Also known as: Pes Planus or Fallen Arches
Flat feet is a common condition, and for many people it doesn’t cause problems. A flat foot is one where the main arch on the inside of the foot sags, and the level to which it sags determines the severity of the case. It is very common for an individual to be unaware that they have a flat foot, and their lives will be completely normal.
There are different types of flat feet; physiological and pathological. The pathological type is where that foot has something structurally wrong with it, whereas a physiological flat foot has a normal make up, but is just naturally rather flat. Feet can be abnormally shaped from birth, but can also become deformed at any stage in life.
There are two common causes of acquired flat feet. Firstly, it can be caused by the inflammation and degeneration of the tibialis posterior tendon; the tendon that passes to the foot on the inside of the ankle. Secondly, arthritis of the joints below and in front of the ankle, in particular the ones in the middle of the ankle (the tarso-metatarsal joints) and the one below the ankle (the subtalar joint).
Symptoms of inflammation and degeneration of the tibialis posterior tendon include pain, swelling and gradual flattening of the foot.
Symptoms of arthritis of joints in the foot include pain on weight bearing and gradual deformity of the foot.
Diabetics, especially those with the disease for many years, can develop a painless flat foot deformity very rapidly when a ‘Charcot’ process takes place. In this process the foot becomes red and very swollen and treatment is absolutely essential.
With any deformity, from flat foot to high arch, it is essential for the cause to be diagnosed accurately. Anyone who has any of these symptoms should see an orthopaedic surgeon specialising in foot and ankle disorders for a diagnosis.
Treatment will depend on the nature and severity of the deformity.
Not all patients with flat feet need surgery, sometimes observation and simple footwear modification is sufficient. Innersoles can be used to support a stiff foot, however they cannot change its shape. Alternatively orthoses can be used - these are a type of shoe insert that control or correct the structural abnormality within the foot.
Physiotherapy can also be used to treat some problems. This treatment cannot correct rigid deformed feet, but can help stretch tight muscles.
Surgery has a lot to offer patients as it can help make the foot look more normal. Doing this will enable the foot to be better equipped to deal with the rigours of everyday life. Surgery combines tendon transfers, reshaping bones, fusing joints and releasing contractures of soft tissue.
Conservative: Patients with flat feet will be given exercises to strengthen the intrinsic muscles of the foot. They will also be given a set of proprioceptive exercises to improve the overall function of the foot and ankle. A lower limb biomechanical assessment is often of great value as insufficiencies in muscle strength or length in the lower limb often contribute to flat feet. Taping the arch is often useful whilst undergoing rehab.
Post surgery: Patients are often in plaster post surgery and depending on the surgical procedure some will be non weight bearing on crutches for a short time period. Early physiotherapy treatment will help to speed up recovery. Treatment techniques to reduce swelling and pain are used. Appropriate exercises will be taught and practised.