Flat Feet
“Flat Feet” is a widely used generic medical term that describes some type of decrease in the height of the arch that is located on the inside of the foot. In some cases, a person with flat feet has a slight decrease in arch height, while in other cases, there is no arch visualized. Flat feet are considered normal in infancy and in young children until 8-10 years of age. Around this time, an arch should be identified. However; most people with flat feet never develop pain.
There are many different terms that are used to describe a person with flat feet. Some of these include pes planus, pes valgus, equino valgus, collapsing pes valgo planus, and talipes calcaneovalgus. Although flat feet is a broad term, it is a very complex disorder that not only affects the arch but also other parts of the foot and/or ankle. The most commonly associated disorders with flat feet are bunions, hammertoes, heel pain, midfoot collapses and dislocations, and an everted or valgus position of the heel and/ or ankle as well as equinus. Since there are so many associated disorders that can cause symptoms with flat feet, the associated disorders should also be treated concurrently when treating flat feet.
In general, there are two very common presentations of flat feet which are termed “flexible” and “rigid”. A “flexible” flat foot means that the arch collapses upon weight bearing of the foot while the arch of the foot is visible when the foot is not touching the ground. Flexible flat feet commonly occur in the pediatric or adolescence and can continue into adulthood. If symptomatic and not properly treated, a flexible flatfoot can become stiff or rigid and potentially develop in a more severe condition. The second common presentation of flat foot is termed “rigid” which means that the height of the arch is the same whether or not the foot is touching the ground during weight-bearing. Rigid flat feet can be caused by many factors including arthritis, tarsal coalitions, and congenital vertical talus.
The severity of symptoms that occur with flat feet varies from person to person as well as the location on the lower leg and foot. The symptoms are not defined by how low the height of the arch is but rather the adaptive changes in bone, tendons, and ligaments. At times, there are patients that have no visible arch height, who are asymptomatic, while patients with a very slight decrease in their arch height have severe symptoms.
After diagnosing flat feet by a physical examination and radiographs as well as other imaging modalities, the treatment regiment should begin promptly. There are non-surgical and surgical treatment protocols to help treat the pediatric as well as the adult acquired flat foot. The conservative treatments are based on controlling the pathological movements of the bones, ligaments, and tendons. This is done by custom molded foot orthotics, and/ or foot and ankle braces. Rest, ice, compression, elevation and an organized physical therapy regiment helps decrease the tenderness, inflammation, and swelling that occurs.
When considerable effort of conservative treatment has failed to relieve symptoms, surgical intervention is indicated. The type of procedure that is performed is highly variable because each flat foot is unique to each other. The principles behind the vast array of surgical procedures available are based on to correct each area of soft tissue, ligament, and bone that is contributing to the pathologic symptoms. The surgical procedures can range from implants, soft tissue releases, and tendon transfers to osteotomies and fusions of bones with or without bone grafts. The recovery period is dependent on the surgical procedure performed which can range from 8- 12 weeks followed by physical therapy.
