A 30 year old presented with complaints of pain in his arch and also on the outside of the right ankle. The pain was worse when walking long distances and when jogging. He had previously been provided with orthotics but these did not resolve the problem.
The photos below indicate the areas of pain.
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There is significant collapse of the arch with hypermobility of all the joints within the midfoot. This is known as a ‘flexible flat foot’ or ‘pes planovalgus’
When standing there was also a loss of movement of the great toe (reduced windlass mechanism)
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The pain in the arch was caused by an accessory navicular bone (accessory navicular syndrome) and the pain in the great toe was a result of the dorsal jamming of the great toe – hallux limitus ( click on each pathology to find out more). Both of these problems are made worse by the flexible flat foot
His previous orthotics did not work as they were just arch supports and only irritated the arch.
An orthotic with rearfoot correction is more appropriate to change the alignment of the heel.
After realignment of the rearfoot with an orthotic with a deep heel cup and changing to a more supportive shoe the pain in the arch and in the great toe resolved.
