What does it mean to have flat feet?
When the normal arch of the foot instep is absent or collapsed and the foot points outwards, one is said to have flat feet. It is important to understand that having flat feet may itself be entirely normal. If the flat feet cause symptoms such as pain and difficulty walking only then is any medical treatment necessary. 10 to 25% of people will have a flat foot and it is one of the commonest foot and ankle conditions seen in clinic. When this condition causes symptoms, it can be dealt with by bracing and orthotic insoles. Surgery may be necessary in certain cases. Mr Shariff will create a suitable management plan for your problem based on your symptoms and severity of deformity.
What is adult acquired flat foot?
This is a condition where the arch of the instep of the foot collapses. It typically occurs more commonly in women at an average age of 50 to 60 years. Being overweight may also contribute to this problem.
What are the causes of a painful flat foot?
There are several causes which can cause a flat foot deformity. Some of the more common ones are:
• Posterior tibial tendon dysfunction - damage to the posterior tibial tendon is the most common causes. The posterior tibial tendon is one of the most important tendons of the leg. It starts as a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inner side of the foot. This tendon helps to holds up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse. Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.
• Arthritis - typically inflammatory arthritis which damages not just the joints but also the capsule and ligaments supporting these joints may cause this condition.
• Diabetic foot collapse (Charcot foot) - This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet, because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate.
What are the symptoms caused by an adult acquired flat foot?
• You may have pain and swelling along the course of the posterior tibial tendon located at the inner aspect of the ankle.
• When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle.
How is this condition diagnosed?
Your consultant will examine your foot clinically and this usually makes the diagnosis clear. X-rays of the foot and ankle are taken and in some instances an ultrasound or an MRI scan may also be ordered to look at the tendon in greater detail.
Can the condition worsen?
The condition usually does worsen with time. As the foot flattens out and the tendon stretches, it may eventually tear. With time arthritis may set into the foot if corrective measures are not taken earlier.
What treatment options are there?
Initially when the deformity is flexible, corrective insoles will improve your symptoms. However if they don't work, particularly in young active individuals, surgery in the form of a flat foot reconstruction by shifting the heel bone and tendon transfer is performed. Once the deformity is fixed and arthritis sets in, a fusion (triple fusion) is the surgery of choice.
Is surgery necessary?
In a vast majority of people simple shoe wear modification and splints will be sufficient to manage the symptoms. If these fail, then surgery can be considered. Surgery can be timed to suit your benefit and options will be discussed in greater detail with you.