The flat/splayfoot is classified according to type, cause, and severity:

1. By type:
   • Flatfoot: Flattening of the longitudinal arch of the foot, causing the foot to "sink."
   • Splayfoot: Lowering of the transverse arch in the forefoot, leading to a widening of the foot.
   • Combination: Simultaneous presence of flatfoot and splayfoot.
2. By cause:
   • Congenital: Misalignment present at birth.
   • Acquired: Developed due to overloading, incorrect loading, or degenerative processes.
3. By severity:
   • Mild: Slight flattening without discomfort.
   • Moderate: Noticeable misalignment with load pain.
   • Severe: Severe deformity with chronic pain and functional limitations.

The causes of these misalignments can be divided into mechanical, genetic, and systemic factors:

• Mechanical causes:
  • Permanent overload from prolonged standing, heavy lifting, or unsuitable footwear.
  • Overweight, which increases the load on the arches of the feet.
  • Misloads, e.g., due to incorrect rolling behavior or foot misalignments such as flatfoot.
• Genetic predisposition:
  • Congenital weakness of the ligament and supporting tissue.
• Systemic causes:
  • Rheumatoid arthritis or other inflammatory diseases.
  • Degenerative processes, such as osteoarthritis in the foot joints.

The symptoms vary depending on the type and severity of the misalignment, but typically include:

- **Pain:** Localized pain in the arch, forefoot, or soles of the feet, especially under load.

- **Pressure points and calluses:** Increased callus formation due to uneven load.

- **Change in foot shape:** Wider forefoot and flattening of the arch.

- **Instability:** Feeling of insecurity or giving way of the foot when walking.

- **Load-dependent complaints:** Pain after prolonged standing, walking, or physical activity.

- **Misalignments:** Pain in the knees, hips, or back due to altered posture.

The diagnosis is made through a thorough medical history, clinical examination, and, if necessary, supportive procedures:

• Medical history:
  • Collection of symptoms, stress patterns, and possible triggers.
• Physical examination:
  • Visual and palpation findings to assess foot shape and arch.
  • Examination of gait and posture.
• Imaging:
  • X-ray: Depiction of bony changes and misalignments.
  • Pedography: Analysis of pressure distribution under the sole of the foot.
• Functional tests:
  • Checking muscle and ligament tension as well as the mobility of the foot joints.

Conservative Therapy

The treatment aims to relieve pain, correct misalignment, and improve foot function:

• Orthopedic Insoles:
  • Support of the longitudinal and transverse arches with individually fitted insoles.
• Physiotherapy:
  • Exercises to strengthen the foot muscles and improve stability.
  • Mobilization and stretching to maintain joint mobility.
• Suitable Footwear:
  • Shoes with good cushioning and sufficient space in the forefoot area.
• Load Reduction:
  • Avoidance of prolonged standing or walking and weight reduction in case of overweight.
• Pain Therapy:
  • NSAIDs: To relieve pain and inflammation.

Surgical Therapy

In severe cases or persistent complaints, surgery may be necessary:

• Osteotomy: Correction of bony misalignments to restore the foot arch.
• Tendon and Ligament Surgery: Reconstruction of damaged structures to stabilize the foot.
• Arthrodesis: Fusion of individual joints in cases of severe pain or instability.

To prevent flat feet and splayfoot and to support foot health, the following measures are recommended:

1. Strengthening the foot muscles: Regular foot exercises to stabilize the arches.

2. Suitable footwear: Avoiding tight or unsuitable shoes, especially with high heels.

3. Load management: Alternating between standing, walking, and sitting to reduce foot strain.

4. Weight reduction: Relieving the feet through a healthy body weight.

5. Regular foot care: Avoiding pressure points and calluses through appropriate care.