Flatfoot Disorders and Current Treatment

Weekend Doctor

By Dr. Thomas F. Vail

Treatment and prevention of adult flatfoot can reduce the
incidence of additional foot problems such as bunions, hammertoes,
arthritis and calluses. And, it can improve a person’s overall
health.
To tell if you have flat feet, wet your feet and stand on a flat,
dry surface that will leave an imprint of your foot.
A normal footprint has a wide band connecting
the ball of the foot to the heel, with an
indentation on the inner side of the foot. A foot
with a high arch has a large indentation and a
very narrow connecting band.
Flat feet leave a nearly complete imprint
with almost no inward curve where the arch
should be.
Although you can do the “wet test” at home,
a thorough examination by a doctor will be
needed to identify why the flatfoot developed.
Causes include a congenital abnormality, a
bone fracture or dislocation, a torn or stretched
tendon, arthritis or neurologic weakness.
An inability to rise up on your toes while standing on the
affected foot may indicate damage to the posterior tibial tendon,
which supports the heel and forms the arch.
If “too many toes” show on the outside of your foot when the
doctor views you from the rear, your shinbone (tibia) may be sliding
off the anklebone (talus), another indicator of damage to the
posterior tibial tendon.
Be sure to wear your regular shoes to the examination. An
irregular wear pattern on the bottom of the shoe is another indicator
of acquired adult flatfoot.
Your physician may request X-rays to see how the bones of
your feet are aligned. Muscle and tendon strength are tested by
asking you to move the foot while the doctor holds it.
Overweight males in white-collar jobs are most apt to suffer
from adult flatfoot disorder, a progressive condition characterized
by partial or total collapse of the arch, according to research.
Symptoms of adult flatfoot include pain, swelling, flattening of
the arch and an inward rolling of the ankle. Because flatfoot is a
progressive disorder by nature, neglecting treatment or preventive
care can lead to arthritis, loss of function of the foot and other
painful foot disorders.
In many cases, flatfoot can be treated with non-surgical
approaches.
A painless flatfoot that does not hinder your ability to walk
or wear shoes requires no special treatment. Other treatment
options depend on the cause and progression of the flatfoot.
Conservative treatment options include:
• Making shoe modifications.
• Using orthotic devices, such as arch supports and custommade
orthoses,
• Taking non-steroidal anti-inflammatory drugs, such as
ibuprofen, to relieve pain.
• Using a short-leg walking cast or wearing a brace.
• Injecting a corticosteroid into the joint to relieve pain.
• Rest and ice.
• Physical therapy.
Flatfoot disorder may gradually worsen to the point that many
of the tendons and ligaments in the foot and ankle are simply
overworking, often to the point where they tear and/or rupture.
In some patients whose pain is not adequately relieved by
conservative treatments, there are surgical techniques available to
correct flatfoot and improve foot function, which can help reduce
pain and improve bone alignment.
As in most progressive foot disorders, early treatment for flatfoot
disorder is also the patient’s best route for optimal success in
controlling symptoms and additional damage to the feet. The goal
is to keep patients active, healthy and as pain free as possible.