Flatfoot, or “fallen arches” or Pes planus, is a deformity in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. The arch of the foot usually develops between the age of 3 and 5 years. Flatfoot is normal in the first few years of life. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved. Rigid pediatric flatfoot however can cause joint pain in the leg when walking or an aching pain in the feet and usually requires intervention.
Causes
Pediatric flat foot is a common condition that is hereditary. It is often caused by loose connections between joints and excess baby fat deposits between foot bones which make the entire foot touch the floor when the child stands up. A rare condition called Tarsal Coalition can also cause flatfoot. In this condition, two or more bones of the foot join abnormally causing stiff and painful flat feet.
Adult acquired flat foot is related to the collapse in the hindfoot due to failure of the posterior tibial tendon and surrounding structures. This is most commonly a “wear and tear of life” issue, but is more common in women and those with higher body mass.
Symptoms
Symptoms of flatfoot include:
- Inside arch of the foot is flattened
- Heel bone may be turned outward
- Pain in the foot, leg, knee, hip, or lower back
- Pain in the heels causing difficultly with walking/running
- Discomfort with wearing shoes
- Inner aspect of the foot may appear bowed out
Diagnosis
The doctor will and observe the patient in standing and sitting positions and perform a physical examination. If the flatfoot is flexible, symmetric, and there is no discomfort, no further tests or treatment are necessary. If pain is associated with the condition, or if the arch does not form on standing on toes, then X-rays will be ordered to assess the severity of the deformity. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be ordered.
Treatment
Symmetric flat feet without pain do not require any formal evaluation or treatment. If there is pain or asymmetry, evaluation and weightbearing X-rays are necessary.
- Avoid participating in activities that cause pain such as walking or standing for long periods of time.
- Short term immobilization in a fracture walker can be recommended.
- Use of an over-the-counter or custom made orthotic device that is worn inside the shoes to support the arch of the foot may be recommended.
- Stretching exercises of the heel that can provide pain relief may be recommended in Physical Therapy
- Pain relief medications such as NSAID’s can help to reduce pain and inflammation.
- Shoe modification: a well‐fitting, supportive shoe can help relieve aching pain caused by flatfoot.
Surgery is rarely needed to treat pediatric flatfoot, however, if conservative treatment options fail to relieve symptoms, then surgery may be necessary to resolve the problem., Various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.
Adult acquired flatfoot can require more extensive bracing or surgical reconstruction depending on the severity of deformity and the tendon conditionEarly surgical correction is aimed at restoring the function of the posterior tibial tendon. Late surgical correction is usually a triple arthrodesis (fusion of the hindfoot) to restore alignment.