Flatfoot, also known as pes planus or collapsed medial arch, is generally an overlooked condition. However, it occurs when the entire sole touches the ground along with the collapse of the foot arch. This alters the shape designed for our body to move. Similar to having a weak foundation at home, this condition, initially unnoticed, can lead to discomfort, pain, and alignment problems throughout the body over time.
Flatfoot, also known as pes planus or collapsed medial arch, is generally an overlooked condition. However, it occurs when the entire sole touches the ground along with the collapse of the foot arch. This alters the shape designed for our body to move. Similar to having a weak foundation at home, this condition, initially unnoticed, can lead to discomfort, pain, and alignment problems throughout the body over time.
Flatfoot does not occur spontaneously. Genetic factors, lifestyle preferences, and certain health conditions can prevent the proper formation of the foot arch or cause it to collapse over time. Here are the main causes of flatfoot:
- Genetics: If flatfoot runs in your family, the likelihood of you having it is high. This is an inherited trait.
- Tarsal Coalition: Restriction of movement due to the fusion of two or more bones in the foot leads to flatfoot. It is usually noticed during adolescence.
- Posterior Tibial Tendon Dysfunction (PTTD) - Adult Acquired Flatfoot: It is a common cause in adults. If the posterior tibial tendon becomes inflamed or ruptured, the medial arch collapses over time, resulting in flatfoot.
- Obesity: Excess weight creates additional pressure on the feet. This pressure tends to flatten the medial arch, especially in adults over time.
- Arthritis: Conditions like rheumatoid arthritis can affect the foot joints and tendons, leading to flatfoot.
- Injury: Foot or ankle trauma, fractures, or sprains can cause the loss of medial arch support and the development of flatfoot.
- Aging: As age advances, tendons and ligaments supporting the foot's medial arch weaken, leading to flatfoot.
- Neurological or Muscle Disorders: Conditions like cerebral palsy or muscular dystrophy can cause flatfoot by affecting muscle tone and control.
- Developmental Issues: Some children do not develop the arch of the medial foot due to developmental issues. This condition remains as developmental flatfoot into adulthood.
Not everyone with flatfoot experiences symptoms. However, when symptoms arise, the body manifests this condition in various ways:
- Pain: It usually occurs in the foot's medial arch or instep, heel, or ankle and worsens after prolonged standing or walking.
- Swelling - Bone Protrusion: Swelling, especially on the inner side of the ankle, may be visible.
- Overpronation: Excessive rolling inward of the foot causes extra strain on the knees and hips.
- Difficulty Finding Shoes: Individuals with flatfoot struggle to find comfort in shoes designed for high-arched feet, especially avoiding slippers.
Flatfoot can occur at any age. Sometimes it is an issue leftover from childhood, and sometimes it develops due to aging, injury, or health problems. Understanding the risk factors is crucial in terms of prevention and management:
- Age: As age progresses, tendons naturally weaken, increasing the risk of flatfoot.
- Obesity: Increased weight strains the foot structure. Therefore, overweight individuals are at risk.
- Diabetes: Diabetes affects the feet by influencing circulation and nerve health. Diabetics are at a higher risk of flatfoot due to decreased tendon elasticity, Achilles tendon shortening, and flatfoot risk.
- Pregnancy: Hormonal changes and extra weight during pregnancy can affect the foot structure and make flatfoot more prevalent.
Diagnosing flatfoot is not difficult, but early diagnosis is important to prevent it from progressing into a more serious condition. Here is how flatfoot is diagnosed:
1. Physical Examination
- Visual Examination:: The doctor examines the feet while standing and walking, checking for the absence of the arch and signs of overpronation.
- Gait Analysis: Your walking pattern is evaluated to detect abnormalities.
- Manual Test:: The flexibility of the foot arch is tested by manipulating the foot, and pain, sensitivity, and tendon functions are assessed.
2. Imaging Tests
- X-ray:: Used to examine bone structure and alignment, detect shape abnormalities, and assess the severity of flatfoot.
- MRI:: Provides detailed images of soft tissues and cartilage to diagnose issues like tendon dysfunction.
3. Other Diagnostic Tools
- Footprint Analysis:: A simple test showing the degree of collapse in the medial arch. These analyses can be evaluated manually or digitally for diagnosis.
- Functional Tests: Activities like toe stands and standing on tiptoes evaluate the function of the tibialis posterior tendon and other tendon and ligament functions.
- Patient History:: Your symptoms, past injuries, and family history of flatfoot are taken into account.
If flatfoot does not cause discomfort, it usually does not require treatment. However, if it is severe or progressive or causes discomfort, the goal of treatment is clear: to reduce pain, improve function, and prevent complications. Here are what can be done for flatfoot:
- Orthopedic Insoles: These insoles provide medial arch support, distribute pressure on the foot evenly, alleviate discomfort, and improve foot alignment.
- Supportive Shoes: Wearing shoes with good medial arch support and a stable heel section can help manage flatfoot symptoms. Shoes that provide less arch support, especially flip-flops, should be avoided.
- Physical Therapy: Exercises that strengthen and stretch the foot and ankle muscles can increase muscle function to better support the medial arch.
- Weight Management: Losing weight in overweight individuals can reduce pressure on the feet, alleviating symptoms.
- Medications: Medications like NSAIDs (nonsteroidal anti-inflammatory drugs) can reduce flatfoot-related pain and inflammation.
- Tendon Transfer: If the posterior tibial tendon is damaged, a tendon (most commonly the FDL tendon) taken from another part of the foot can be transferred to support the arch.
- Osteotomy (bone corrective procedure): Cutting and realigning the bones aims to improve foot structure and support the medial arch.
- Arthrodesis (joint fusion): Fusing certain foot joints is used in severe flatfoot cases to maintain the medial arch and provide stability.
- Lateral Column Lengthening (calcaneal osteotomy): This surgical procedure involves making a bone cut on the outer side of the foot (heel bone - calcaneus) followed by inserting a bone graft to reconstruct the medial arch, improving foot alignment with an increased talonavicular joint overlap.
Surgery is not always necessary to manage flatfoot:
- Foot Exercises: Regular exercises like toe raises and towel scrunches can strengthen foot muscles and naturally increase arch support.
- Rest and Ice Application: Resting and applying ice to the affected area can reduce inflammation if flatfoot causes pain.
Preventing Flatfoot - Reduce Risks
Preventing flatfoot or at least managing its risk is in your hands:
- Healthy Weight Maintenance: Reduces pressure on the foot's medial arch. Regular exercise and a balanced diet play a key role in this regard.
- Wearing Supportive Shoes: Provides correct medial arch support and foot alignment. Shoes with good medial arch support should be preferred, while high-heeled shoes should be avoided.
- Foot Strengthening Exercises: Strengthening the supporting muscles of the medial arch. Perform exercises like toe raises and medial arch lifts regularly.
- Monitoring Early Symptoms: Early diagnosis can prevent progression. Seek medical help if you notice any changes in foot structure or experience pain.
Flatfoot may seem like a trivial problem, but if left uncontrolled, it can lead to significant discomforts and other complications. Understanding the causes, symptoms, and available treatment options is crucial in effectively managing this condition. You can manage flatfoot with non-surgical methods, orthopedic insoles, and physical therapy. Taking preventive measures like healthy weight maintenance and wearing supportive shoes plays a vital role in reducing the risk of flatfoot.
