Flat feet, also known as fallen arches, occur when the natural arch of the foot is lost or underdeveloped due to various reasons. While it can be seen as a natural process during childhood, flat feet that develop later in adulthood can lead to significant pain, walking difficulties, and a decline in quality of life. This condition can pose both physical and psychological challenges, especially for individuals who spend long hours standing.
What is Flat Feet?
Flat feet refer to a condition where the natural arch of the foot is insufficient or completely absent. This causes the sole of the foot to make full or partial contact with the ground.
In a Healthy Foot: The arches act as shock absorbers during walking, running, and jumping.
In a Flat Foot: The lack of an arch disrupts the balance of the foot structure, potentially causing pain in the foot, knee, hip, and lower back.
Flat Feet in Children
Babies are naturally born with flat feet. The arch develops as they begin to walk. However, in some children, this arch does not fully form, becoming more noticeable in adulthood.
Flat Feet in Adults
Flat feet in adults often affect one foot and can arise from weakening connective tissues, trauma, or rheumatologic diseases as a person ages.
Types of Flat Feet
Flexible Flat Feet: The arch is visible when no weight is placed on the foot, but disappears when weight is applied.
Rigid Flat Feet: The arch is absent both when sitting and standing.
Congenital Flat Feet: The arch fails to develop due to a structural defect present at birth.
Acquired Flat Feet: This develops due to weakened connective tissues, injuries, or rheumatologic conditions.
Causes of Flat Feet
Flat feet can result from genetic predispositions, trauma, or medical conditions encountered throughout life. The collapse or absence of foot arches occurs due to a combination of various factors. The causes of flat feet are classified into congenital (present from birth) and acquired (developed later in life).
Congenital Flat Feet:
Some individuals are born with flat feet. Genetic factors play a significant role in the formation of foot arches. In certain families, flatter arches are more common, and some congenital conditions can affect foot structure and prevent arch development.
Common causes of congenital flat feet include:
Genetic Predisposition: Individuals with a family history of flat feet are at higher risk.
Congenital Anomalies: Conditions like clubfoot, tarsal coalition, and other skeletal abnormalities can affect foot structure.
Connective Tissue Disorders: Conditions such as Ehlers-Danlos syndrome or Marfan syndrome can lead to weak or underdeveloped arches.
Neurological and Muscular Disorders: Neurological and genetic disorders such as cerebral palsy and Down syndrome can also affect foot structure.
Acquired Flat Feet:
Acquired flat feet occur when the arches, which developed normally, collapse later in life. This condition is often seen in adulthood, particularly after the ages of 50–60, due to aging, injuries, or specific health problems.
Common causes of acquired flat feet include:
Posterior Tibial Tendon Dysfunction: The posterior tibial tendon is one of the most critical structures supporting the foot arch. Weakening or dysfunction of this tendon can lead to flat feet. This tendon may also rupture during sports activities, leading to the development of flat feet.
Trauma and Injuries: Fractures in the foot bones, damage to connective tissues, or prolonged immobility can weaken arch support.
Rheumatologic Diseases: Both degenerative and inflammatory forms of arthritis can cause deformities in the foot joints, disrupting arch structure.
Nerve Damage and Diabetes: Nerve damage caused by diabetes (Charcot foot) can result in bone deformities and weakening of the supportive ligaments, leading to arch collapse.
What Are the Symptoms of Flat Feet (Pes Planus)?
Flat feet may not cause noticeable symptoms in every individual. However, over time, it can alter the body's movement and weight-bearing mechanisms, leading to pain and functional problems. The absence of the arch in the foot causes an uneven distribution of weight in the lower body, potentially resulting in more serious problems over time.
Early Symptoms
The initial symptoms of flat feet are usually felt in the foot and ankle areas. In the early stages, the following may be observed:
Foot Pain: A common complaint, especially after standing or walking for long periods.
Ankle and Calf Pain: Discomfort and tightness in the ankle and calf region.
Advanced Symptoms
As flat feet progress, they can cause more noticeable and chronic issues. Over time, the following symptoms may occur:
Gait Abnormalities: Structural changes in the foot may disrupt walking patterns, causing additional stress on muscles and joints.
Foot Deformities: Bunions (big toe protrusion) and hammer toes are often associated with flat feet.
Chronic Pain: Persistent pain in the feet, ankles, or legs, even while at rest.
Flat feet do not only affect the feet but also place additional stress on other areas of the body, leading to pain:
Knee Pain: Imbalance in the feet places excessive pressure on the knee joints.
Hip Pain: Changes in walking patterns and posture can result in hip discomfort.
Lower Back Pain: The inability of the feet to properly support the body's weight can lead to spinal problems and back pain.
Problems Associated with Flat Feet
Flat feet can predispose individuals to other health issues over time:
Repetitive Strain Injuries: Continuous overloading of the foot and leg muscles can cause repetitive injuries.
Ankle Instability and Sprains: Imbalances caused by flat feet increase the risk of ankle sprains.
Arthritis: Inflammation and degeneration can develop in the joints of the foot and ankle.
How Are Flat Feet Diagnosed?
Flat feet are diagnosed through a detailed foot examination and by observing the patient walking barefoot. X-rays of the feet are taken to assess the degree of flatness.
In adults, if flat feet develop later in life, MRI imaging may be used to check for tendon problems or ligament injuries.
How Is Flat Feet Treated?
1. Non-Surgical Treatment Methods for Flat Feet
Orthotic Devices: Special insoles placed inside shoes can support the foot arch, reduce pain, and improve walking balance.
Proper Footwear Selection: Supportive and comfortable shoes should be chosen. Shoes specifically designed for people with flat feet are recommended.
Exercises: Exercises that strengthen the foot and leg muscles can help alleviate the symptoms of flat feet.
Example Exercises:
Picking up small objects using the toes.
Heel raises.
Arch-supporting stretches (e.g., plantar fascia stretch).
Weight Control: Excess weight places additional stress on the foot arch, worsening flat feet symptoms. Maintaining a healthy weight is essential.
2. Flat Feet Surgeries
Surgery is typically considered for individuals who do not respond to non-surgical treatments, experience severe symptoms, or develop flat feet in adulthood. Surgical options include:
Tendon Repairs: If degeneration of the posterior tibial tendon contributes to flat feet, surgical repair of this tendon may be necessary.
Bone Surgeries: Procedures to correct the foot arch, such as bone realignment or fusion, may be performed.
Arthrodesis (Joint Fusion): In severe cases of flat feet, procedures such as triple arthrodesis, which stabilize foot joints without affecting ankle movement, are performed to reduce pain and correct flat feet.
Adult-Acquired Flatfoot
Adult-acquired flatfoot is a painful condition characterized by the collapse and loss of the foot arch.
Who Is at Risk for Adult-Acquired Flatfoot?
It is more common in women over the age of 60 compared to men. The likelihood of developing adult-acquired flatfoot increases in:
Pregnant women
Individuals with hypertension
Diabetic patients
Long-term corticosteroid users
Patients with rheumatic diseases such as rheumatoid arthritis
What Causes Adult-Acquired Flatfoot?
The most common cause is the dysfunction or, in some cases, rupture of the posterior tibial tendon. This tendon wraps around the back of the ankle and attaches to the navicular bone on the inner side of the foot, playing a crucial role in maintaining the foot arch.
Over time, the tendon can degenerate, lose functionality, and eventually rupture, leading to arch collapse and flatfoot development.
In athletes, the posterior tibial tendon may rupture suddenly during competitions or intense
training due to high physical exertion.
What Are the Symptoms of Adult-Acquired Flatfoot?
Pain and Swelling: Pain and swelling on the inner side of the foot and ankle, especially after long walks.
Loss of Arch: The arch gradually collapses and worsens over time.
Outer Ankle Pain: In advanced stages, pain may develop on the outer side of the ankle.
How Is Adult-Acquired Flatfoot Diagnosed?
A detailed examination and foot X-rays can easily diagnose adult-acquired flatfoot. The posterior tibial tendon is evaluated using MRI imaging to assess its condition.
How Is Adult-Acquired Flatfoot Treated?
Non-Surgical Treatments:
Casting or Walking Boot: Used in the early stages, especially when the condition is diagnosed promptly.
Custom Insoles: Special insoles tailored to the patient can help, particularly in the early stages.
Foot-Ankle Orthosis: Used in more advanced stages of the condition to provide additional support.
Adult-Acquired Flatfoot Surgery
When deciding on surgery for patients with adult-acquired flatfoot, it is essential to evaluate which parts of the foot are affected and to what extent. One or more of the following surgical procedures may be selected:
1. Tendon Transfer:
When the damaged or ruptured posterior tibial tendon cannot be repaired, a flexor digitorum longus (FDL) tendon transfer is commonly performed. The FDL tendon is transferred to the navicular bone, where the posterior tibial tendon typically attaches, and secured through a drilled tunnel in the bone.
2. Calcaneal Osteotomy:
In advanced stages of adult-acquired flatfoot, the heel bone (calcaneus) may shift outward. In calcaneal osteotomy, a controlled fracture (osteotomy) is created in the heel bone, dividing it into two pieces. The rear part is then shifted inward and fixed with two screws, aligning the heel bone directly under the tibia (shin bone).The goal is to restore proper alignment and balance to the foot structure.
3. Arthrodesis (Joint Fusion):
In the final stages of adult-acquired flatfoot, fusion surgeries are performed on specific joints in the foot. These procedures not only restore the normal shape of the foot but also eliminate the patient’s pain.
Conclusion
Flatfoot can largely be managed with early diagnosis and appropriate treatment, significantly improving quality of life. Detecting and addressing flatfoot during childhood plays a critical role in preventing more severe complications in later years.
In adults, neglecting symptoms can impact treatment success. Consulting an experienced orthopedic specialist is essential for effective treatment.
Orthotic devices, proper footwear, and regular exercises are highly effective in non-surgical treatments.
In advanced cases, surgical interventions offer permanent solutions.
For a healthy life, foot health should not be overlooked, and professional support should be sought when necessary.
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