The appearance of flat feet is normal and common in infants, partly due to "baby fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Training of the feet, especially by foot gymnastics and going barefoot on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood.
An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension.
The primary symptom of flatfeet is the absence of an arch upon standing. Additional signs of flatfeet include the following. Foot pain. Pain or weakness in the lower legs. Pain or swelling on the inside of the ankle. Uneven shoe wear. While most cases of flatfeet do not cause problems, complications can sometimes occur. Complications include the following, bunions and calluses, inability to walk or run normally, inflammation and pain in the bottom of the foot (plantar fasciitis), tendonitis in the Achilles heel and other ligaments, pain in the ankles, knees, and hips due to improper alignment, shin splints, stress fractures in the lower legs.
Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.
pes planus radiology
Non Surgical Treatment
When pain results from a fallen arch, the physician may prescribe these. Rest and ice. A brace to help support the fallen arch. Physical therapy to strengthen and stretch the foot. Orthotics (arch supports) to compensate for a fallen arch. The physician may tell the patient to choose shoes that have proper arch supports and avoid non-supportive shoes such as flip-flops. If obesity contributed to the fallen arch, the patient should lose weight.
Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
Wear Supportive Footwear. Spend the money it takes to get proper fitting and quality footwear with good arch supports. Most sufferers of fallen arches and plantar fasciitis are born with high arches that sag as they get older. Good footwear can prevent this from becoming a problem. Flat feet, however, can become just as problematic. So, really we should all be wearing good footwear to avoid this potentially painful condition. Take It Easy. If your heel starts to hurt, take a rest. If the pain doesn?t go away after several days of resting, it may be time to see a podiatrist. Orthotics. Special insoles to support the arch of the foot can provide some much needed help. You can buy these at your local drugstore (not recommended), or you can have them specially made and custom fit for your feet. It can take awhile to get just the right one for your foot, but sometimes it can be just what you needed. Weight Control. Yes, maintaining a sensible diet with your ideal weight can be beneficial in many ways. It makes sense to think that the more weight your arches are supporting, the more easily they will fall and become painful.
Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.