Common informationen

This term, meaning "inflammation of the metatarsal heads", is often used in the case of pain in the forefoot. If this area is painful for any reason, it immediately has an effect on muscle tension and influences all joints. Any pain in our feet triggers an immediate evasive reaction. Should this reaction fail to free the body of the pain, further evasive reactions are constantly triggered. For this reason, rendering the foot pain-free is the foundation of all healing in the body.But why do we get pain in the forefoot?


All people in the first world get splayfoot at some point in life. Splayfoot is when a pressure point develops beneath the heads of metatarsal bones II, III and IV in the forefoot because they are protruding downwards. Unfortunately, the common literature speaks of the myth of a transverse arch, which collapses at some point in life. This is nonsense. When walking naturally, our forefoot distributes the force of the step and, in particular, push-off across all five metatarsal heads, in line with the bones' absorbing ability. This means: the stronger the bone is, the more momentum it can absorb. The surface of the foot that comes into contact with the ground adapts to the surface that it is walking on in order to transfer the power in the best way possible. Herein lies the reason for splayfoot developing. It is not the collapse of any structure due to overload in old age, but acclimatisation to an unaltered surface. This can happen very early in life, because we rarely allow our children to run around with no shoes on.
For historical and fashion-related reasons, today all of our shoes feature a concave arch in the forefoot area, i.e. the insole is formed in such a way that the middle part of metatarsal heads II-IV lies lower than the outer part, I and V. This means that even babies' feet lie – tension-free – in a hollow, thus exposing metatarsal heads II, III and IV. If the child then moves primarily on this surface, the foot quickly forms into this structure as they grow. This very quickly creates childhood splayfoot, which can even cause pain when running barefoot.

For this reason, shoe manufacturers that make "spherical" children's shoes are the creators of whole generations of potential pain patients that have a low threshold for strain. As all shoes on all price levels are shaped in a "spherical" way, no one is able to avoid this vicious circle. On the contrary, a person that is used to "spherical" shoes is barely able to withstand even surfaces as their feet – and their muscles, fasciae and bones – have changed due to this acclimatisation. Thus, right from the beginning our feet are deformed in such a way that the middle metatarsal heads have to bear the greatest force. This quickly leads to pain caused by overload, and splayfoot can be diagnosed as early as during nursery school.

If the aforementioned pain-evading reactions then occur, even small children can experience various types of pain. Muscle pain in the arms and legs, as well as back pain, are not related to age but to foot pain.

Morton's neuralgia

Morton's neuralgia refers to very painful strain-related nerve damage in the forefoot. It is nerve irritation that occurs around the metatarsal heads, primarily between the III and IV. This issue can be and is caused by the aforementioned form of insole. Added to this is the foot's natural reaction in an attempt to avoid pain. If pain threatens to occur through the development of splayfoot, our cerebellum reacts with a command to relieve the area at risk of pain. As the first pain generally occurs beneath the second metatarsal head, increased ground pressure in the big toe provides the necessary relief. Minimal raising of the inside edge of the foot by the big toe then shifts the greatest pressure to metatarsal head III, with a lateral shear component. Due to the "spherical" form of the insole, the foot tends to be centred the middle, meaning that metatarsal heads IV and V are pressed against metatarsal head III. This narrows the natural distance between metatarsal heads II and IV. Therefore, this nerve irritation can happen at any time. One could be forgiven for thinking that this misplacement could be treated simply by raising the metatarsal heads, but long-term acclimatisation to the depression means that few people are able to withstand this reversal. This means that many are trapped in their pain by wearing everyday shoes.

Why is splayfoot so harmful?

The long toe muscles, which originate in the lower leg, help to maintain our balance when standing by exerting different amounts of pressure on the ground through the toes; when walking they influence the direction of the foot’s rolling mechanism. They ensure that we are able to walk and stand securely. The two outer toes, in particular, have a type of sensor function, which tells the cerebellum that we are standing securely. Pain in the ball area forces reactions in the toe muscles. The extensor hallucius longus and flexor hallucius longus represent the start of our muscle chain. This means that forced reactions in these muscles have an effect on the entire body straight away.
The effects are described in other sections.

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