The splayfoot is a malposition of the foot bones that can lead to premature joint wear, increased tendency to inflammation and pain in the feet, knees and back. If treatment with orthopaedic insoles and physiotherapy does not bring about an improvement, surgical correction should be considered.

Have you been diagnosed with a foot deformity? Do you have pain when walking, standing or with prolonged weight bearing? Are you considering having foot surgery?


Dr Tonio Gottlieb is an expert in all foot diseases and a specialist in foot surgery. He will advise you comprehensively and show you possible procedures. During the examination, Dr. Gottlieb always keeps the whole foot and the associated body statics in mind and responds individually to your wishes and needs.

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What is a splay foot?

 Splayfoot | www.jordicervera.comThe splay foot is a combination of several foot malpositions in all three planes:

  • frontal plane: outwardly bent calcaneal tuberosity
  • sagital plane: lowered longitudinal arch of the foot under load
  • horizontal Plane:lowered transverse arch with broadly splayed metatarsals

What does a splayfoot look like?

The reliable diagnosis of foot malpositions is the responsibility of the foot specialist or the foot surgeon or orthopaedist. However, medical laypersons can also recognise the typical characteristics of splay foot:

  • Rear view of the foot: Whether backwards in the mirror or by means of a mobile phone photo - in the case of a splayfoot, the feet are not straight, but show an X-position with the heel pushed outwards and the inner ankles bent inwards.
  • Footprint: Whether barefoot in the sand or a wet footprint on the bathroom floor - here the 'normal foot' shows a curved L-shape. In contrast, the splayfoot results in a large-surface imprint with a relatively straight inner side of the foot, the L-shape is cancelled out. Often there is also an inwardly protruding bunion (hallux valgus).

Is a splayfoot a flat foot?

Yes. The colloquial term "flat foot" is somewhat more inaccurate. The medical term "flat foot" describes the changes in all involved planes (frontal, sagital and horizontal).

How does a splayfoot develop and what are the causes?

In some people, the development of splayfoot is inherited, in others it is an acquired deformity - as a result of the insufficient development of the arch of the foot in childhood or due to accidents, illnesses and lack of exercise.

Who can get a splayfoot?

Flat Feet is often caused by a weakening of the foot muscles and tendons as a result of lack of movement and immobilisation of the feet in shoes; a predisposed foot deformity can be additionally aggravated by such foot weakness. Other risk factors are:

  • Severe overweight - every kilo means an additional load for the arch of the foot
  • Unsuitable footwear - shoes with high heels increase the load on the forefoot and promote the development of splayfoot
  • Overloading due to heavy carrying and/or standing for long periods of time - a possible resulting stretching of the ligaments favours the lowering of the arch of the foot, especially in people who work, for example, in nursing, retail or in certain skilled trades.
  • advancing age - the age-related reduction in the strength of the connective tissue and ligaments favours foot malpositions
  • Congenital connective tissue weaknesses, e.g. Marfahn syndrome, Ehlers-Danlos syndrome
  • Pregnancy: hormonal changes or weakness of the connective tissue

Flatfeet can also be the result of accidents or diseases that disrupt the interaction of bones, tendons and muscles in the arch of the foot. These include, for example, torn ligaments, torn tendons, tendonitis or rheumatism. Especially in middle-aged women, the cause is often a weakening of the tibialis posterior tendon, which connects the posterior tibial muscle to the tarsus.

Certain medications, especially steroids, can also weaken the tendons of the arch of the foot and contribute to the development of the bent low splayfoot. A frequent occurrence of this foot malposition can also be observed in diabetics and hypertensive patients.

How can I recognise a child's flatfoot?

In children, flat feet are mostly due to the current developmental phase: Both the "flat feet" padded with baby fat when learning to walk and the temporary buckling feet of pre-school children are mostly normal. It is only at the age of about 8-10 years that the arch of the foot is more solid and stable.

If parents have the impression that the foot malposition is more pronounced compared to children of the same age or hinders the movement, a visit to a foot specialist or orthopaedist is recommended.

Flatfoot: What symptoms can be associated with it?

Flatfeet can cause discomfort when walking, especially on uneven ground and when climbing stairs. It can also cause pain - not only in the feet themselves, but also in the knees, hip joints and back.

The real cause of these symptoms is often difficult to localise at this point, special medical knowledge and trained eye of the foot and ankle specialist are needed!


Dr. Gottlieb always keeps an eye on the whole foot and the associated body statics during the examination. He looks at the foot in resting position and under load, and also analyses the patient's gait. In this way, you always receive a well-founded, cause-oriented therapy recommendation.

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Flatfoot | www.jordicervera.comWhat complaints and pains can occur with flatfoot?

The Flatfoot leads to an incorrect load, which can cause the following symptoms:

  • Overuse pain on the inside of the foot and ankle, "burning soles" and rapid fatigue on exertion
  • Formation of pressure sores, calluses and corns
  • Formation of a heel spur
  • Formation of a hallux valgus
  • Favouring inflammation and signs of wear and tear (arthrosis)
  • Disbalances of the musculoskeletal system including knee, hip and back pain

Can a flatfoot cause hallux valgus?

Yes. In the case of flatfoot the metatarsal bones are spread open, which pushes the ball of the big toe inwards. Tight shoes that squeeze the toes together also contribute to the development of hallux valgus.

Knee pain due to flatfoot

Non physiological processes in the foot throw the entire muscular and skeletal system out of balance and affect all the joints above it. The knee, as the immediate "neighbouring joint", has to compensate the most for the foot's malposition; at the same time, the reduced cushioning function in the case of a bending and lowering splayfoot leads to an increased load.
Thus, the flatfeet can cause an oblique position of the lower leg. Due to the compensatory malposition of the knee joint, it is again unevenly loaded and the cartilage is worn down on one side - this can lead to knee pain.

Back pain due to a flatfoot

Flatfeet changes the statics of the entire musculoskeletal system up to the spine. As a result, all the joints above are exposed to additional stress. This can lead to poor posture (hollow back), muscle tension and back, neck and headaches. Since the collapsed arch of the foot provides insufficient cushioning, intervertebral disc problems can also occur.

What can flatfoot therapy look like?

It is not possible to make a blanket statement about which treatment is the best for a flat foot: In any case, a detailed clinical examination by a foot specialist is necessary in order to be able to make a precise diagnosis with suitable treatment recommendations.

Whether it's an initial diagnosis or a well-founded second opinion - it's best to make a personal consultation appointment right away! Dr.Gottlieb examines you with the utmost care and always responds individually to your needs and wishes.


At what point does a deformity in the case of flatfoot require treatment?

In case of repeated or persistent pain in one or both feet and/or joint and back problems, a foot and ankle specialist should be consulted: Early treatment is often comparatively simple and successful and can prevent serious consequential damage. It is irrelevant whether the pain occurs in the resting position, during relaxed walking or "only" during sport or when more weight is placed on the foot.

As a rule, symptoms of flatfeet can be treated well with orthopaedic insoles and physiotherapy; in the case of an irreversible deformity, surgery can help.

In the case of slight foot malpositions that do not cause pain or other discomfort, acute treatment is usually not necessary. However, preventive foot exercises are recommended in any case. Whether special footwear is required for running sports varies from individual to individual - expert advice from a podiatrist is recommended here.

Dr Tonio Gottlieb recommends:

"Consult an experienced foot specialist at an early stage. Not only pain when walking, but also in the knee, in the hip joints or in the back can be clear indications of a foot disease or a bending, lowering and spreading foot."

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Surgery for flatfeet: What you should know about surgery?

Surgery for flatfeet | www.jordicervera.comSurgical correction of the flatfoot should always be carried out by a specialist foot surgeon in order to achieve the best possible results.

There is no "patent remedy" for surgery - every operation is different and follows a treatment plan that is tailored to you and takes into account the statics of the entire body. The basis is always a thorough diagnosis with physical examination and imaging procedures (X-ray, ultrasound, MRI).

Modern foot surgery is minimally invasive. Depending on the individual situation, surgery is performed on the ligaments, tendons or joint capsules, and if necessary also on the bone:

  • Surgery of the tibialis posterior tendon (removal of the inflamed connective tissue around the tendon or transplantation, i.e. replacement with the toe flexor tendon).
  • Bone realignment (osteotomy) for displacement of the calcaneus or tarsus; osteotomy of the metatarsal bones
  • Joint fusion (corrective arthrodesis) of the hindfoot joints, especially the lower ankle joint, with screws

After the operation, a rest period of 6-10 weeks is required. The foot may only be partially loaded and is protected by a so-called walker (lower leg foot orthosis).

Flatfoot surgery: what costs can arise?

The costs for the treatment of a flatfoot vary from case to case - it depends on the respective diagnosis and the chosen therapy measures.

For the initial appointment with Dr. Gottlieb, 100-150 Euros should be estimated, additional costs may be added for additional examinations (e.g. Doppler sonography - 100 Euros).

Before each operation, an individual cost estimate is prepared, which precisely breaks down all positions:

  • The costs for outpatient surgery are charged according to the German Medical Fee Schedule (GOÄ).
  • The costs for inpatient surgery are generally covered by the health insurance. The billing of the accompanying, pre- and post-inpatient outpatient treatment with Dr. Gottlieb is done according to GOÄ.
  • In the case of special requests regarding the choice of hospital and surgery date, e.g. urgent surgery with an operation in a private hospital, the patient is billed as a "self-payer". In this case, the hospital settles directly with the patient, and the pre- and post-inpatient outpatient treatment with Dr. Gottlieb is billed according to GOÄ.

Flatfoot surgery: possible risks and complications

Before every operation, the patient is informed about the associated risks. On the one hand, these are general anaesthetic and surgical risks, such as wound healing disorders, infections and thromboses.

In order to keep these risks as low as possible, Dr. Tonio Gottlieb attaches great importance to careful planning and execution of the surgery as well as intensive pre- and post-operative care. His extensive expertise and active research in the field of foot surgery, his many years of experience and the empathetic, competent consultation always guarantee you the ideal treatment result.

Dr. Tonio Gottlieb advises:
"If a bend-lower-spreadfoot operation is necessary, it is usually more complex than other interventions because three dimensions of the foot are involved. Depending on the initial situation, surgical procedures are combined and highly individually adapted to the patient and his or her personal situation. Therefore, place yourself exclusively in the hands of a highly experienced and recognised foot surgeon."

Treating flatfeet without surgery: What can you do about a flatfoot?

Surgical correction is not necessary in all cases of flatfeet - often a remedy can be found through an individually adapted combination of other measures. Whether orthopaedic insoles, physiotherapy or taping - Dr Gottlieb will be happy to advise you on the treatment options available!

Are exercises useful for a flatfoot?

When diagnosing a bent and splay foot, podiatrists and orthopaedists often notice a lack of mobility of the feet and only weakly developed foot muscles. Here, mobilising, activating and strengthening exercises are recommended that make the feet more mobile and strengthen them.

Physiotherapists, orthopedic foot and ankle surgeons and podiatrists provide expert guidance in the selection of suitable exercises and their correct performance. The programme learned under guidance should then be continued at home in consultation with your specialist or therapist.

Are insoles necessary for a flatfoot?

Orthopaedic insoles can help to bring the heel into the correct position, straighten the arch of the foot and thus bring the entire musculoskeletal system back into balance.

Medical insoles are always individually manufactured - with a precise fit based on a footprint, in various materials (e.g. cork, leather, soft foam or carbon). Whether and which insoles are recommended in individual cases is decided by your attending doctor after a thorough examination.

Is taping useful in case of a flatfoot?

Tape bandages made of elastic adhesive plaster tape have a stabilising effect without restricting mobility. They support and stabilise muscles, ligaments and joints and can help prevent unwanted movements.

Supportive tape dressings can be used for flatfeet to alleviate particular overuse conditions and to relieve the arch of the foot in the short term.

Do barefoot shoes help against complaints of flatfoot?

Barefoot walking promotes foot health and is4 also recommended for painless flat feet: When walking barefoot, the feet feel every unevenness of the ground, the constant balancing and equalising stimulates and strengthens the foot muscles.

But be careful: when running barefoot, you are challenging your foot! If it is already limited in its performance due to its flat-footed position, you will quickly overstrain it by running barefoot on hard ground.

Take the foot training slowly so that muscles, ligaments and bones can get used to the new strain. Barefoot shoes provide protection from shards and other hazards. Special barefoot paths in spa parks, Kneipp and sauna facilities are particularly stimulating. With foot reflexology mats or pebble mats, this feeling can also be experienced at home.

Does physiotherapy help with flatfoot?

Physiotherapy can support the treatment of the bending and splaying foot through manual therapy, appropriate stretching, mobilisation and strengthening exercises as well as spiral dynamics.

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How can you prevent a flatfoot?

The best way to prevent foot malpositions such as the flatfoot is regular training of muscles and ligaments - from targeted foot gymnastics to barefoot walking.

Equally important is the choice of suitable footwear: on special occasions, of course, it may be pointed pumps with high heels. In everyday life, however, you need enough space for your toes, flat heels to cushion the heel and flexible, not too thick shoe soles.

It is also helpful to maintain a healthy normal weight - this is especially true if you put strain on the musculoskeletal system in your everyday working life through heavy lifting and/or standing for long periods of time.

The correct foot position against a flatfoot

A healthy, upright posture favours ergonomically correct movement sequences and thus also the correct position of the feet. In the case of flatfeet, it is often helpful to analyse standing and walking and to pay particular attention to the natural rolling movement of the foot.


Do you suffer from unclear pain in your feet, joints or back? Would you like to get a second opinion on the diagnosis of flatfeet? Are you considering having a foot operation to be able to go through everyday life again without pain? Dr Tonio Gottlieb will be happy to advise you - why not make a personal appointment right now!

Book a private consultation now!


Spreiz-, Senk- Und Plattfuss - Es muss nicht immer gleich eine Op sein

“Eigentlich gibt es ,den‘ perfekten Fuß nur im Lehrbuch“, weiß Dr. Tonio Gottlieb. „Ich spreche lieber von einem Durchschnittsfuß“, erklärt der Facharzt für Chirurgie und zertifizierte Fußchirurg aus Zehlendorf.