Flatfoot

What is flatfoot?

Flatfoot, also known as "fallen arches" or pes planus, is a deformity in which the arch of the foot that runs lengthwise along the sole has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved. Rigid flatfoot, however, can cause joint pain in the leg when walking or aching pain in the feet and usually requires intervention.

What are the causes/risk factors of flatfoot

Flat foot is a common condition that can run in families. 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 while standing 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.

Signs and symptoms of flatfoot

Flatfoot deformity is characterised by the following signs and symptoms:

• Inside arch of the foot is flattened
• Heel bone may be turned outward
• The inner aspect of the foot may appear bowed out
• Pain in the foot, leg, knee, hip, or lower back
• Pain in the heels causing difficultly with walking/running
• Discomfort with wearing shoes
• Inability to bear weight on the affected foot
• Tired, achy feet with prolonged standing or walking

Diagnosis of flatfoot

Your doctor will perform a physical examination and observe the foot in standing and sitting positions. If the arch forms while standing up on his toes, then the flatfoot is flexible and no further tests or treatment is necessary. If the pain is associated with the condition, or if the arch does not form on standing on toes, then X-rays are ordered to assess the severity of the deformity. A computed tomography (CT) scan is done if a tarsal coalition is suspected and if tendon injury is presumed a magnetic resonance imaging (MRI) is recommended.

Conservative Treatment

Children with flatfoot that do not exhibit any other symptoms are monitored as they grow to assess for any changes. For symptomatic flatfoot, your doctor may suggest some of the following non-surgical treatments.

• Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time.
• Orthotic devices: Your surgeon may advise on the use of custom made orthotic devices that are worn inside the shoes to support the arch of the foot.
• Physical Therapy: Stretching exercises of the heel can provide pain relief.
• Medications: Pain-relieving medications such as NSAID's can help to reduce pain and inflammation.
• Shoe modification: Using a well‐fitting, supportive shoe can help relieve aching pain caused by flatfoot.

If conservative treatment options fail to relieve your child's symptoms then surgery may be necessary to resolve the problem. Depending on the condition, various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.