UNDERSTANDING FOREFOOT VARUS: SYMPTOMS AND TREATMENT OPTIONS

Our feet are the foundation of our body’s movement, and when something is misaligned, it can throw everything off balance. One common but often overlooked structural issue is forefoot varus. If you're dealing with chronic foot pain, ankle instability, or even higher issues in your knees or hips, forefoot varus might be playing a role. Let’s dive into what this condition is, how it presents, and what you can do to treat it.

WHAT IS FOREFOOT VARUS?

Forefoot varus is a congenital foot deformity where the front part of the foot (the forefoot) is inverted relative to the rearfoot when the subtalar joint is in a neutral position. In simpler terms, the inside of the foot sits higher off the ground than it should, especially when standing flat. This misalignment can force the foot to compensate in ways that lead to pain and dysfunction.

COMMON SYMPTOMS OF FOREFOOT VARUS

Because forefoot varus causes your foot to compensate during walking or standing, it can lead to a wide range of symptoms — many of which may seem unrelated at first. Here are some of the most common:

Excessive Pronation - The most noticeable sign is overpronation — when the foot rolls inward too much during walking or running. This can affect the entire kinetic chain, from foot to hip.

Arch Pain or Collapse - The extra strain from overpronation can cause the arch to collapse, leading to flatfoot symptoms or discomfort along the medial (inner) part of the foot.

Plantar Fasciitis - The inward roll and arch strain can inflame the plantar fascia — the thick band of tissue running across the bottom of your foot — leading to heel pain.

Shin Splints or Knee Pain - The altered biomechanics can affect how your leg muscles work, potentially leading to shin splints or patellofemoral (knee) pain.

Metatarsalgia or Ball-of-Foot Pain - The uneven pressure on the forefoot may cause pain in the ball of the foot or under the toes.

Frequent Ankle Sprains  - Because the foot is less stable, especially on uneven ground, ankle instability and sprains are more common.

Calluses or Corns - Abnormal pressure points may form on the ball or inside of the foot, causing thickened skin or calluses.

DIAGNOSING FOREFOOT VARUS

A proper diagnosis usually involves a physical examination by a podiatrist, orthopedic specialist, or physical therapist. They’ll assess your foot alignment in a non-weight-bearing position and observe how your foot moves during walking. Sometimes, imaging or pressure plate analysis may be used to confirm the diagnosis and rule out other conditions.

TREATMENT OPTIONS

The good news? Forefoot varus can be managed effectively with a combination of conservative treatments. Here are some common approaches:

Custom Orthotics - The cornerstone of treatment. A custom foot orthotic with forefoot posting can correct alignment and reduce abnormal pronation. Over-the-counter insoles rarely provide enough support for this condition.

Supportive Footwear - Wearing shoes with good arch support and motion control can help stabilize the foot and improve comfort during walking or exercise.

Physical Therapy - Targeted exercises can strengthen foot and ankle muscles, improve balance, and retrain your gait to reduce stress on your lower limbs.

Stretching - Tight calf muscles and Achilles tendons often accompany poor foot mechanics. Regular stretching can help reduce compensatory strain.

Activity Modification - Temporarily reducing high-impact activities (like running or jumping) can help reduce pain during a flare-up while you work on correction strategies.

Weight Management - Less weight on the feet means less stress on the joints and soft tissues, which is especially important when structural misalignments are present.

Surgical Intervention (Rare) - In severe or unresponsive cases, surgical correction may be considered, but this is typically a last resort.

Forefoot varus might not be a household term, but it’s a significant factor in many chronic foot and leg issues. If you’re experiencing recurring pain, unusual wear on your shoes, or postural imbalances, it’s worth having your foot structure evaluated. The earlier you address the problem, the easier it is to prevent long-term complications.

Your feet carry you through life — make sure they’re supported every step of the way.

If you or someone that you care for suffers from pain in the feet, ankles, knees, hips, and/or lower back, the pain may be due to misalignment caused by faulty biomechanics, which can be treated and corrected with the help of custom orthotic insoles. To schedule your comprehensive biomechanical evaluation, contact us or call our Sports Medicine Podiatry Center and book an appointment at our Marlton, N.J., Sports Medicine Facility or Ridley Park, P.A. Office location with one of our podiatric sports medicine specialists today by calling (610) 522-9200.