Flat feet and fallen arches are common conditions that are in most cases asymptomatic. However, in patients who do have symptoms, treatments are available that can help reduce pain and promote efficient movement. Orthotic devices are well recognised as an excellent treatment and podiatrists can offer these different treatment modalities as individualised treatments for patients.
There are many different causes of flat feet, which can be separated into two main categories. The first category, congenital flat foot, is a condition that one is born with or is predisposed to at birth. This type includes the completely asymptomatic, pediatric flexible flat foot-by far the most common form of congenital flat foot. Flexible means that an arch is present until weight is put on the foot, at which time the arch disappears. This foot type is a result of the fact that all people are born with different physical features. Some people have bigger noses than others, just as some people have flatter feet (of course, there is no known correlation between the two). Any alteration in the many building blocks of the foot can influence its shape. At the other end of the spectrum, yet within the same category of congenital flat foot, exist several rare, more severe forms of flat foot. These severe conditions include Vertical Talus, Congenital Calcaneal Valgus, and Tarsal Coalitions - all of which are more rigid (no arch with or without weight on the foot) and definitely symptomatic. Luckily, these are much less common, but can usually be identified by specialists at the time of presentation and treated appropriately. The second category, acquired flat foot, develops over time, rather than at birth. Many different factors can contribute to the development of flat feet. These include the types of shoes a child wears, a child's sitting or sleeping positions, compensation for other abnormalities further up the leg, or more severe factors such as rupture of ligaments or tendons in the foot. Very commonly, the reason for flat feet is that the foot is compensating for a tight Achilles tendon. If the Achilles tendon is tight, then it causes the foot to point down, or to plantarflex (as occurs when stepping on the accelerator of your car). Even minimal amounts of plantarflexion can simulate a longer leg on that particular side, assuming that the other foot is in the normal position. The body therefore tries to compensate by pronating, or flattening out the arch, thereby making up for the perceived extra length on the affected side.
Most people do not exhibit any symptoms of flat feet, but if the condition is due to an underlying problem, symptoms can include foot pain, mainly in the arch or heel areas, difficulty standing on tiptoes, swelling that occurs on the inside of the ankle, pain in the calf, knee, hip, or lower leg area, both feet lie flat on the ground with no gap, Shoes may not fit properly, heel may tilt away from the midline of the body more than usual, absence of foot arch when standing. If you are experiencing these symptoms and have flat feet, you should consider seeing your doctor or a podiatrist immediately for an examination.
Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.
Non Surgical Treatment
Custom orthotics are specially designed insoles, which are made for your by prescription. This is done by taking a plaster cast of the foot in its neutral position and is then sent to a laboratory, with your prescription to be made to your exact specifications. The insole then correctly aligns your foot and as a result your body. This will relieve abnormal strain of tissues and structures which can cause pain. For less severe mal-alignments or for sports use a wide variety of temporary insoles.
In cases of flat feet that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required and in some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.
Donning a first-rate pair of arch supports, therapeutic socks and proper footwear before heading out to enjoy hours of holiday fun is one option to consider. Your podiatrist can help you find just the right ones. Once you have them on, they?ll help ease the amount of pressure being put on your body and keep the blood flowing in the right direction. While you?re standing in line, consider doing a bit of exercise as well. We?re not talking about channeling your inner Jack LaLanne here. Otherwise, you might attract the attention of the mall security guards. Simple ankle rotations and walking in place may help to reduce edema and give your flat feet a bit of a break. If you happen to be in a shopping mall or center where foot massages are available, take advantage of them periodically. They are likely to make you feel better and it?s a great excuse to carve out a few quiet moments for yourself. If you can?t visit a professional, tuck a personal foot massager into your purse. That way, you can lightly massage your own feet during the car ride home. Lastly, there are certain foods and nutritional supplements available that may reduce edema caused by standing on flat feet for hours at a time. The list includes potassium rich foods like raisins, bananas, baby carrots, nuts and yogurt. So, you may want to pack a snack for those trips to the mall or hit the food court before you hit the stores.
Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.