What Are Flat Feet:
Flat feet occur when the normal arches of the foot partially or completely collapse and come into complete or near complete contact with the ground. Roughly 25%-30% of the population have flatfeet with only about 10-20% of those patients symptomatic. This condition can be present at birth otherwise known at congenital or be acquired later in life. Acquired flatfeet are often secondary to a prior injury or as a result of age.
Symptoms of Flat Feet:
Flatfeet can result in rolling of the foot inwards when walking. Pain may or may not be present when walking on uneven ground depending on the cause of the flatfoot. Generally speaking, in the early stages of a painful flat foot, pain presents on the instep of the foot with symptoms such as tired arches or swelling. During the later stages of a painful flatfoot - patients may experience pain near the outside of their ankle. Untreated painful flatfeet (but not always) can lead to various forms of tendonitis and arthritis of the foot and ankle.
Diagnosis:
The diagnosis of flat feet is often made by visual inspection with the assistance of imaging tests such as x-rays, MRIs and CT scans when necessary. The ‘too many toes’ test is an example of a sign of flat feet and is performed when your doctor stands behind you and counts the number of toes peeking out to the sides. In the normal population, only the pinky toe is seen, however patients with flatfeet may have 3 or 4 toes visible from behind the patient.
Flat Feet in Children:
Flat feet in children are a common condition in which the arch has not started to develop until age 2 or 3. Once the arch has fully developed in a child, and he or she still has painful flat feet, we advise consultation with our offices for evaluation. Rarely, flat feet are caused by foot bones that are joined together. When abnormal foot bones are joined together, called a coalition, one foot may appear flatter than the other and your child may exhibit pain while walking on uneven terrain.
Flat Feet in Adults:
Adult-acquired causes for flat feet can be secondary to prolonged barefoot walking and most often are associated with tendonitis of the strongest tendon to support your arch: the posterior tibial tendon. When weakness of the posterior tibial tendon occurs, your arch may collapse. A fallen arch most commonly occurs in women over 40 and patients who are obese. Some other conditions linked with adult – acquired flat feet are rheumatoid arthritis, leg length inequality, Marfan’s syndrome and pregnancy.
Fallen arches are almost always permanent. Many people will have a condition known as flexible flat foot in which the arch is visible when lifting the great toe. A smaller percentage of patients will have a condition known as rigid flat foot in which the arch is firmly collapsed on the ground and cannot be recreated by lifting the great toe. Rigid flat feet are often associated with arthritis.
Treatment of Flatfeet:
Non-operative:
Non-operative treatment of flatfeet is generally the mainstay of treatment for most pathologies. Support of the arch along with non-steroidal anti-inflammatory medications (NSAIDs) and eventually tendon strengthening is the mainstay of non-operative management. Orthotic devices are additional support in your shoes which are custom fitted or over the counter devices to support the arch from falling while standing or walking. Once initial inflammation is treated, support and strengthening are the next phase of non-operative care. Maintenance of arch support is crucial with orthotic support being worn in your shoes for the rest of your life to prevent reoccurrence of pain and discomfort.
Operative:
Operative reconstruction of flatfeet is only recommended when non-operative management has failed. Operative treatment can consist of rearrangement of the bones and repair or re-orienting the course of tendons. Additionally, lengthening of your Achilles tendon may be necessary. Finally, operative treatment may involve stiffening of your hindfoot to alleviate pain and discomfort.
The Doctors and staff at Premier Orthopaedic Associates have been providing quality care to the residents of South Jersey for over 30 years. They would like to welcome Dr. Benjamin Marder to the practice. Dr. Marder has extensive surgical experience from his training at the University of Pennsylvania and has added Fellowship training with specific focus on flat foot surgical reconstruction for adults and children.
