Flat Foot

Plymouth Orthopaedic and Sports Injury Clinic

 Flat Foot (Pes Planus) is a common symptomatic presentation.  It usually occurs in three different age groups, although not every presentation is typical.

 

Children

It is very common for young children to have mobile flat feet.  As the child goes up on tiptoes, the arch of the foot will reform.  This condition resolves with growth and no treatment is required.  The child should be encouraged to be as active and normal as possible.

 

Adolescents/Young Adults

In this agegroup, patients present with hind foot pain of progressive severity.  Often, they do not realise that the foot is flat, but on examination, it will be stiff.  Both feet can be affected.  This is caused by a Tarsal Coalition.  One of the joints in the hind-foot has failed to completely form, and the bones on either side of the joint are tethered together.  This causes abnormal loads in the affected joint as well as neighbouring joints, generating the pain.

Treatment

Guided injections may provide temporary relief, but if symptoms persist surgery is an appropriate option.  depenting on age at presentation, and the state of the joints, it may be possible to surgically excise the coalition restoring movement.  In more advanced cases, joint fusion is a more dependable option.  We would always try to avoid fusing joints in younger patients if possible.

 

Middle aged and beyond....

This is quite a common problem, and is seen more frequently in women.  It is a degenerative condition.  Usually it is caused by failure of the soft tissue structures supporting the arch of the foot.  A tendon called Tibialis Posterior becomes inflamed and painful and may eventually rupture. As the arch of the foot collapses, the hind-foot usually deviates outwards.  This is called Plano-valgus Deformity.  The joints of the hind-foot are abnormally loaded, and eventually become arthritic.

Occasionally, plano-valgus deformity is caused by degeneration or trauma to joints of the mid-foot.  Rarely, a very severe bunion (Hallux Valgus) can destabilise the foot to such an extent that a plano-valgus deformity occurs.

Treatment

In the early stages, this condition can be managed with orthotic support (insoles) and guided injections to reduce inflammation and pain.  In more advanced cases, surgery becomes an appropriate option.  This can either be aimed at reconstructing soft tissues and realigning the heel bone (Tibialis Posterior reconstruction and heel shift) or alternatively fusing jointts to relieve joint pain whilst realigning the foot.

This is quite complex surgery, and your surgeon will spend some time discussing with you the relative benefits and drawbacks of the options.  In particular it is important to emphasise the long recovery from such surgery.  Usually there is a period of six weeks non weigh-bearing in plaster, with a further six weeks in plaster or orthopaedic boot.  It takes a year for a foot to really recover from surgery!