Flat Feet
What are flat feet?
Most feet have a space on the inner side where the bottom of the foot is off the ground; this is known as the "arch" of the foot. The height of this arch varies from one person to another. Small children do not have an arch; it develops between the ages of 3 and 10. People who have a low arch,or no arch at all, are said to have ‘flat feet.’
What causes flat feet?
They may be entirely normal or relate to an underlying disorder. In cases where it is normal, flat feet may run in the family, have a similar appearance on both feet and remain reasonably supple. Rarely, it is caused when the foot formed in the womb; a joint may be malformed or two or more bones may be fused together. These feet are stiff and flat, and the problem is usually obvious in childhood.
Occasionally a flat foot develops later in adult life. This may be due to a ruptured tendon (the tibialis posterior tendon), ligament, arthritis or an injury causing stiffness and distortion of the joints of the foot.
Some people with diseases of the nervous system or muscles such as cerebral palsy, spina bifida or muscular dystrophy may develop flat feet because some of their muscles are weak and their muscles do not work well together. Their feet are usually stiff and the deformity tends to get worse with time.
What are the common symptoms?
Most flat feet cause no symptoms. Some people get an ache in the arch, or around the ankle. Shoes may wear out quickly. If there is an underlying disorder that develops in adulthood, then the foot may change shape by becoming more flat and sometime the heel may not sit in the correct place.
When should I consult a healthcare professional?
Most flat feet cause no trouble and do not need treatment. You may consider consulting your GP or other healthcare professional if:
Your feet cause you a lot of pain that is not helped by wearing well-fitted shoes.
Your shoes wear out very quickly.
Your foot or feet seem to be getting flatter.
Your feet seem very stiff.
You cannot feel your feet normally, or they seem weak.
What treatments are there for flat feet?
The choice of treatment depends upon the underlying cause and the severity of symptoms. If you have mild symptoms and the foot is supple, then insoles that support the arch can help. This can be supplemented with physiotherapy to help stretch the Achilles tendon and strengthen some of the muscles in your legs. If you have more severe symptoms, then the foot and ankle may need to supported in a splint or removable boot.
If your symptoms continue despite trying non-surgical management, then surgery may be needed. The type of surgery is dependent upon the underlying cause and whether you have arthritis in your joints.
Benefits of flat foot surgery
The outcome of surgery is usually good but it doesn’t mean that all the people who have the surgery will be completely pain free. In most patients, the main benefits are:
Relief or improvement of pain and disability.
Greater independence and activity levels.
Risks of flat foot surgery
As with any surgery, there are associated risks. If you are overweight, smoke or are not active, you are at greater risk of developing complications after surgery and it may take longer to recover. You may want to discuss this with your GP or health professional what you can do before surgery. The individual risks vary according to the type of surgery but include:
Stiffness or persistent pain in the foot or ankle.
Nerves may be damaged in very few cases, which could lead to chronic pain that is worse than the pain before surgery.
There is a very low risk of a blood clot forming in the leg which is also known as a deep vein thrombosis (DVT). The main danger of this complication is that the clot travels to the lungs which can be fatal.
Infections will occur in a few patients. They can often be treated by antibiotics. Occasionally, wounds can become more deeply infected and require further surgery.
Further progression of deformity can happen which may require additional surgery.
It is important to remember that most complications are minor and can be easily and successfully treated.