Flat Feet: A Problem Commonly Ignored
There are many patients who come with aching feet to the orthopedic surgeon. Foot deformities are mostly ignored or given little attention till they really hamper patient’s work. Many anxious mother’s get their kids because the grandmother notices a “flat” foot. Here is a guide to the real “flat feet”.
There's an easy way to tell if you have flat feet. Simply wet your feet, and then 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.
Most people have "flexible flatfoot" as children; an arch is visible when the child rises up on the toes, but not when the child is standing. As you age, the tendons that attach to the bones of the foot grow stronger and tighten, forming the arch. But if injury or illness damages the tendons, the arch can "fall," creating a flatfoot.
In many adults, a low arch or a flatfoot is painless and causes no problems. However, a painful flatfoot can be a sign of a congenital abnormality or an injury to the muscles and tendons of the foot. Flat feet can even contribute to low back pain. If the condition progresses, you may experience problems with walking, climbing stairs and wearing shoes. See your doctor if:
- Your feet tire easily or become painful with prolonged standing.
- It's difficult to move your heel or midmost around, or to stand on your toes.
- Your foot aches, particularly in the heel or arch area, with swelling along the inner side.
- Pain in your feet reduces your ability to participate in sports.
- You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid arthritis will develop a progressive flatfoot deformity.
Diagnosis
Although you can do the "wet test" at home, a thorough examination by a doctor will be needed to identify why the flatfoot developed. Your doctor will get a “footprint” done at his clinic. There is a software available which reads your print and gives valuable information to the orthotist. A qualified orthotist then makes a custom made footwear for you. Possible causes include a congenital abnormality, a bone fracture or dislocation, a torn or stretched tendon, arthritis or neurologic weakness. For example, an inability to rise up on your toes while standing on the affected foot may indicate damage to the posterior tibial tendon (PTT), 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 PTT.
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 doctor 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.
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Treatment
A painless flatfoot that does not hinder your ability to walk or wear shoes requires no special treatment or orthotic device. 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 custom-made orthoses
- Taking nonsteroidal 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
In some cases, surgery may be needed to correct the problem. Surgical procedures can help reduce pain and improve bone alignment. Types of surgery your doctor may discuss with you include:
- Arthrodesis, or welding (fusing) one or more of the bones in the foot/ankle together
- Osteotomy, or cutting and reshaping a bone to correct alignment
- Excision, or removing a bone or bone spur
- Synovectomy, or cleaning the sheath covering a tendon
- Tendon transfer, or using a piece of one tendon to lengthen or replace another
Having flat feet is a serious matter. If you are experiencing foot pain and think it may be related to flat feet, talk to your orthopedic surgeon.
General tips to prevent aching feet:
- It is always better to wear a shoe than a chappal or a sandal.
- Always buy your footwear in the late evenings. Our foot size varies during the day and is the largest at around 4to 6 PM. The footwear purchased at that time always will fit better.
- Pay lot of attention to the sole. Sole should be flexible to allow the toes to “break” while taking a step.
- Buying a good quality sports shoe can save you a lot of money spent on pain killers and doctor’s fees!
- Elderly people should use shoes with good impaction absorption system to reduce the load on their arthritic knees. Remember that the force which one exerts while walking on the ground is imparted against one’s knees according to the second law of Newton, so reducing this load protects one’s knees.
