What is Flatfoot?
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have a partial or total loss of the arch.
Other characteristics shared by most types of flatfoot include:
- The toes and front part of the foot point outward.
- The heel tilts toward the outside and the ankle appears to turn in.
- A short Achilles tendon, which causes the heel to lift off the ground earlier when walking and may act as a deforming force.
- Bunions and hammertoes may occur in some people with flatfeet.
Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flatfoot. In addition, adults who are overweight frequently have flatfoot.
Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.
The term "flexible" means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff.
Symptoms, which may occur in some persons with flexible flatfoot, include:
- Pain in the heel, arch, ankle, or along the outside of the foot.
- "Turned-in" ankle.
- Pain associated with a shin splint.
- General weakness/fatigue in the foot or leg
Diagnosis of Flexible Flatfoot
X-rays are usually taken to determine the severity of the disorder.
- Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
- Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
- Orthotic devices. Custom orthotic devices give more support to the arches.
- Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
- Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.
- Surgery. In severe cases where pain is not adequately relieved by other treatments, surgery may be considered.
A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, joint fusions, or insertion of implant devices.
In selecting the procedure or combination of procedures for your particular case, consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
What is Pediatric Flatfoot?
Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as a pediatric flatfoot, a term that actually includes several types of flatfoot.
Most children with flatfoot have no symptoms, but some children have one or more symptoms. When symptoms do occur, they vary according to the type of flatfoot. Some signs and symptoms may include:
- Pain, tenderness, or cramping in the foot, leg, and knee
- Outward tilting of the heel
- Awkwardness or changes in walking
- Difficulty with shoes
- Reduced energy when participating in physical activities
- Voluntary withdrawal from physical activities
Flatfoot can be apparent at birth or it may not show up until years later, depending on the type of flatfoot. Some forms of flatfoot occur in one foot only, while others may affect both feet.
Types of Pediatric Flatfoot
Various terms are used to describe the different types of flatfoot. For example, flatfoot is either asymptomatic (without symptoms) or symptomatic (with symptoms). As mentioned earlier, the majority of children with flatfoot have an asymptomatic condition.
Symptomatic flatfoot is further described as being either flexible or rigid. Flexible means that the foot is flat when standing (weight-bearing), but the arch returns when not standing. Rigid means the arch is always stiff and flat, whether standing on the foot or not.
Several types of flatfoot are categorized as rigid. The most common are:
- Tarsal coalition. This is a congenital (existing at birth) condition. It involves an abnormal joining of two or more bones in the foot. Tarsal coalition may or may not produce pain. When pain does occur, it usually starts in preadolescence or adolescence.
- Congenital vertical talus. Because of the foot's rigid "rocker bottom" appearance that occurs with congenital vertical talus, this condition is apparent in the newborn. Symptoms begin at walking age, since it is difficult for the child to bear weight and wear shoes.
There are other types of pediatric flatfoot, such as those caused by injury or some diseases.
The child's walk (gait) and range of motion of the foot should be evaluated. Because flatfoot is sometimes related to problems in the leg, the knee and hip should be examined..
X-rays are often taken to determine the severity of the deformity.
If a child's flatfoot is asymptomatic, treatment is often not required. Instead, the condition will be observed and re-evaluated periodically. Custom orthotic devices may be considered for some cases of asymptomatic flatfoot.
In symptomatic pediatric flatfoot, treatment is required. One or more approaches, depending on the child's particular case. Some examples of non-surgical options include:
- Activity modifications. The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing.
- Orthotic devices. Custom orthotic devices fit inside the shoe to support the structure of the foot and improve function.
- Physical therapy. Stretching exercises provide provides relief in some cases of flatfoot.
- Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
- Shoe modifications. The proper choice of shoes is important.
When is Surgery Needed?
In some cases, surgery is necessary to relieve the symptoms and improve footefunction. A variety of techniques to treat the different types of pediatric flatfoot. The surgical procedure or combination of procedures selected for your child will depend on his or her particular type of flatfoot and degree of deformity.