Asymmetrical feet

In this section, Cypress Foot and Ankle specialist Dr. Christopher Correa discusses foot function and what it means to have asymmetric feet. Have you ever looked down at your feet and realized that one foot is flatter than the other? Is that even possible? Aren’t the feet just mirror images of one another? In some cases, asymmetry between feet is from one leg physically being longer than the other. This usually occurs in the setting of a previous injury or joint replacement surgery. Other possible causes for this can be mid or hind foot instability caused by either structural damage within the foot, damage or tearing of the posterior tibial tendon, previous leg injury, or a muscular imbalance originating elsewhere along the kinetic chain (foot, knee, hip, or back), such as scoliosis or pelvic imbalance. Let's take a quick look at lower extremity function to understand why.

Each foot and ankle is part of a complex mechanical system designed to allow for energy-efficient ambulation via a system of ligaments, tendons, and bones. These elements work in concert through coupled motions known as supination and pronation to achieve this goal. That being said, the feet and ankle are attached to the rest of the body, and the position of the foot does cause changes in posture further up the system and vice versa. For example, when rotating one foot inward, causing it to flatten out (pronation), the rotation is carried further up the leg, causing the knee to rotate inward. The opposite is true for external rotation of the foot (supination). In this way, we can sometimes see foot posture causing back pain and low back issues contributing to foot or ankle pain.

This complex interaction begs the question of whether the foot posture controls the hip, or does the hip control the foot posture? The answer is “it depends”. When a muscular imbalance occurs in the hip and lower back, it can lead to changes in the posture of both feet, leading to an apparent unequal leg length. In reality, in this situation, the limbs are not uneven, but rather they are placed in an unequal position. Conversely, if there is damage to foot structures that leads to loss of arch height, this can lead to compensation at the hip and even cause hip pain in spite of the problem originating somewhere else. While there are many examples of foot issues that can lead to a loss of arch height, one such example is posterior tibial tendon dysfunction – a condition where damage to the posterior tibial tendon leads to loss of muscle strength and arch height. If left untreated, it can lead to foot, hip, and knee pain and arthritis. So, if the foot pain is coming from the hip, or is the hip pain coming from the foot? Sometimes custom orthotics with a lift can help correct the foot posture of the 2 sides and serve as a way to balance the patient out. If you or someone you know has asymmetrical feet, give the experts at Select Foot and Ankle Specialists a call and take the first step towards recovery today!