Flat Feet

The flatfoot is a complex foot disorder. There are various types of flatfoot. Each has its own varying etiologies, deformities, and symptoms. However, the common feature of all flatfeet is the partial or total collapse of the arch. Other signs of flatfoot include outward deviation of the toes, outward tilting of the heel, inward tilting of the ankle, having a tight Achilles tendon, and early heel lift off of the ground during gait, and having deformities such as bunions and hammertoes. 

The flatfoot deformity may be rigid where the rearfoot joints are stiff and not moveable. Arthritis of the foot and or ankle joints may be associated with the rigid flatfoot. The flatfoot deformity may also be flexible where the rearfoot joints are manually reducible to the ideal corrected position. This flatfoot is usually attributed to rearfoot musculoskeletal instability and weakening of medial tendon structures. 

One of the most common types of flatfoot is flexible flatfoot. This variation usually starts in childhood and progresses as one ages into adulthood. Flexible flatfoot presents with a flattened arch when the foot is standing or weight-bearing. However upon weight-bearing, the arch of the foot presents itself again. Symptoms of flexible flatfoot include pain located to the inside heel, arch, and ankle where the soft tissue structures are overly stretched. Associated symptoms of flexible flatfoot include general arch and foot fatigue, pain along the medial tendon, shin splints, and pain located in the lower back, hip, or knee.

The foot and ankle surgeon will examine how one stands and walks before determining if there is flatfeet. X-rays are taken to evaluate the joints. CT or MRI may be ordered for additional imaging evaluation. Nonsurgical treatments include activity modification, weight loss, orthotics, immobilization, medications, physical therapy, shoe modifications, and ankle foot orthosis (AFO) devices.  Surgery may require multiple procedures to fully address the various components of the deformity.