Flat Feet

A Patient's Guide

Flat feet, also known as pes planus or fallen arches, is a condition where the arches of the feet are low or non-existent. While flat feet can be present at birth (congenital) or develop over time (acquired), it affects people of all ages. The arch, which runs lengthwise along the sole of the foot, is essential for distributing body weight and providing balance. Without a proper arch, various complications can arise, leading to discomfort and other foot-related issues.

Flat feet are often identified during childhood but can also develop in adulthood due to injury, illness, or simply wear and tear over time. This condition can be asymptomatic, meaning some individuals with flat feet experience no pain or discomfort. However, others may experience symptoms that can affect their daily activities and quality of life.

Symptoms and Signs

Flat feet can present a variety of symptoms and signs, which can range from mild to severe. Some common symptoms include:

Foot Pain: Pain is a frequent complaint among individuals with flat feet. This pain can occur in the arch area, heel, or the outer side of the foot. The pain often worsens with activity and prolonged standing.
Swelling: Swelling along the inside of the ankle can be a sign of flat feet. This occurs because the lack of arch support places additional strain on the ankle, leading to inflammation.
Fatigue: People with flat feet often experience foot fatigue after standing or walking for extended periods. This fatigue results from the foot muscles working harder to support the body without the natural arch structure.
Difficulty in Movement: Individuals with flat feet might have difficulty with certain movements, such as standing on their toes or participating in sports that require quick foot movements.
Changes in Footwear Fit: Over time, flat feet can lead to changes in the shape of the feet, causing shoes to fit differently. This can result in increased wear on the inside of the soles and the need for wider shoes.
Knee, Hip, and Back Pain: Flat feet can cause misalignment in the legs and hips, leading to additional stress on the knees, hips, and lower back. This misalignment often results in pain and discomfort beyond the feet.

Assessment

To diagnose flat feet, a thorough examination by a healthcare professional is essential. The diagnostic process may include:

Medical History: A detailed medical history is taken to understand the patient's symptoms, onset, and any underlying conditions that might contribute to flat feet.
Physical Examination: The healthcare provider will examine the feet while the patient stands and walks. This examination helps assess the arches' structure and functionality and identify any areas of pain or tenderness.
Imaging Studies: X-rays, MRI, or CT scans may be used to provide a detailed view of the bones and soft tissues in the feet. These imaging techniques can help identify any structural abnormalities or underlying issues, such as arthritis or tendon damage.
Gait Analysis: Rarely, gait analysis is used which involves studying the patient's walking pattern using video or pressure sensors. This analysis can reveal how flat feet affect movement and posture, helping to guide treatment options.

Conservative Treatment

Treatment for flat feet depends on the severity of the condition and the presence of symptoms. The goal is to alleviate pain, improve foot function, and prevent further complications. Treatment options include:

Lifestyle Modifications:
- Weight Management: Maintaining a healthy weight can reduce stress on the feet, alleviating symptoms and preventing further strain.
- Activity Modification: Avoiding activities that exacerbate symptoms, such as prolonged standing or high-impact sports, can help manage pain and discomfort.
Orthotic Devices:
- Arch Supports: Over-the-counter or custom-made orthotic inserts can provide the necessary arch support, distributing pressure more evenly and reducing pain.
- Supportive Footwear: Wearing shoes with good arch support and cushioning can improve foot alignment and reduce discomfort. Athletic shoes, particularly those designed for stability, are often recommended.
Physiotherapy:
- Stretching and Strengthening Exercises: Physiotherapy can help strengthen the muscles and tendons in the feet and lower legs, improving arch support and foot function.
- Manual Therapy: Techniques such as massage and mobilisation can help reduce pain and improve flexibility in the feet and ankles.
Medications:
- Pain Killers: Over-the-counter pain medications, such as ibuprofen or paracetamol, can help manage pain and reduce inflammation.
- Corticosteroid Injections: In cases of severe pain, corticosteroid injections in to the triple joint complex may be used to reduce inflammation and provide temporary relief.

Surgical Treatment

When conservative options fail to adequately control symptoms, advanced treatment of surgery may be offered. In general, flexible deformity will be amendable to osteotomy, tendon transfer and ligament repair, whereas stiff joints with arthritis will require joint fusion surgery. Options will depend upon your goals and the severity of disease:

Tendon Transfer: Surgery may be necessary to replace the function of damaged tendons, particularly in cases of posterior tibial tendon dysfunction (PTTD). This usually involves taking the tendon which bends to the toes and inserting it in to the arch.
Osteotomy: This procedure involves cutting and realigning bones to reshape the foot. Metalwork is used to hold the bones in place but this can be removed once the bone is healed.
Arthrodesis (Joint Fusion): Arthrodesis, or joint fusion, is a surgical option for severe flat feet associated with arthritis. This procedure involves fusing the bones of the hind foot to eliminate pain and improve stability. While arthrodesis can limit joint movement, it can provide significant pain relief and improve overall foot function.

Summary

Flat feet, while common, can vary significantly in their impact on individuals. For some, the condition is benign and requires no treatment, while for others, it can lead to significant pain and mobility issues. Early diagnosis and intervention will help in managing symptoms and preventing complications. With appropriate treatment, most people with flat feet can lead active, pain-free lives. If you suspect you have flat feet or are experiencing related symptoms, consult a healthcare professional such as Shelain Patel who has experience of managing them, for a thorough evaluation and personalised treatment plan.