dr. Karl Lockett in his practice. Please note some patients also enjoy the benefits of additional treatments such as shockwave therapy and customised orthotics.

Dr Karl Lockett is not liable for your foot and ankle condition without consultation and informed consent.

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Causes, Stretches, Treatment, Recovery, and More

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Plantar fasciitis

Plantar fasciitis is the most common cause of arch pain and one of the most common orthopedic complaints reported. It’s caused by inflammation, overuse, or injury to the plantar fascia. The plantar fascia is the ligament that connects the front of your foot to your heel. It’s often seen in runners, but it can also occur in nonrunners.

If you have plantar fasciitis, you may feel pain and stiffness in the heel and arch. Pain is typically worse upon awakening and becomes more painful after prolonged standing or activities where you’re on your feet.

If you frequently experience plantar fasciitis, you may need to wear a different type of shoe or get inserts to provide additional comfort and support to your foot. Stretches can also help relieve pain from plantar fasciitis.

Posterior tibial tendon dysfunction (PTTD)

PTTD, also known as adult-acquired flatfoot, occurs when you have an injury or inflammation to the posterior tibial tendon. The posterior tibial tendon connects the inner foot to a muscle in the calf. PTTD can cause arch pain if the posterior tibial tendon is no longer able to support the arch.

With PTTD, arch pain is likely to extend along the back of the calf and inner aspect of the ankle. You may also have ankle swelling. Pain typically occurs during activities, such as running, not afterward.

You may need to wear an ankle brace or custom shoe insert to treat PTTD. Physical therapy may also help. In some cases, you may need surgery to treat the condition.

Overpronation

Overpronation is used to describe the way your foot moves when you walk. In people who overpronate, the outer edge of the heel hits the ground first, and then the foot rolls inward onto the arch. This overly flattens the foot. Over time, overpronation can damage muscles, tendons, and ligaments, and cause problems that lead to arch pain.

If you overpronate, you may also experience:

knee, hip, or back pain
corns or calluses
hammer toe

You may also notice extra wear on the inside part of the bottom of your shoe, specifically on the inside of the heel and the ball of the foot.

If you overpronate, you may want to consider stability shoes. These shoes help correct your step when you walk. Inserts may also help. Ask a store associate at a local shoe store for recommendations, or talk to a podiatrist or orthopedic surgeon. A podiatrist is a doctor who specializes in foot health. Exercises and stretches may also help.

Cavus foot

Cavus foot is a condition where the foot has a very high arch. It may be an inherited structural abnormality, or it could be caused by neurological conditions, like cerebral palsy, stroke, or Charcot-Marie-Tooth disease. Pain is most commonly felt in people with cavus foot when walking or standing. Other symptoms may include:

hammer toe
claw toe
calluses

You may also be more prone to ankle sprains because of foot instability.

As with other arch conditions, special orthotic shoe inserts may help relieve your pain. You may also want to wear shoes with extra ankle support, especially when participating in sports. Look for high-topped shoes. In some cases, you may need surgery.

Occasional arch pain is typically no cause for concern. In these cases, you may be able to find relief from home remedies, like soaking your foot, massage, or rest.

If you frequently experience pain, of if the pain doesn’t improve or gets worse with home remedies, talk to your doctor. Arch pain can progress to more serious foot condition, and may even lead to damage in your back, knees, and ankles. If you have diabetes, it’s especially important to stay on top of foot injury or pain.

Your doctor will assess your medical history and conduct a physical examination to pinpoint the location of your pain. They will likely ask you to flex and point your foot while pushing on the ligament. Your doctor will also look for any signs of inflammation like redness or swelling. Your reflexes, coordination, balance, and muscle tone will all be checked.

Diagnostic testing may include:

X-rays
MRI scans
CT scans
ultrasound

Understanding when and where you experience arch pain could be key to your diagnosis.

You may be able to relieve your arch pain on your own at home or with some minor lifestyle changes. In some cases, home remedies may need to be used in addition to medical treatment.

Rest

When you first notice the pain, rest your foot and take a break from activities that put a lot of stress on your feet, like running or sports with a lot of jumping, such as basketball. You may need to avoid strenuous activities for a few days, or longer if the pain persists.

You may also try icing your foot. Apply ice to your foot 10–15 minutes twice a day, until pain subsides.

Stretch

If you suspect plantar fasciitis, you can try this self-release stretch:

Place your ankle on your thigh and cradle your toes in one hand.
With the other hand, gently fold the foot in on itself by pushing down and in on the heel.
Gently push the toes toward the heel, and hold for 3–5 minutes.
Do this once a day, or whenever you experience pain.

Here’s an easy stretch you can do at work. You’ll need a lacrosse ball, which you can find online or at a sporting goods store. You can also use a foam roller, water bottle, or tennis ball.

Sitting in a chair, remove your shoe.
Place a lacrosse ball under the ball of your foot.
Roll the ball using your foot, slowly moving the ball down your foot and to the arch. Continue rolling the ball under your foot to massage the area.
Do this for 5–10 minutes.

Stretching your calves can help relieve tightness or pain in your feet, including the arches. To stretch your calves:

Stand about an arm’s length from a wall. Facing it, place your hands on the wall.
Place your right foot behind your left.
Keep your right knee straight and your right heel on the floor as you slowly bend your left leg forward.
You should feel a stretch in your right calf. Hold the stretch for 15–30 seconds and then release.
Repeat three times on the right side, and then switch legs.

Try over-the-counter (OTC) remedies

Over-the-counter arch supports and supportive shoes may help reduce pain and prevent injury in the future. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), may also help reduce inflammation and pain.

Avoid unsupportive footwear

Walking barefoot or wearing unsupportive shoes, such as flip-flops, may aggravate pain and make your condition worse. If you usually go barefoot around the house, consider getting supportive shoes that you can wear around the house, instead.

Your doctor may recommend additional treatments depending on your diagnosis. Treatments may include:

prescribed supportive shoes with specially designed shoe inserts or arch supports, or customized foot orthotics
night splints
prescription-strength NSAIDs or cortisone injections
physical therapy
bracing
casting
surgery

Your doctor may recommend that you lose weight and temporarily refrain from certain physical activities, like prolonged standing, running, or high-impact sports.

The amount of time it takes to recover depends on the underlying cause of your arch pain. It may take 3–12 months to recover from conditions like plantar fasciitis, even with treatment. If surgery is necessary, it may take a year after the surgery to get back to your normal. It may be necessary to wear a cast for weeks or months. If your doctor prescribes orthotics, you may need to wear them indefinitely.

Many of the home remedies for arch pain can also be used to help prevent pain from returning.

Wear supportive shoes with shoe inserts or arch supports, and avoid going barefoot or wearing unsupportive shoes, like flip-flops. Wearing unsupportive footwear on hard surfaces for prolonged periods creates many of the conditions that lead to arch pain.
Stretch. Begin a regular regimen of stretching exercises. Stretching your calves and the rest of your legs can help your feet, too, so don’t forget to include these areas. Invest in anti-fatigue mats. If you regularly stand in the same spot for extended periods of time, these mats can help reduce your risk for foot pain. Consider putting one on the floor in front of your kitchen sink if you spend a lot of time doing dishes. If you have a standing desk, get one for work, too.

Arch pain is often a symptom of an underlying condition affecting your foot. Left untreated, it could become chronic or long-term. It’s important to see your doctor and begin treatment if the arch pain persists for more than a few days. Isolating the cause is the first step toward finding the cure.

Hollow foot – causes, symptoms, diagnosis and treatment

Hollow foot is an abnormal increase in the height of the arch of the foot. It is the opposite of flat feet, in which the arch is lowered and flattened. Occurs after foot injuries and in some diseases of the neuromuscular system, less often it has a hereditary character. It is manifested by external deformation, pain and fatigue when walking. The diagnosis is made taking into account the data of the examination, the results of plantography and radiography. Treatment is often conservative (physiotherapy, exercise therapy, orthopedic shoes), with progressive deformity, surgery is indicated.

General information

Hollow foot – an excessive increase in the arch of the foot. It is observed in a number of diseases of the nervous and muscular systems. It can develop after foot injuries (crush injuries, severe fractures of the tarsal bones), especially those suffered in childhood. Sometimes it is inherited. Accompanied by rapid fatigue and pain when walking. It becomes the cause of the formation of calluses and the development of deformation of the fingers. In some cases, it proceeds without any functional disorders.

The reason for visiting a doctor is usually intense pain in the feet and the inability to fit shoes “to fit the foot”. With a slightly and moderately pronounced hollow foot, conservative therapy is performed. With progressive deformity, surgical intervention is indicated. Traumatologists-orthopedists are engaged in treatment. If the cause of the development of the pathology is diseases of the nervous system, neurologists simultaneously carry out the therapy of the underlying disease.

Hollow foot

Causes

At present, the exact mechanism of formation of the hollow foot has not been elucidated. It is assumed that this pathology usually occurs as a result of muscle imbalance as a result of hypertonicity or paretic weakening of individual muscle groups of the lower leg and foot. At the same time, experts note that in some cases, when examining patients with a hollow foot, it is not possible to confirm a noticeable increase or decrease in muscle tone.

Hollow foot can be formed in a number of diseases and malformations of the neuromuscular apparatus, including poliomyelitis, muscular dystrophy, spinal dysraphia (incomplete fusion of the median suture of the spine), Charcot-Marie-Tooth disease (hereditary sensorimotor neuropathy), polyneuropathy , syringomyelia, cerebral palsy, Friedreich’s ataxia (hereditary ataxia due to damage to the spinal cord and cerebellum), meningoencephalitis, meningitis, malignant and benign tumors of the spinal cord. Less commonly, pathology develops as a result of foot burns or improperly fused fractures of the calcaneus and talus. In about 20% of cases, the factors that provoked the formation of deformity remain unclear.

Pathoanatomy

The foot is the most complex anatomical formation, consisting of many elements: bones, muscles, ligaments, etc. All this complex of tissues acts as a single whole, providing support and motor function. Violation of the normal relationships between the individual elements of the foot leads to a “failure” of the mechanisms of standing and movement. The load is not properly distributed between different departments, the foot quickly gets tired, starts to hurt and deforms even more.

With a hollow foot, the curvature of the longitudinal part of the arch is increased, the first metatarsal bone at the base of the big toe is lowered, and the heel is slightly turned inwards. Thus, there is a “twisting” of the foot. Depending on the localization of the most deformed section in traumatology and orthopedics, 3 types of cavus are distinguished. In the posterior type, due to insufficiency of the triceps muscle of the leg, the posterior abutment of the plantar arch is deformed. Due to the traction of the ankle flexors, the foot “goes” into the flexion position, the heel drops below the anterior sections. The posterior type of the hollow foot is often accompanied by valgus deformity, which occurs due to contracture of the peroneal muscles and the long extensor of the fingers.

The intermediate type is observed quite rarely and is formed with contractures of the plantar muscles due to shortening of the plantar aponeurosis (with Lederose’s disease) or wearing shoes with excessively hard soles. With the anterior type, forced extension of the foot is observed with support only on the fingertips. The forefoot arch is lowered, the heel is located above the forefoot. Violation of the relationship between the posterior and anterior sections is partially eliminated under the weight of the body.

Due to the increase in the height of the arch in all types of the hollow foot, the load is redistributed to different parts of this anatomical formation: the middle part is not loaded enough, and the calcaneal tuberosity and metatarsal heads, on the contrary, suffer from constant overload. The fingers are gradually deformed, taking on a claw-like or hammer-like shape, the main phalanges rise upward, and the nail phalanges are strongly bent. Painful corns form at the base of the fingers.

However, an increase in the arch of the foot does not always entail the consequences listed above. In some cases, a very high arched vault is detected in perfectly healthy people. As a rule, in such cases, the shape of the foot is inherited, is a distinctive family trait, and does not cause functional disorders and secondary deformities. In such cases, a change in the shape of the foot is considered as a variant of the norm, no treatment is required.

Symptoms of the hollow foot

The patient complains of fatigue when walking, pain in the feet and ankles. Many patients note that they experience significant difficulties in choosing comfortable shoes. On examination, an increase in the height of the inner and outer arch, expansion, flattening and some adduction of the forefoot, deformity of the fingers, as well as painful calluses (more often in the area of the little finger and at the base of the first finger) are revealed. More or less pronounced stiffness of the foot is often noted.

With a hollow foot due to poliomyelitis, a mild unilateral paresis is usually observed in combination with the equinus of the foot. Muscle tone is reduced, the deformation does not progress. In cerebral lesions, on the contrary, there is an increase in muscle tone, spastic phenomena and increased tendon reflexes. The process is also one-sided, not progressive. With congenital malformations, the deformity is bilateral, prone to progression during periods of increased growth (5-7 years and 12-15 years).

In Friedreich’s disease, the pathology is bilateral, progressive. In the family anamnesis cases of the same disease usually come to light. An increase in the arch of the foot is combined with ataxia, severe gait disturbances, mild sensory disorders and symptoms of damage to the pyramidal tracts (contractures, spasms and pyramidal signs). In Charcot-Marie-Tooth disease, there is a progressive bilateral deformity of the feet in combination with muscle atrophy, which gradually spreads from bottom to top.

Diagnostics

To clarify the diagnosis, X-ray of the foot and plantography are prescribed. With a weakly expressed hollow foot, a protrusion along the outer edge and an excessive deepening of the concave arc of the inner edge are determined on the plantogram. With moderate severity of the pathology, the concavity extends to the outer edge of the foot. With a pronounced deformation, the imprint of the sole is divided into two parts. In advanced cases, the contours of the fingers disappear from the print, due to their pronounced claw-like deformation.

If a disease of the neuromuscular system is suspected, the patient is referred for a consultation with a neurologist, a detailed neurological examination is performed, X-ray of the spine, CT and MRI of the spinal cord, electromyography and other studies are performed. For chronic injuries of the tarsal bones, in some cases, a CT scan of the foot may be required. For the first time revealed hollow foot in the absence of diseases of the neuromuscular apparatus and previous injuries is a reason to suspect a tumor of the spinal cord and refer the patient for examination to an oncologist.

Treatment of the hollow foot

The tactics of treating this pathology is determined by the cause of the disease, the age of the patient and the degree of enlargement of the arch of the foot. With mild and moderate deformations, massage, physiotherapy and physiotherapy exercises are prescribed. Non-fixed forms are amenable to conservative correction with special shoes with a raised inner edge without arching. A pronounced fixed hollow foot, especially in adults, is subject to surgical treatment.

Depending on the cause of the development and the type of pathology, osteotomy, wedge or crescent resection of the tarsal bones, arthrodesis, dissection of the plantar fascia and tendon grafting can be performed. Quite often various combinations of the listed operational techniques are used. Surgical intervention is carried out under general anesthesia or conduction anesthesia in a planned manner in a trauma or orthopedic department.

In most cases, the best option is a combined Kuslik or Chaklin operation. The Kuslik method involves redressing or open dissection of the plantar aponeurosis in combination with a wedge-shaped or falciform resection of the cuboid bone. After removal of the resected area, the front sections of the foot are bent towards the rear, and the back – in the direction of the sole. The wound is sutured and drained, a plaster boot is placed on the leg for 6-7 weeks.

In Chaklin surgery, the plantar aponeurosis is also cut or redressed. Then the bones of the tarsus are exposed, the extensor tendons are retracted to the sides, a wedge-shaped resection of the head of the talus and part of the cuboid bone is performed. The navicular bone is removed completely or partially, depending on the degree of deformity. With a pronounced omission of the I metatarsal bone, its osteotomy is additionally performed. In the presence of the equinus, at the final stage, a tenotomy of the Achilles tendon is performed. If the position of the foot could not be completely corrected during the operation, a cast is applied for a period of two weeks, then the bandage is removed, the final correction is made and the cast is applied for another 4 weeks.

In addition, in some cases, the Albrecht technique is used to correct the hollow foot, which involves a wedge resection of the talus neck and anterior calcaneus. With pronounced and progressive deformities, the Mitbread method is sometimes used – triple arthrodesis in combination with lengthening of the Achilles tendon, osteotomy of the first metatarsal bone and muscle transplantation. Then plaster is applied for 6-7 weeks.

In the postoperative period, physiotherapy, antibiotics, painkillers, massage and exercise therapy are prescribed. It is mandatory to use special shoes with a raised outer edge in the back of the foot and a raised inner edge in the forefoot. During operations involving muscle transplantation, at the initial stages, rigid berets are additionally installed in the shoes, which protect the transplanted muscles from excessive stretching.