What is flatfoot? Its forms and treatment

09 January 2022
Dr. Elviz Qasımov

Flatfoot (Pes Planovalgus)

If you have complaints of flatfoot, you are most likely familiar with the phenomenon in which the arch of the foot is completely on the floor when you stand. A healthy person’s foot consists of 26 bones that are combined into 33 joints, and there are more than 100 muscles, tendons, and ligaments attached to them. The leg tendons form a tight band around the bones of the foot and heel, thus forming the so-called arch of the foot. With insufficient tension of the ligaments, the size of the arch under the foot decreases and flatfoot develops. This condition can occur in both children and adults. The arch of the foot affects a person’s gait and ability to take steps. The existence of the arch of the foot contributes to the even distribution of a person’s body weight. In order to adapt to different surfaces, the ligaments must be elastic and strong.

Flatfoot can cause pain and discomfort for the patient during the day and during physical activity.

The signs and symptoms

The main symptoms of flat feet are pain and deformities that affect the external (cosmetic) appearance of the foot. Pain worsens during running, exercise and other physical activities. If the pain the patient experiences under the heel and foot is excruciating, he may have trouble walking. In some cases, you may observe swelling around the inner edge of the ankle and along the tendon of the foot. The instability in walking and standing that occurs with flat feet causes increased stress/stress on the hip and knee joints. In such cases, pain in the back and joints of the lower extremities occur. In most cases, patients complain of rapid wear and widening of their shoes. The lack of a healthy foot arch leads to the appearance of a “gait characteristic of flat feet”.

What causes flatfoot?

In adults, flat feet occur for a number of reasons:

  • Genetic/hereditary factors
  • Soft ligaments
  • Weak and torn tendons
  • Sprains and bone fractures
  • Tarsal coalition – congenital articulation of the tarsal bones
  • Disease: rheumatoid arthritis
  • Cerebral palsy, muscular dystrophy, and other similar neuromuscular diseases
  • Overweight and obesity
  • Pregnancy
  • Old age

Posterior tibial tendon dysfunction

This picture shows dysfunction of the posterior tibial tendon

The posterior tibial tendon is one of the main supporting structures that contribute to the formation of the arch of the foot. Dysfunction of the posterior tibial tendon is the most common cause of flatfoot in adulthood due to too much stress and inflammation. Posterior tibial tendon dysfunction, is caused by insufficiency of the tendon, and it affects the surrounding ligamentous apparatus structures, and due to this, becomes the cause of tendon deformity.

These symptoms, which we see more often in adults, occur after running, walking, or going down/climbing stairs. Posterior tibial tendon insufficiency is mostly progressive, which means that if it is not treated early, complications can occur.

The image shows posterior tibial tendon insufficiency

Flatfoot in children

All children are born with flat feet. The vault of the foot begins to form in children after three years of age. It takes time for the tendons to strengthen and the arch to emerge. Sometimes excess fatty tissue can hide the contours of the arch of the foot.

There are two types of flat feet – rigid and elastic (soft). Rigid flatfoot is often caused by bone deformities, tarsal coalition (articulation of the bones of the foot), congenital and hereditary abnormalities. Elastic flatfoot is noticeable when your foot makes contact with the ground – for example, when you lift your foot up, standing on tiptoes. But it disappears under the action of a person’s body weight on the lower extremities. This type of flat feet is most often seen in children.

How is flatfoot diagnosed?

Patients who come to the doctor with signs of flat feet first undergo a physical examination. The doctor collects information about the family history, clarifies whether other family members have had the same complaints. During the clinical examination, the doctor observes the condition of the foot while walking, while trying to stand on the fingertips, and examines the foot in anterior and posterior projection.

Pictured here is a test where the patient is standing on his or her fingertips

The too many toes test

Toe raise Jack test

After the clinical tests, X-rays are prescribed to look at the general structure of the bones and identify the causes of flatfoot.

Treatment for Flatfoot

The method of treatment of flat feet varies depending on the cause of its occurrence, the severity of the deformation and the presence of pain.

Patients who suffer from excess weight should take care of its reduction, because their flatfoot develops on the background of excess weight, and weight loss can lead to a reduction in the degree of complaints.

Restriction of physical activity: in order to reduce the degree of the patient’s complaints, he is prescribed three weeks of rest and warned to avoid movements that may aggravate the symptoms. It is advised to wear a special ankle brace and use a cane.

Decrease in pain: if the tendon is inflamed and damaged and the pain is unbearable, they will wear a special ankle brace and take non-steroidal anti-inflammatory drugs (tablets or gels).

Physiotherapy: under the supervision of a physiotherapist, you can do exercises to strengthen the leg muscles and perform certain procedures that can reduce the severity of pain and other complaints.

Choosing the right footwear: In general, patients who have pain signs is recommended to choose comfortable and loose shoes. Women in particular can reduce the intensity of pain that bothers them during the day by choosing light, low-heeled shoes that support the arch of the foot.

Orthoses and soles: the doctor prescribes orthoses and special shoe inserts to form the arch of the foot. Depending on the type of flat feet, they can be chosen individually for the patient or they come in standard sizes.

Treatment of flat feet in children: Supervision plays a major role in the treatment of children under three years of age. For support, shoe inserts can be used, selected individually. In addition, it is recommended to perform special exercises that contribute to the formation of the arch of the foot.

Surgical methods of treatment of flat feet

Surgical method of treatment is recommended for patients with ineffective conservative treatment, unbearable pain, and deformities of the foot. The method of treatment for tendon detachment and bone abnormalities (irregularities) is chosen after certain tests.

  • Repair a damaged and torn tendon
  • Tendon grafting to form a foot arch
  • Tendon transfer from the opposite side of the foot, to protect the arch of the foot and support the elevated foot
  • Connecting one or more bones of the foot to form a vault (arch) – arthrodesis
  • Removing bones or bone processes – excision
  • Cutting the bones of the foot and then reshaping them – osteotomy
  • Restoration of tendon length or replacements by tissue tendon
  • If the Achilles tendon is short, it can be lengthened by surgery, reducing the intensity of pain
  • Clearing the space around the tendon (synovectomy)
  • Normalizing the arch of the foot, by lengthening the bones, the outer surface of the foot (lateral surface lengthening)
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