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Midfoot conditions

Severly pronated foot (a flat foot)The midfoot is primarily made up of your foot’s arch, which consists of a series of many small complex joints. The arch is considered the bridge which connects the ball of your foot and your heel, the two areas which bear most of your body’s weight when standing and walking.

Healthy function of the midfoot is very important as its flexibility allows for the foot to adapt to uneven ground, and therefore helping you to maintain balance. Because the midfoot is the high-point of the foot, the joints in this area are subject to problems if the arch falls, flattens or collapses. A foot with a collapsed arch is considered an unstable foot and this can result in excessive stress on the joints and soft tissue (i.e. plantar fascia) of the midfoot, with subsequent pain.

Flat feet (Pronated feet)

Flatfeet is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

  • “Toe drift,” in which the toes and front part of the foot point outward
  • The heel tilts toward the outside and the ankle appears to turn in
  • A tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
  • Bunions and hammertoes may develop as a result of a flatfoot.

Flexible Flatfoot


Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.

The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing.

Depending on the symptoms caused by the flat feet, the treatment regime may involve, stretching, muscle strengthening, footwear advise and/or insoles/orthotics,

Acquired flat foot/posterior tibial tendon dysfunction (PTTD)

foot diag 1The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

High arches (Cavus foot)

A Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

Like flat feet this condition can be symptomless, but if pain occurs such as, calluses on the soles of feet, ankle instability or hammer/clawed toes the orthotics will help.

Stress fractures

Stress fractures of the lower extremities account for 95% of all stress fractures in athletes. In the foot the most common sites are the metatarsals (forefoot) whilst in the lower leg it is in the lower third of the tibia.

They are also common in the metatarsals of older patients who may have a degree of osteoporosis

Stress fractures are overuse injuries and result from fatigue failure within the bone, although surrounding muscles actually fatigue first. The muscles are unable to absorb added shock and this is then transferred to the bone leading to a tiny crack.

Symptoms are usually gradual in onset but progress to more intense localised pain with swelling. Pain is usually most severe during exercise but may also be present at rest.

Poor lower leg mechanics (flat feet), poor footwear, poor training and diet insufficiencies can all be factors which cause stress fractures.

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