Flat Foot Deformity

Flat feet are a common problem for many people. For some, this position is normal and if there is no pain, no treatment is necessary. If there is pain present, it is important to determine the cause of the pain so that appropriate treatment can be provided.

Causes

• Congenital alignment: Many people have had flat feet all of their lives and it is simply the normal alignment for them. There is no evidence that having flatfoot will lead to any problems in the future if there is no pain.
• Tendon insufficiency: This is the most common cause of adult acquired flatfoot deformity. The posterior tibial tendon supports the arch of the foot and allows for rigid push off of the foot. Through inflexibility, trauma, chronic overuse, and simply wearing out, this tendon can become first inflamed, then stretched out and finally incompetent which will lead to a progressive flatfoot.
• Ligament incompetence: An important ligament called the spring ligament can be injured or become stretched out over time which can lead to progressive deformity.
• Tarsal coalition: This is often a cause for flatfeet in children and adolescents, but more and more adults are being recognized as having this problem. It occurs when bones in the foot fail to separate during development, leading to stiffness and pain that usually occurs in adolescence when the bones become fully formed.

Evaluation

Most of the time, the cause of a flatfoot can be determined with a physical examination and plain x-rays. Occasionally an MRI or CT scan will be used to assess the tendons or joints more extensively than plain x-rays can provide.

Treatment

• Most of the time early irritation of the posterior tibial tendon can be treated with non-operative treatment. Usually a regimen of stretching, bracing, anti-inflammatories, and occasionally physical therapy will resolve the pain.
• When the foot has collapsed, non-operative treatments can often help to alleviate pain, but unfortunately, it will not change the position of the foot.
• Orthotics can be helpful and full length; soft ones are usually the best for comfort.
• Injections can be used to alleviate symptoms of impingement and arthritis, but should not be done around the tendon and it can lead to a rupture of the tendon.
• Surgery is reserved for those patients who are not helped with non-operative means. The type of surgery done depends on the cause of the flatfoot and the extent of the progression. The options can include repair of the tendon, transfer of another tendon to replace the worn tendon, and fusion of the joints to improve the alignment of the foot.