Overview
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA. If you've ever seen your footprints in the sand and they looked more like bricks than feet, then you probably have flat feet. Simply stated, a flat foot is a foot that does not have an arch when standing. In the medical world, flat feet are associated with "pronated" feet. Pronated is merely the term used to describe the position of the foot when it is flexed upward (dorsiflexed), turned away from the body (abducted), and the heel is rolled outward (everted), all at the same time. A certain amount of pronation is required for normal walking, but too much pronation is often considered a foot's "worst enemy." Over time, excessive pronation can lead to many unpleasant problems including heel pain, bunions, hammertoes, shin splints, and even knee, hip, or back pain. In fact, one orthopedic surgeon discovered that 95% of his total knee replacement patients and 90% of his total hip replacement patients had flat feet. An easy way to tell if you pronate too much is to take a look at your athletic shoes-excessive wearing of the inside heel (arch side of the shoe) as compared to the outside is a classic indication of excessive pronation.
Causes
When flat feet develop at a later age, they are known as fallen arches. The arches may fall because the muscles supporting them are no longer able to do so. In addition the spring ligament within the foot may have lost some of its tension allowing the arch of the foot to flatten. Other conditions causing fallen arches include sudden weight gain, a nervous system injury, or a loss of sensation caused by a disease such as diabetes. Most people with fallen arches are flat on both feet.
Symptoms
Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.
Diagnosis
An examination of the foot is enough for the health care provider to diagnose flat foot. However, the cause must be determined. If an arch develops when the patient stands on his or her toes, the flat foot is called flexible and no treatment or further work-up is necessary. If there is pain associated with the foot or if the arch does not develop with toe-standing, x-rays are necessary. If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your health care provider may recommend an MRI.
Non Surgical Treatment
Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels. Flexible flatfeet with some pain can be relieved with the use of orthotics-shoe inserts that support the arch-and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons. For rigid or inflexible flatfeet, treatment varies depending on the cause. Tarsal coalition if often treated with rest and the wearing of a cast. If this is ineffective, surgery can be done to separate the bones or to reset the bones into a correct position. If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon. The prognosis after surgery is generally good. Complications include pain and some loss of ankle motion, especially when trying to turn the foot in or out. This may be improved with physical therapy.
Surgical Treatment
Common indications for surgery are cerebral palsy with an equinovalgus foot, to prevent progression and breakdown of the midfoot. Rigid and painful Pes Planus. To prevent progression, eg with a Charcot joint. Tibialis posterior dysfunction, where non-surgical treatment is unsuccessful. Possible surgical procedures include Achilles tendon lengthening. Calcaneal osteotomy, to re-align the hindfoot. Reconstruction of the tibialis posterior tendon. For severe midfoot collapse of the arch, triple arthrodesis may be indicated.
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA. If you've ever seen your footprints in the sand and they looked more like bricks than feet, then you probably have flat feet. Simply stated, a flat foot is a foot that does not have an arch when standing. In the medical world, flat feet are associated with "pronated" feet. Pronated is merely the term used to describe the position of the foot when it is flexed upward (dorsiflexed), turned away from the body (abducted), and the heel is rolled outward (everted), all at the same time. A certain amount of pronation is required for normal walking, but too much pronation is often considered a foot's "worst enemy." Over time, excessive pronation can lead to many unpleasant problems including heel pain, bunions, hammertoes, shin splints, and even knee, hip, or back pain. In fact, one orthopedic surgeon discovered that 95% of his total knee replacement patients and 90% of his total hip replacement patients had flat feet. An easy way to tell if you pronate too much is to take a look at your athletic shoes-excessive wearing of the inside heel (arch side of the shoe) as compared to the outside is a classic indication of excessive pronation.
Causes
When flat feet develop at a later age, they are known as fallen arches. The arches may fall because the muscles supporting them are no longer able to do so. In addition the spring ligament within the foot may have lost some of its tension allowing the arch of the foot to flatten. Other conditions causing fallen arches include sudden weight gain, a nervous system injury, or a loss of sensation caused by a disease such as diabetes. Most people with fallen arches are flat on both feet.
Symptoms
Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.
Diagnosis
An examination of the foot is enough for the health care provider to diagnose flat foot. However, the cause must be determined. If an arch develops when the patient stands on his or her toes, the flat foot is called flexible and no treatment or further work-up is necessary. If there is pain associated with the foot or if the arch does not develop with toe-standing, x-rays are necessary. If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your health care provider may recommend an MRI.
Non Surgical Treatment
Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels. Flexible flatfeet with some pain can be relieved with the use of orthotics-shoe inserts that support the arch-and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons. For rigid or inflexible flatfeet, treatment varies depending on the cause. Tarsal coalition if often treated with rest and the wearing of a cast. If this is ineffective, surgery can be done to separate the bones or to reset the bones into a correct position. If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon. The prognosis after surgery is generally good. Complications include pain and some loss of ankle motion, especially when trying to turn the foot in or out. This may be improved with physical therapy.
Surgical Treatment
Common indications for surgery are cerebral palsy with an equinovalgus foot, to prevent progression and breakdown of the midfoot. Rigid and painful Pes Planus. To prevent progression, eg with a Charcot joint. Tibialis posterior dysfunction, where non-surgical treatment is unsuccessful. Possible surgical procedures include Achilles tendon lengthening. Calcaneal osteotomy, to re-align the hindfoot. Reconstruction of the tibialis posterior tendon. For severe midfoot collapse of the arch, triple arthrodesis may be indicated.
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