The flat foot is a common disorder. Up to 20 percent of adults have flat feet. Considering the frequency with which we encounter the flat foot, understanding about flat feet is poor.

As is most people know, a flat foot is characterised by loss of the arch. This is but one of the features needed to make a diagnosis of a flat foot. Using this criteria alone would leave many people with normal feet with normal feet labelled as having flat feet. Other features to confirm the diagnosis include:

  • Hindfoot valgus (heel pointing outwards)
  • Forefoot abduction ( front of the foot pointing outwards)
All infants are born with flat feet. The normal arch develops by 7 to 10 years of age. This does not occur in up to 20 percent of the population, leaving them with flat feet. This type of flat foot is known as the congenital flexible flat foot. Contrary to popular belief, it does not increase the incidence of injury or disability.
If a person with a congenital flexible flat foot does develop foot pain, treatment usually consists of the use of customised orthotics (insoles) and appropriate footwear. In the rare situation where these measures do not work and the pain is incapicitating and interfering with daily activities, surgery may be necessary to address the problem.
A more common scenario of a painful flat foot is an adult who has foot pain associated with a worsening congenital flexible flat foot or someone who developed a flat foot in adulthood. This entity is known as an adult acquired flat foot (or posterior tibial tendon dysfunction in the medical parlance). This condition is  more common among ladies above the age of 40 years but can also be seen in high demand individuals, like runners, of any age or gender.
The posterior tibial tendon is a structure which plays an important role in the maintenance of the foot arch. In this condition, the tendon undergoes degeneration and stretches out, much like a rubber band which has lost its elasticity.

“In patients who present late, joints in the foot have to be fused in order to correct the severe deformity.”

As the degeneration worsens, the tendon stretches out more, resulting is a progressively flatter foot. Pain from this condition results from multiple sources:

  • Pain from tendon degeneration and inflammation
  • As the arch collapses, bones begin to abut and rub against each other, resulting in pain
  • Arthritis from the abnormal loading of joints with increasing deformity

As with all ailments, there is a spectrum of severity when a patient with this condition presents for medical attention. In the early stages of this disorder, a patient is usually put in a cast to rest the damaged tendon. Failing this, a surgical procedure to remove inflamed tissue and a repair of the damaged area of the tendon is performed. As the disorder becomes more advanced, surgery is performed to adjust the position of the bones in the foot, to correct the deformity. At the same time, other tendons are recruited to augment the function of the damaged posterior tibial tendon, in order to maintain the arch. In patients who present late, joints in the foot have to be fused (made stiff and rigid) in order to correct the severe deformity.

It is important to recognise this disorder early as severity worsens with time. Early treatment is less invasive and is associated with better outcomes than treatment of the disorder in its advanced stages.

Most people with flat feet are able to lead an active lifestyle without more foot dysfunction than a person with normal arches. Pain from flat feet can be treated. Do seek professional help if you have painful flat feet, particularly if it is associated with a worsening or a new deformity.

Dos for flat feet

  • Lead a healthy, active lifestyle if you have a painless, long standing flat foot
  • Seek advice before buying sports shoes – especially for running

Don’ts for flat feet

  • Ignore a foot which is getting flatter in adulthood
  • Neglect a painful flat foot – something can be done to help you

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