Foot malpositions

Author: K. Zbinden

Definition

What are foot malpositions?

A foot malposition describes deviations from the foot’s natural shape and statics. The human foot is a complex structure consisting of 26 bones, numerous joints, ligaments, tendons and muscles, which together provide stability, mobility and shock absorption. A healthy foot shape is characterized by a well-developed longitudinal and transverse arch, which distributes the load evenly when walking and standing.
If these arch structures change or weaken, foot malpositions develop. These malpositions not only affect the position of the foot, but also influence the entire leg axis as well as the ankle, knee, hip and back. The correct interaction of muscles, tendons and ligaments is crucial for healthy foot function. If this interplay is disrupted—for example due to lack of movement, incorrect loading or unsuitable footwear—the foot can no longer adequately perform its natural shock absorption. The result is overuse, misloading and often pain in the foot or ankle, which in the long term can promote further problems in the musculoskeletal system.

What types of foot malpositions are there?
There are various forms of foot malpositions that differ in their characteristics and effects. Often, individual malpositions do not occur in isolation, but in combination with each other. Among the best-known and most widespread foot malpositions are hindfoot valgus (pronated foot), fallen arch, flatfoot, splayfoot and high-arched foot.

• ◉ Hindfoot valgus

  In hindfoot valgus, the heel tilts inward so that the foot axis is no longer straight. This malposition often occurs in combination with a fallen arch. Due to the inward collapse, the inner side of the foot bears more load, which can lead to pain, fatigue and reduced stability. Hindfoot valgus can be congenital or develop over time due to weak connective tissue, excess weight or misloading. The altered statics often also affect the knee and hip joints. In toddlers, this foot position is considered a normal developmental stage and is therefore not regarded as requiring treatment.

• ◉ Fallen arch

  A fallen arch is characterized by a flattened longitudinal arch. As a result, the inner edge of the foot sinks downward and the natural shock-absorbing function is impaired. Body weight is distributed less optimally, which can lead to pain in the foot, in the ankles or even in the knees. A fallen arch often develops over the course of life due to weakening of muscles and ligaments. It is one of the most common foot malpositions in adulthood.

• ◉ Flatfoot

  In flatfoot, the longitudinal arch has almost completely collapsed, so the foot lies almost entirely on the ground. Compared to a fallen arch, the flattening is more pronounced. This results in the loss of a large part of the natural shock absorption, which can lead to complaints in the foot as well as in joints above. Flatfoot can be congenital or develop over the course of life. Due to the changed foot shape, there is often overuse of muscles and ligaments.

• ◉ Splayfoot

  In splayfoot, the transverse arch of the foot is flattened. This widens the forefoot and places greater load on the metatarsal bones. Body weight is no longer distributed evenly, which can lead to pressure points, pain in the forefoot area and the formation of calluses or corns. Splayfoot often develops over the course of life, encouraged by inactivity, excess weight or unsuitable footwear.

• ◉ High-arched foot

  The high-arched foot is the counterpart to a fallen arch or flatfoot. Here, the longitudinal arch is excessively pronounced. As a result, a large portion of body weight is placed on the heel and forefoot. This point loading can lead to pain, instability and pressure points. In most cases, a high-arched foot develops due to altered muscle tone in the foot and calf muscles. It usually develops over the course of life and often first appears in adulthood. In some cases, a high-arched foot can be congenital. Due to significant shortening, the foot is less elastic and is less able to cushion impact when walking.

Causes of foot malpositions

The causes of foot malpositions often lie in modern lifestyles and changing environmental conditions. The foot is a highly complex and resilient system that must absorb, cushion, transmit and control forces with every step. For this to work smoothly, the foot depends on regular movement, active muscular work and natural loading stimuli. If the foot is moved too little over long periods, loaded one-sidedly, or restricted in its natural function by unsuitable footwear, functional adaptations occur. These adaptations form the basis for the development of foot malpositions such as hindfoot valgus, fallen arch, splayfoot, flatfoot or high-arched foot. While our ancestors mostly walked barefoot on natural, uneven ground—thereby continuously training the foot muscles as well as the longitudinal and transverse arches—today’s daily life is often characterized by sitting, monotonous movement patterns and hard floors. These conditions directly affect the statics, stability and mobility of the foot. The following describes how these changes contribute to the development of foot malpositions.

Lack of movement and a sedentary lifestyle
Insufficient movement means the foot can no longer use its natural functional range. Foot joints, muscles and fascia require regular movement to remain stable, resilient and adaptable. If the foot is moved too little, several functional changes occur that promote foot malpositions.

• ◉ Weakened muscles

  The arches of the foot are not only supported passively by ligaments and tendons, but are stabilized primarily actively by the foot muscles. With lack of movement, this musculature gradually deteriorates. This especially affects the small intrinsic foot muscles located directly in the foot, which are responsible for the shape and tension of the longitudinal and transverse arches. When these muscles lose strength, the arch can no longer maintain its natural height. The longitudinal arch sinks, promoting the development of a fallen arch or flatfoot. At the same time, the transverse arch loses stability, which can lead to the formation of a splayfoot.
  Without muscular guidance, the foot more easily deviates from its optimal axis when standing and walking. The heel often tilts inward, leading to hindfoot valgus. This malposition affects not only the foot itself but alters the entire leg axis up to the knee and hip. This can cause additional complaints that extend far beyond the foot.

• ◉ Changes in muscle and fascia tension

  A sedentary lifestyle often leads to shortening in the muscle and fascia chains of the legs, particularly in the calf muscles and the posterior chain. These altered tension relationships are transmitted directly to the foot. Shortened structures pull the foot into certain positions and influence the alignment of the arch. Depending on the individual characteristics, this can promote both a flattening of the arch and an excessive arching typical of a high-arched foot.
  This altered tension makes it even harder for the foot to move freely and harmoniously. Natural springiness is lost and the foot responds less flexibly to loads. This increases the risk that malpositions become entrenched or new complaints arise.

• ◉ Reduced foot mobility

  If the foot is not regularly used through its full range of motion, individual joints lose mobility. The many small joints in the foot need movement to remain supple and functional. Without this movement, they increasingly stiffen. The foot’s natural adaptability decreases, leading to overload of certain structures while others continue to weaken.
  This reduced mobility reinforces existing malpositions because the foot can no longer compensate for misloads. At the same time, the likelihood of pain increases, as load can no longer be distributed evenly. Over time, this can lead to a vicious circle: less movement leads to more complaints, and more complaints lead to even less movement.

Hard, flat floors and rigid, supportive shoes

In addition to lack of movement, today’s environmental conditions also have a significant impact on foot statics. Hard, flat floors and rigid, supportive shoes alter the natural biomechanics of walking and standing.

• ◉ Increased force impact

  When walking on soft, yielding surfaces such as grass, sand or moss, the impact energy is gently absorbed and cushioned by the ground. Hard, level surfaces such as concrete or asphalt, on the other hand, reflect this energy almost completely back into the foot, significantly increasing the load on foot structures. The foot has a natural shock-absorbing function that cushions impacts during walking or running. Hard floors and rigid shoes impair this protective function because shock forces are hardly filtered. As a result, the foot structures must permanently compensate for higher loads, which in the long term can lead to overload, malposition or wear.

• ◉ Shortened reaction time of the foot muscles

  In addition, hard floors and stiff shoes not only lead to increased force impact, but also cause these forces to be transmitted to the foot more quickly. Due to the earlier and higher force impact, the foot muscles have less time to actively stabilize. In particular, the transverse and longitudinal arches cannot be activated and therefore can no longer optimally fulfill their shock-absorbing and load-bearing function. Due to the reduced activity of the foot muscles, the foot relies more on ligaments and passive structures. This can promote the development of hindfoot valgus or worsen existing foot malpositions. Because of insufficient muscle activation, the foot can no longer roll off in a controlled manner after heel strike. The midfoot and forefoot sink downward uncontrollably. In the long term, this can lead to malpositions, overuse or premature fatigue of the foot muscles.

• ◉ Restriction of natural foot movement

  Hard, flat floors as well as rigid, strongly supportive shoes significantly restrict the natural rolling movement from the heel via the midfoot to the forefoot. Due to the shortened reaction time of the foot muscles, the foot often collapses downward uncontrollably after heel strike, preventing the natural rollover. At the same time, stiff shoe soles and unyielding floor surfaces reduce the physiological range of motion of the feet. This restricted mobility leads to overload of certain muscles and joints, while other areas are activated too little. Underchallenged structures lose strength and stability, which in the long term can result in muscle loss and joint stiffening. The interaction of the foot muscles becomes imbalanced, leading to muscular dysbalances. As a result, malpositions such as hindfoot valgus, fallen arch, high-arched foot or splayfoot can develop or worsen more easily.

Symptoms of foot malpositions

It is important to mention that the following lists are the most common symptoms of foot malpositions. The list is not complete or conclusive, and atypical complaints may also occur. The severity of symptoms depends, among other things, on the type of malposition, the degree of severity, the duration of misloading and the individual physical constitution. Because foot malpositions affect the statics of the entire musculoskeletal system, complaints may occur not only in the foot itself, but also in the ankle, knee, hip or back. If complaints persist or worsen, a medical or therapeutic professional should be consulted. Common symptoms of foot malpositions:

• ◉ General foot pain: Pain when walking, standing or with prolonged loading, often in the area of the arch or the forefoot.
• ◉ Load-dependent foot pain: Increasing complaints with longer walking distances, in everyday life or during sports activity.
• ◉ Pain in the arch: Typical with fallen arch or flatfoot, often described as pulling or tiring.
• ◉ Forefoot pain: Common with splayfoot, especially under the metatarsal heads.
• ◉ Heel pain: Can occur with various foot malpositions, especially with altered load distribution.
• ◉ Pain on the inner or outer side of the foot: Varies depending on the malposition, e.g., with hindfoot valgus or high-arched foot.
• ◉ Ankle pain: The altered foot position often results in increased loading of the ankle joint.
• ◉ Knee pain or hip complaints: Result of axis deviations triggered or aggravated by a foot malposition.
• ◉ Back pain: Especially in the lower back due to altered statics and misloading.
• ◉ Rapid fatigue of the feet: Feeling of heavy or tired feet after only a short load.
• ◉ Start-up pain: Pain when standing up after prolonged sitting or lying down that improves after a few steps.
• ◉ Pressure pain: Pain when wearing certain shoes, especially in the forefoot or heel area.
• ◉ Calluses and pressure points: Thickened skin areas due to uneven loading, typical with splayfoot or high-arched foot.
• ◉ Swelling in the foot or ankle: Especially after prolonged loading or at the end of the day.
• ◉ Feeling of instability: Feeling of the foot giving way, especially with hindfoot valgus or muscular weakness.
• ◉ Restricted movement in the foot: Reduced mobility of individual foot joints due to over- or underuse.
• ◉ Change in gait pattern: Unconscious protective or compensatory behavior when walking.

The symptoms mentioned for foot malpositions can occur individually or in combination and may intensify over time. If left untreated, a foot malposition can lead to chronic complaints and secondary damage in adjacent joints. Early assessment and targeted therapy are therefore crucial.

Conventional therapies - What helps with foot malpositions

Various conventional therapy approaches are available to treat a foot malposition. The measures listed below represent a selection of common treatment forms and are not exhaustive. Often, several therapy approaches are combined to relieve complaints such as arch pain, ankle pain or foot fatigue. A medical evaluation is recommended to determine the appropriate therapy on an individual basis.
Conventional treatment options for foot malpositions:

• ◉ Relief and rest periods: Temporary reduction of load-bearing activities can alleviate acute complaints. Loads should be built up again gradually.
• ◉ Cold or heat applications: Cold can reduce acute inflammation or pain in the foot area, while heat relaxes tense muscles and fascia.
• ◉ Physiotherapy: Specific exercises improve mobility, strengthen foot and lower-leg muscles and stabilize the arch.
• ◉ Manual therapy: Therapeutic techniques can release joint blockages that often occur with foot malpositions.
• ◉ Stretching exercises: Regular stretching of the Achilles tendon, calf and foot muscles prevents tension and supports the natural foot shape.
• ◉ Strengthening exercises: Building up foot, ankle and lower-leg muscles stabilizes the arch and improves load distribution.
• ◉ Medication therapy: Pain-relieving and anti-inflammatory medications provide short-term symptom relief.
• ◉ Braces and orthoses: Provide additional stability, help correct malpositions and effectively prevent overload.
• ◉ Orthopedic insoles: Custom-made insoles support the arches, can correct a malposition and distribute pressure evenly.
• ◉ Taping: Kinesio tape can promote stability and relieve pain in malpositions such as hindfoot valgus or splayfoot.
• ◉ Physical therapies: Ultrasound or electrotherapy can improve circulation and regeneration in the foot.
• ◉ Weight reduction: Less body weight reduces pressure on the arch and ankle joints.
• ◉ Injection therapy: For persistent inflammation, cortisone or hyaluronic acid injections can be used locally.
• ◉ Surgery: In rare, severe cases (e.g., pronounced flatfoot or high-arched foot), surgical intervention may be necessary.

Many of these conventional measures do alleviate symptoms, but do not permanently address the functional causes of the malposition. Foot malpositions often result from lack of movement, a sedentary lifestyle, as well as hard floors and rigid shoes that limit natural foot dynamics. This is where the kybun mechanism of action comes in: it offers a holistic approach to stabilize the arch, activate the musculature and reduce the load on the feet in the long term.

kybun mechanism of action - What helps with foot malpositions

The kybun products aim to compensate for the health-damaging consequences of hard, flat floors and rigid, supportive shoes while actively addressing lack of movement and a sedentary lifestyle. Thanks to the elastic, springy properties of kybun products, the feet are relieved on the one hand and activated on the other. This dual effect initially helps reduce pain in hindfoot valgus, flatfoot, splayfoot, high-arched foot or fallen arch. At the same time, the causes of a foot malposition are addressed in the long term.

• ◉ Optimized pressure distribution

  The foot can sink into the elastic-springy material so that the entire sole is enclosed by the kybun sole. This distributes pressure peaks evenly and significantly reduces point loading on the forefoot and heel. Especially with malpositions such as splayfoot or high-arched foot, where local pressure points often develop, the gentle distribution of load provides noticeable relief. This protects the feet, reduces stress on the joints and can alleviate complaints over the long term.

• ◉ Reduction of force impact through the cushioning effect

  When stepping in kybun shoes, the elastic-springy material is compressed. Similar to an airbag, the compressible sole absorbs a large part of the acting forces. This significantly relieves the feet, ankles and arches and protects them from mis- and overload.

• ◉ At heel strike, the foot can gently sink into the kybun material, delaying the onset of loading. This time delay enables the muscles to actively stabilize the arch. Well-activated musculature protects tendons, ligaments and joints and supports natural alignment in the case of foot malpositions.

• ◉ Activation of foot and lower-leg muscles

  On the elastic-springy kybun sole, the feet must constantly perform small compensatory movements to maintain balance. This specifically activates the foot and leg muscles. Strong musculature stabilizes the longitudinal and transverse arches, supports physiological rollover and reduces overpronation or supination. In this way, malpositions are corrected, muscular deficits reduced and complaints when walking or standing alleviated.

Balance and EMG

Balance ability was measured with a force plate by tracking the movement of the body’s center of mass from front to back (ant-post) and side to side (med-lat) while standing. In parallel, electromyography (EMG) recorded muscular activity.

• ◉ Natural rollover and increased range of motion

  When walking in kybun shoes, the foot sinks gently into the material at heel strike, delaying the load in time. The surrounding musculature can react actively, stabilize the joint and initiate a controlled rollover. This reduces the risk of overpronation in hindfoot valgus or misloading in splayfoot. At the same time, the range of motion of the foot and toe joints is used, the longitudinal and transverse arches are gently stretched, and foot flexibility is improved.

• ◉ Protection of the fascia

  Fascia connects the body, gives it form, transmits forces and enables harmonious movement. If fascia is tense, stuck together or matted, this system functions only to a limited extent. Lack of movement as well as hard floors and stiff shoes promote such changes. An elastic-springy surface protects the fascia and enables the full range of motion of the foot joints. The feet roll off more naturally; muscles, ligaments and tendons work actively, are strengthened and protected from mis- and overload. The natural movement sequence gently stretches the fascia, maintains its mobility and protects the feet from tensile and compressive loads that can lead to foot malpositions.

• ◉ Improved circulation and regeneration

  The additional movement on the elastic-springy material increases circulation around the feet. Oxygen and nutrient supply improve, while pro-inflammatory substances are transported away. This supports the regeneration of foot joints, ligaments, tendons and muscles that are mis- and overused due to a foot malposition.

• ◉ Promoting movement and reducing sitting time

  The elastic-springy kybun products increase the joy of movement, activate the musculature and promote circulation. At the same time, they reduce the duration of sedentary activities, prevent muscular shortening and promote the physiological movement mechanics of the foot. Every step strengthens the arch, improves stability and helps to balance malpositions in the long term.

Application tips for foot malpositions

Before wearing kybun shoes for the first time, you should consider a few application tips. Correct use of the shoes can help alleviate complaints associated with hindfoot valgus, fallen arch, splayfoot, flatfoot or high-arched foot and activate the musculature in a targeted way.

• ◉ At first, wear kybun shoes only as long as your body allows. Take breaks if the foot or lower-leg muscles become tired or if complaints occur. Treating a foot malposition takes time, as muscles first react and adapt to the activation.
• ◉ Press the heel slowly and in a controlled manner into the kybun material to feel the sole’s give. Find a load point at which the malposition—such as hindfoot valgus or fallen arch—is relieved and no pain occurs. At the beginning, make sure not to force the rollover over the forefoot too strongly to avoid overloading the arch.
• ◉ Start with small, flat steps to protect the arch and toe joints. Especially in the case of acute complaints in the midfoot or forefoot, rollover should initially be reduced. As you get used to it, you can slowly increase the range of motion of the feet.
• ◉ Make sure the foot neither tilts inward (overpronation) nor outward (supination). The elastic-springy sole supports even force distribution, stabilizes the longitudinal and transverse arches and reduces misloading.
• ◉ Use kybun shoes in combination with targeted strengthening and mobility exercises for the foot and lower-leg muscles. This promotes stabilization of the arch, supports natural movement mechanics and enhances the effect of the shoes. Regular practice helps to balance a foot malposition in the long term and reduce complaints.

Helpful exercises for foot malpositions

To enhance the effectiveness of kybun shoes and increase the likelihood that complaints caused by hindfoot valgus, flatfoot, fallen arch, splayfoot or high-arched foot are reduced, we recommend the following exercises. The selection is not exhaustive and can be supplemented with additional exercises. As a general rule: complaints must not become worse during the exercises. Mild, pleasant and releasing “pain” is normal and desired.
The exercises are divided into the following areas: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, the areas are combined to treat foot malpositions sustainably and improve the function of the arch.

Correct walking in kybun shoes
The quality of every step is crucial in order to relieve the feet and correct a foot malposition in the long term.

Controlled heel strike

• ◉ Press the heel deep into the elastic-springy material to use cushioning and muscle activation.
• ◉ Find a load point at which complaints are reduced or do not occur.
• ◉ Check foot alignment so the foot neither tilts inward nor outward.
• ◉ Place the midfoot and forefoot slowly and in a controlled manner.
• ◉ Do not force active rollover over the forefoot at first; focus on physiological heel strike.

Controlled rollover

• ◉ Light, natural rollover over the forefoot.
• ◉ Adjust range of motion individually.
• ◉ If possible, slowly increase the range of motion without provoking pain.

Muscle length training
Targeted stretching of the calf, shin and foot muscles supports lifting of the arch and reduces loading in foot malpositions.

Sole of the foot

• ◉ Take the foot in both hands.
• ◉ Actively pull the forefoot toward the shin so that a stretch is felt in the sole.
• ◉ Hold the exercise for 30 seconds, 3× per foot.
• ◉ Perform 1–2× daily.

Foot wringing

• ◉ Take the foot in both hands.
• ◉ Wring the foot in all possible directions, using the full range of motion of all joints.
• ◉ Hold the exercise for 30 seconds, 3× per foot.
• ◉ Perform 1–2× daily.

Fascia rolling
Fascia training promotes the elasticity of the foot and lower-leg muscles, optimizing tension relationships in the foot.

Sole of the foot

• ◉ Actively roll out the sole with a foam roller or ball from the heel to just before the metatarsal heads. Deliberately avoid the ball of the foot if pain is severe.
• ◉ Perform the exercise slowly and in a controlled manner.
• ◉ Adjust pressure to personal perception, but go to the tolerable pain threshold.
• ◉ Roll out localized adhesions more intensely and/or hold the position at that point.
• ◉ 3 minutes per foot.
• ◉ Perform 1–2× daily.

Calf muscles

• ◉ One leg bent, the other leg on the foam roller. Increase pressure by placing both legs on the roller. Increase further by stacking the legs.
• ◉ If pain occurs in the wrist, the exercise can also be done on the forearms.
• ◉ Actively roll out the calf from just above the heel to just below the back of the knee.
• ◉ Perform the exercise slowly and in a controlled manner.
• ◉ Adjust pressure to personal perception, but go to the tolerable pain threshold.
• ◉ Roll out localized adhesions more intensely and/or hold the position at that point.
• ◉ At least 3 minutes per foot.
• ◉ Perform 1–2× daily.

Strengthening
Targeted strength training stabilizes the arch, strengthens the foot and lower-leg muscles and reduces misloading in hindfoot valgus, flatfoot, splayfoot, high-arched foot or fallen arch.

Foot muscles longitudinal arch

• ◉ Stand upright with feet hip-width apart.
• ◉ Heel and ball of the foot have even contact with the ground.
• ◉ Slowly lift the longitudinal arch without the heel or ball losing contact with the ground.
• ◉ Also make sure the movement comes from the feet and the lift is not caused by outward rotation of the knees.
• ◉ Hold the position at the highest point for 4 seconds.
• ◉ Lower the foot again slowly and in a controlled manner.
• ◉ 3 sets of 8–12 repetitions per foot.
• ◉ Perform 2–3× weekly.

Foot muscles transverse arch

• ◉ Lay a towel or similar flat on the floor.
• ◉ Place the foot at the beginning of the towel.
• ◉ Use the toes to grip the towel and pull it toward the foot by flexing the toes.
• ◉ 3 sets of 8–12 repetitions per foot.
• ◉ Perform 2–3× weekly.