Cause and origin

One long-term sequela of maldistributions of stress is osteoarthritis of the midfoot. Unlike the forefoot, the midfoot actually forms an arch. When walking naturally, the longitudinal arch has evolved to absorb the momentum of the step, store the energy in the muscles and tendons and make it available to the body again during the push-off phase. This ensures that the person moves forward in an energy-efficient way. Efficient muscles and tendons are essential in order to fulfil this task.

Barefoot walking automatically trains these structures and keeps them functioning into old age. For this to happen, the push-off phase must be completed by the big and second toe when stepping. If this is not possible, osteoarthritis of the midfoot may develop at a later date.
The reasons for deviation from this ideal gait direction are development of splayfoot, support of the longitudinal arch and permanent squint positioning due to soft sole material.

Splayfoot is the most effective of these. 
As explained before, because splayfoot is caused by "spherical" forms of insole, it has an effect on the midfoot very early on, initially moving the gait direction towards the fourth toe.

This means that the flexor in the big toe is put under more strain. During this phase, the longitudinal arch raises and the pressure when stepping moves outwards. This puts extreme strain on the navicular bone and metatarsal IV.

Köhler disease

If this phase lasts for longer, aseptic necrosis may develop in the navicular bone (Köhler disease I). This is due to extreme pressure, which constantly compresses the bone structure when standing, meaning that during the short phases of relief the bones cannot absorb enough nutrients to be able to sustain themselves. This phenomenon can also occur in metatarsal heads II to IV (Köhler disease II). Fatigue fractures in metatarsal IV can also be explained in this way. Such manifestations occur virtually exclusively during childhood and adolescence, among light children.

It is only in the case of a very low bodyweight that the flexor in the big toe is able to shift the gait direction so far outwards over an extended period of time.If the musculature tires due to constant overload, the gait direction also moves back to the painful splayfoot. In order to avoid this, the foot actively depresses its longitudinal arch, turns the forefoot outwards and shifts the gait direction to the inside of the big toe. This relieves the navicular bone and creates an overpronator.

Trying to take corrective action by supporting the longitudinal arch forces the gait direction back to the painful splayfoot and generates uncontrollable reactions to the pain throughout the entire body.

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