What is flatfoot?
Flatfoot—also known as pes planus—is a disorder that develops when the arch on the inside of the foot becomes flattened (fallen arch), making it painful to participate in daily activities, especially walking and running.
What are the symptoms of flatfoot?
In most cases, patients do not experience any symptoms. Those who do, however, experience pain in the foot—particularly in the arch or heel—that may worsen with activity. Patients may also experience swelling that occurs on the inside of the ankle, as well as knee or even back pain due to the fallen arch.
What causes flatfoot?
Flatfoot is normal in small children (e.g., toddlers) because the arch develops over time as the child grows. In certain situations, the arch may not even develop at all, which is also normal.
When flatfoot occurs in adults, it may be the result of stress on the tendon that helps support the arch, as well as the aging process. It can also develop after accidents or injuries and sometimes is due to genetics in certain patients.
How is flatfoot diagnosed?
During a physical exam, the physician will observe the feet from both the back and the front, and ask the patient to stand on tiptoe. The physician may also want to check the wear pattern on the bottom of the patient’s shoes to see where pressure is being placed on the foot.
Diagnostic testing may also be recommended, which can include:
- X-rays, which are primarily used to detect the presence of arthritis
- Computed tomography (CT) scan, which provides more detailed images than a standard X-ray
- Ultrasound, if tendon injury is suspected
- Magnetic resonance imaging (MRI) to provide a detailed image of both the hard and soft tissues of the foot and ankle
How is flatfoot treated?
If flatfoot is causing pain, swelling or discomfort, a specialist may recommend one of several nonsurgical options, including:
- Orthotic devices to reduce symptoms, such as over-the-counter or custom-designed shoe inserts
- Physical therapy to improve form and technique for patients engaged in light to moderate exercise, as well as those who heavily participate in sports or other athletic activity
- Stretching exercises for patients who have shortened Achilles tendons in addition to flatfoot
- Supportive shoes, such as a quality sneaker (as compared to a sandal or flat-soled shoe)
If the patient still experiences pain and discomfort after all other methods of treatment have failed, a combination of surgical procedures may be needed to improve the alignment of the foot. These include:
- Double or triple arthrodesis, a fusion of the joints to give the foot strength and correct arthritis that may have developed within the joints of the foot (double or triple indicates the number of joints that are fused together)
- Lateral column lengthening, in which a portion of the heel bone is cut and a wedge is implanted into the opening to make the bone “longer” and rotate the foot back from an outward-facing position
- Medial calcaneal osteotomy, where the heel is readjusted to the correct position and secured in place using metal screws or plates
Recovery following flatfoot surgery will depend heavily on the techniques being utilized as well as the individual patient. The surgeon will discuss with the patient what to expect following the procedure.
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