Flat Foot - Dr. Jeffrey E McAlister

Flat Foot

Flat Feet

People who have flat feet have little or no arch, meaning their feet lay flat on the ground. The medical term for flat feet is posterior tibial tendon dysfunction (PTTD). This is where changes in the tendon impair its ability to support the arch, resulting in flattening of the foot.

Flat feet is problematic because the arch of the foot is what normally helps distribute body weight. It’s common for people with flat feet to walk on the inner side of their foot as the foot may roll; this is known as pronation. As a result, a person may wear through a pair of shoes on one side faster. Although not a life-threatening condition, flat feet may require treatment if it is painful. Having flat feet can further complicate other ankle, foot, or lower leg conditions that a person may already suffer from.

Symptoms, Causes, Risk Factors, and Treatment of Flat Feet

Symptoms of Flat Feet

The most common symptom of having flat feet is ankle and arch pain. This can happen because of strained muscles and connecting ligaments. Abnormal stresses of the hip and knee may also worsen pain in these joints, which may be even more likely to occur if the ankles are turned inward. The pain may affect different parts of the body, including the:

  • Arch of the foot
  • Calf
  • Knee
  • Hip
  • Lower back
  • Lower legs

In addition, as the arch flattens in the early stages, an inward rolling of the ankle occurs with pain on the inside of the foot and ankle. Later, as the condition progresses, the foot will roll outward and the pain will typically shift to the outside of the foot below the ankle. Arthritis can develop when the posterior tibial tendon has significantly deteriorated.

Causes of Flat Feet

There are several different causes of flat feet. The most common cause is that it’s a hereditary foot type, in which a parent may pass the genetic trait to their children, predisposing them to issues related to flat feet.

Another condition called flexible flatfoot may also be the cause. Flexible flatfoot is when a person has arches while they sit, but no visible arch when they stand. This condition is common in children and is often outgrown, but that is not always the case.

Arches may also fall over time due to wear and tear on the posterior tibial tendon running along the inside of the foot to the ankle, which helps support the arch. This is termed “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. The condition will typically worsen, especially if it isn’t treated early.

Risk Factors for Flat Feet

Factors that may increase your likelihood of having flat feet include:

  • Aging
  • Diabetes
  • Rheumatoid arthritis
  • Obesity
  • Injury of the foot or ankle
  • Improper, ill-fitting shoe gear

Treatment Options for Flat Feet

Common treatment options to alleviate the pain associated with flat feet consist of:

  • Arch supports (orthotic inserts) – Either over-the-counter or custom designed.
  • Immobilization Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal. A patient may need to completely avoid all weight-bearing for some time.
  • Stretching exercises – People with flat feet often have a shortened Achilles tendon. Exercising the tendon may reduce pain.
  • Supportive shoes – Wearing shoes that provide more support to the arch may cause less pain than shoes that provide minimal support.
  • Physical therapy (PT) – PT is often utilized in individuals who are athletes, especially runners as flat feet may contribute to overuse injuries.

When is Surgery for Flat Feet Indicated?

Surgical treatment of a flat foot is typically discussed after conservative measures have failed. Supportive foot orthoses can last up to several years and may prevent surgery, but if the foot is painful despite the orthoses, surgery may be the next step. Surgical reconstruction is performed when the arch is collapsed but still flexible.

An MRI (magnetic resonance image) or advanced imaging is often ordered to assess the severity of the tendon damage. A surgical approach is then devised to have a successful outcome and rehabilitation, with the overall goal being to improve the alignment and function of the foot. Typically, a combination of procedures is performed to repair the ligaments and tendons that support the arch.

Additionally, a combination of procedures is often performed to reconstruct the flat foot through correcting deformities in the bones and repairing ligaments and tendons.

Surgical Techniques for Flat Feet

  • Medializing Calcaneal Osteotomy – Used when the heel bone has shifted out from underneath the leg.
  • Lateral Column Lengthening – Performed when the foot is outwardly rotated.
  • Medial Cuneiform Dorsal Opening Wedge Osteotomy or First Tarsal-Metatarsal Fusion – Used when the arch collapse leads to the big toe side of the foot being raised above the ground.
  • Tendon and Ligament Procedures – Used to correct a stretched and dysfunctional posterior tibial tendon
  • Double or Triple Arthrodesis – In the later stages of flat feet, when the deformities are inflexible and arthritis may be present, this procedure may be used. It involves fusion of one or more of the foot joints.

Dr. McAlister is a fellowship-trained foot and ankle surgeon with expertise in treating flat feet both conservatively and in all surgical techniques when surgery is required.  If flat feet is a condition causing you pain in one or both feet, it’s important to seek treatment early for the best outcome.

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