Splayfoot insoles: how to spot and relieve a fallen forefoot

You kick off your shoes after a long day and you see it straight away: a thick patch of callus under the ball of your foot. Your forefoot feels wide and tender, your shoes pinch at the front, and sometimes there is that burning sensation, as if you have been walking on a pebble. Sound familiar? Then you are probably dealing with a splayfoot: the collapse of the transverse arch in your forefoot. It is one of the most common foot conditions there is, and the good news is that you can do a lot about it yourself. In this article you will learn what a splayfoot is, how it develops and how support under the transverse arch can ease the pressure on your forefoot.

What is a splayfoot?

Your foot has not one but three arches: two longitudinal arches and a transverse arch that runs across your forefoot. That transverse arch stretches from the ball of your big toe to the ball of your little toe. It is formed by the five metatarsal bones and held together by ligaments, tendons and the small muscles of the foot. Ideally, as you roll through a step your weight rests mainly on the first and fifth metatarsal, while the three bones in between stay lifted like a little bridge.

With a splayfoot that transverse arch drops. The metatarsals spread apart, your forefoot becomes visibly wider and the middle heads sink downwards. As a result your body weight lands on areas that were never built for it: the vulnerable middle metatarsal heads. Your body responds with extra callus as natural protection, and in time with pain.

Worth knowing: a splayfoot is not the same as a flat foot. With a flat foot the longitudinal arch on the inside of your foot collapses, making the foot roll inwards. A splayfoot is about the transverse arch in the forefoot. The two do often occur together, because the same weakness in ligaments and muscles affects both arches. And do not confuse a splayfoot with metatarsalgia either: that is the name for the pain under the ball of your foot, while a splayfoot is often the underlying cause of that pain.

What causes a splayfoot

A splayfoot rarely comes from one single thing. It is usually the sum of your build and years of loading, under which the connective tissue in your forefoot slowly gives way:

• Build and connective tissue: some people simply have more elastic ligaments. If a splayfoot runs in your family, your chances are higher.
• Weakened foot muscles: the small muscles in your foot actively hold the transverse arch up. If you are always in closed shoes, you hardly use them.
• Getting older: ligaments and tendons lose elasticity and the fat pad under your forefoot gets thinner - exactly where you need cushioning.
• Carrying extra weight: every additional kilo arrives on your forefoot amplified as you push off.
• High heels and narrow shoes: a heel shifts your weight forwards and a narrow toe box squeezes the metatarsals together. The classic trigger.
• Long hours standing at work: standing still on a hard floor loads the transverse arch far more constantly than walking does.
• Pregnancy: extra weight plus the hormone relaxin, which temporarily softens your ligaments, can leave the arches permanently dropped.
• Rheumatoid arthritis and inflammatory conditions: these attack the small joints and ligaments in the forefoot, so the transverse arch gives way sooner.

Symptoms: how to spot it

A splayfoot usually creeps up on you. These signs point towards it:

• A wider forefoot: your shoes pinch at the front, or you find yourself buying half a size up while your heel then slips.
• Callus under the ball of your foot: often clear callus patches or corns under the second and third metatarsal head - precisely where the pressure is too high.
• Pain or a burning feeling under the forefoot that builds as the day goes on and gets worse on hard surfaces or in thin shoes.
• The sensation of walking on a pebble or a rucked-up sock, even though there is nothing in your shoe.
• Tired, heavy feet after standing or walking, sometimes with a cramping feeling in the forefoot.
• Changes in toe position: a big toe that drifts sideways (hallux valgus) or claw and hammer toes often follow on from a splayfoot.

When might it be something else? If the pain is mainly a dull, pressing ache under the metatarsal heads with no radiation, that fits metatarsalgia - a complaint that very often sits on top of a splayfoot. Does the pain feel electric, shooting or burning instead, radiating into your third and fourth toe, perhaps with tingling or numbness? Then a Morton's neuroma could be involved, a trapped nerve between the metatarsals. That one regularly develops on the back of a splayfoot too, so the approach largely overlaps.

Bracefox® Arch Support Insoles - ErgoSole

Supports the foot arches and can ease the pressure under your forefoot.

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What can you do yourself?

You cannot simply push a dropped transverse arch back into its old shape. What you can do is spread the pressure better and keep your foot active, so the symptoms settle and the position does not get worse. Many people notice a difference within a few weeks with this approach:

• Choose shoes with a wide toe box and a low heel. Your toes need to lie loosely side by side. A heel of no more than two to three centimetres keeps your weight behind your forefoot rather than on it.
• Get support under the transverse arch. This is where insoles come in. An insole with a metatarsal pad - a small raised cushion that sits just behind the metatarsal heads - lifts the transverse arch slightly. That spreads the load across the whole forefoot instead of two overloaded heads. This is the principle behind insoles for a splayfoot, and it is where many people feel the most relief.
• Break them in gradually. Start with a couple of hours a day and build up to full days over about two weeks. A short adjustment period is normal, ongoing pain is not.
• Look after your callus, but do not cut it away. Soak your feet, file gently and finish with a urea cream. If you have diabetes or rheumatoid arthritis, always have callus treated by a podiatrist or chiropodist.
• Walk barefoot on grass or sand now and then. That wakes up the small foot muscles that hold your transverse arch up.
• Vary how you load your feet. If you stand a lot, shift your weight regularly. An anti-fatigue mat at work helps too.
• Keep an eye on your weight. A few kilos less means noticeably less peak pressure under your forefoot with every step.

3 exercises for your forefoot

These exercises train the muscles that support the transverse arch and keep your forefoot supple. Do them daily, calmly and within a comfortable range.

Exercise 1: Towel scrunches

1. Sit on a chair with your bare foot flat on a towel spread out on the floor in front of you.
2. Grip the towel with your toes and pull it towards you bit by bit, without lifting your heel.
3. Then push the towel back away from you. Repeat twice per foot, once or twice a day.

Exercise 2: Short foot (lifting the arch)

1. Sit upright with your foot flat on the floor; heel and ball of the foot stay in contact.
2. Now draw the ball of your foot towards your heel, as if making the foot shorter, without curling your toes. You will feel the arch lift.
3. Hold for 5 seconds, relax and repeat 10 times per foot. If you can manage it standing, you are training exactly the muscles you need as you push off.

Exercise 3: Toe spreads and calf stretch

1. Spread your toes as far apart as you can without lifting them, hold for 5 seconds and relax. Repeat 10 times. If spreading is hard, weave your fingers between your toes for a moment.
2. Then place your hands on a wall, step the leg you want to stretch well back and keep the heel on the floor.
3. Bend your front knee until you feel the stretch in your calf, hold for 30 seconds and repeat 3 times per leg. Supple calves reduce the pressure on your forefoot with every step.

When to see your doctor

A splayfoot is harmless in itself, but there are situations where it is worth having it checked. Book an appointment with your GP or a podiatrist if:

• the symptoms have not clearly eased after six to eight weeks of wider shoes, insoles and exercises;
• the pain limits you daily in walking, working or exercising;
• you have diabetes, rheumatoid arthritis or circulation problems and notice callus, cracks or changes in sensation in your foot - always have that looked at and never cut it yourself;
• there is a wound, blister or black discolouration under a patch of callus, or the foot is red, warm and swollen;
• you developed sudden severe pain in the forefoot after a workout or a long day and can barely bear weight - a stress fracture then needs ruling out;
• you have persistent tingling or numbness in your toes.

Your doctor can usually tell a lot from the position of your foot and the pressure pattern in your callus, and will refer you to a podiatrist if needed.

Our recommendations for a splayfoot

Support starts underneath your foot. The Bracefox® Arch Support Insoles - ErgoSole are a medical device that supports the natural shape of your foot. Because the insole lets your arches share the load, peak pressure on the middle metatarsal heads can come down - exactly where the callus and the burning of a splayfoot show up. Wear them consistently in your everyday shoes, ideally ones with a roomy toe box, and build up over two weeks.

Are you mainly after soft cushioning for long days on your feet, in trainers or casual shoes for example? Then the Bracefox® Daily Insoles - AeroSoll make a comfortable addition. They replace the thin, worn original insole in your shoe and cushion the ball of your foot and your heel, so your forefoot feels less tender by the end of the day.

Bracefox® Daily Insoles - AeroSoll

Soft cushioning under forefoot and heel for long days on your feet.

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Frequently asked questions about splayfoot