What is flatfoot?
Flatfoot is an anatomical deformity of the foot characterized by the collapse or absence of the normal arch of the foot and is accompanied by heel valgus. The foot arch typically starts to develop when the infant begins walking, i.e., after the age of 12–18 months, and is completed around the age of 5–6 years.
What are the types of Flatfoot?
Flatfoot is classified into:
- Flexible Flatfoot, which accounts for most cases and is usually found in both feet. This type of flatfoot is typically caused by laxity of the ligaments of the foot and is the least severe form, causing mild or almost no symptoms. Infant flatfoot falls into this category. In this case, the foot retains its elasticity without restricting movement.
- Rigid Flatfoot is a more severe form caused by fusion (consolidation) of the foot bones or other anatomical and neurological issues. It is easily recognized due to the complete absence of the foot arch, is almost always associated with pain, and requires treatment. It may appear at any point during life or show early signs due to heredity. The bony or cartilaginous bridge connecting the heel to the navicular or ankle, as well as the vertical ankle, are the most frequent congenital causes of rigid flatfoot.
- Compensatory Flatfoot, which develops secondarily due to another abnormality such as Achilles tendon shortening or mild spastic clubfoot.
What are the symptoms of Flatfoot?
Primarily, children do not complain of pain or other discomforts. Symptoms are usually observed by the parents, who often report that their children experience easy fatigue, frequent falls, or unstable walking. They also note rapid wear and deformation of footwear.
How is Flatfoot diagnosed?
Flexible flatfoot is typically noticed by the parents, as infants are unable to recognize it, and they seek medical advice. Pediatricians are usually the first specialists parents consult.
The diagnosis of flatfoot is straightforward and begins with a clinical examination of the foot. In cases of flexible flatfoot, imaging tests are generally not required.
A plantar pressure study, a special painless and risk-free examination that records and analyzes the walking pattern, may be recommended.
In cases of rigid flatfoot, a complete family history is taken, and imaging tests such as X-rays of the foot with special views, CT scans, and rarely bone scintigraphy may be required.
What is the treatment for Flatfoot?
In the majority of children, flexible flatfoot corrects itself by the age of 6, requiring no intervention. Treatment is recommended when the child shows symptoms, such as pain and easy fatigue of the foot.
Conservative treatment:
The goal is to prevent worsening of the deformity and simultaneously correct the problem. Cases of mild to moderate flexible flatfoot are painless and do not require special treatment.
Each case of flatfoot is unique, and therefore a plantar pressure study is the appropriate diagnostic test to choose special orthotics for each patient. Orthotic insoles elevate the foot arch and maintain the subtalar joint in a neutral position. Insoles are also recommended, especially in cases where flatfoot coexists with heel valgus, to restore the mechanical function of the foot and Achilles tendon.
A child with flatfoot can participate in various physical activities, as exercise does not worsen the condition. For children with high athletic activity and mild symptoms, rest is the best and simplest treatment.
Surgical treatment
Surgical intervention is applied in more severe cases that do not respond to conservative treatment. Surgery should be considered after careful examination of all parameters in each patient and is a decision made by the specialist orthopedic surgeon.
Summary
The majority of children with flatfoot are unlikely to develop symptoms or foot deformities. It is important for parents to promptly consult a pediatric orthopedic specialist if they notice any possible signs or if the child complains of discomfort or pain. Early diagnosis is essential to address flatfoot promptly, if deemed necessary.
Adult Flatfoot
It is usually idiopathic, meaning there is no clear cause for its occurrence, and as with children, it is typically a flexible flatfoot. However, the orthopedic physician must investigate the possibility of ligamentous laxity, tarsal bone fusion, posterior tibial tendon disorders, post-traumatic deformity, degenerative and inflammatory arthritis, and neuromuscular disorders (diabetes, peripheral neuropathy).
Clinical Presentation
In flexible flatfoot, the only symptom may be pain after prolonged standing or walking. When the patient stands, flatfoot is apparent, and the heel is in external rotation, while the opposite occurs when standing on tiptoe.
Conversely, rigid flatfoot is often painful and does not correct when standing on tiptoe. In this case, one must investigate potential underlying issues. Pain is present on the inner side of the ankle, but in advanced stages, it may also be on the outer side. There is gait disturbance due to the pain.
An orthopedic examination is necessary to clarify the causes of flatfoot and determine the appropriate treatment.
Valuable information regarding posture and gait is obtained through plantar pressure studies. Proper orthotic insoles aid in walking, standing, and physical activity.