Flat Feet Introduction

An estimated one in five adults in the UK has some degree of flat feet and for the majority, this causes no difficulties in any way.

However some people do experience problems caused by flat feet and timely referral to a specialist is vital if serious long term difficulties are to be avoided.

Flat Feet Symptoms

What is a flat foot – how is it defined?

A normal foot has an arch running along the length of the inner side of the foot. A person with a flat foot has little or no arch, the heel tilts outwards (valgus) and the forefoot may rotate outwards (abduction) when standing or walking.

Are we born with flat feet or can they develop over time?

Both are possible. We are born with flat feet, developing the arch during childhood, but for some, this development does not take place. Also, it is possible to acquire flat feet later in life, typically during your forties and fifties. The shape of the foot is determined by your genes but also by the shape of the bones, the supporting ligaments and the muscles and tendons that move the foot.

Causes of Flat Feet

Many people simply happen to have flat feet; often the condition runs in the family. In some cases, there is over-pronation, when the foot rolls in too much when walking. This is often due to excessive laxity in the joints and can be related to weight gain. The main reason for a flat foot developing later in life is a dysfunction of the tibialis posterior tendon which is essential for foot alignment. If this tendon weakens or ruptures, the foot will roll in and flat foot is likely to develop.

Diagnosis for Flat Feet

You should see your GP and ask for a referral to a foot and ankle specialist if:

  • you are in pain (even if it is a small amount of pain). It is important to remember that flat feet can cause pain elsewhere in your body, due to poor gait and your weight being loaded unevenly up through your body with each step. If you have flat feet and are experiencing knee pain, back pain or headaches, it is important to consider whether your foot structure is contributing to pain.
  • your foot feels stiff or hypermobile;
  • you wear out shoes very quickly;
  • your feet seem weak.

Problems related to flat feet are classified into different stages and these stages define what sort of treatment can be carried out.

Stage one

There is inflammation of the tendon but no obvious deformity. Diagnosis is made during a physical examination and confirmed by ultrasound or MRI.

Stage two

The severity of the flat foot is increasingly evident but it is not stiff or arthritic.

Stage three

The condition is increasingly painful and has lead to stiffness and arthritis in the hind foot.

Stage four

The arthritis has spread to the ankle joint.

Flat Feet Treatment

Will I need surgery for flat feet?

If you see a specialist at an early stage (stage one or two), it is normally possible to correct the way your walk and therefore resolve pain by simple steps, namely the use of insoles, orthotics, rest and sometimes physiotherapy. Surgery is sometimes required if the condition is more severe. The following procedures may be considered:

The calcaneal osteotomy

Sometimes known as the ‘heel shift’, this procedure involves moving the calcaneam, the large bone at the back of the heel which is out of alignment, correctly re- positioning it and then securing the bone using screws. At LFAC, we can sometimes, where appropriate, carry out this procedure in a minimally invasive way.

A tendon transfer

A tendon transfer is considered if the tibialis posterior tendon is severely damaged. A tendon is taken from one of the lesser toes, which is then transferred to run behind the medial malleolus. This does not affect the function of the toes and patients make a full recovery.

Fusion

At the final stages (stage 3 and stage 4) of adult flat foot, the fusion of joints needs to be considered in order to effectively eliminate pain.

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