Flatfoot Deformity in Adults

What is a flatfoot?

A flatfoot condition is where the arch of the patient is decreased and painful.  This condition can occur in early life and also as an adult.  Females have a higher incidence of this condition especially with excessive weight.  Children commonly have a flat foot which is asymptomatic and often times will outgrow the condition .

What causes a flatfoot? 

There are multiple reasons that people develop a flatfoot.  The simplest cause is abnormal motion of the foot.  If the patient has a foot that has a collapsed arch then that means that the posterior tibial tendon is compromised.  The posterior tibial tendon (PTT) is a very important structure that holds the arch of the foot up when weight bearing.  If there is a problem with this tendon, pain can occur on the inside of the arch and the foot will take on a flat appearance.  This condition is called posterior tibial tendon dysfunction or PTTD. 
 
Obesity is a major cause of PTTD and therefore should be mentioned.  When patients gain excess weight the body begins to change the way its joints, muscles and tendons function.  Specifically in the foot, the posterior tibial tendon starts to work harder and will recruit other muscles to help lift the arch up.  Not only does the weight affect the posterior tibial tendon, but also all the tendons that are responsible in supporting the foot throughout the walking cycle.   
 
Another cause of a flatfoot is a tarsal coalition.  A tarsal coalition is when two or more bones fuse together to cause the foot to be flat.  Typically this is seen at a young age but it tends not be symptomatic until adulthood.  Tarsal coalitions are not very common and can require more aggressive treatment plans depending on the extent of the coalitions. 
 

Adult Flatfoot adult flatfoot flatfoot symptoms

How do we diagnose adult flatfoot?

Adult flatfoot is diagnosed primarily by clinical exam.  The doctor will perform a physical exam to assess the overall structure of the foot.  Your doctor will determine the overall shape of the flat foot and will determine what treatment plan would be most beneficial.  MRI imaging can be used in conjunction with standard x-rays to assess both the soft tissue abnormalities and also boney deformities.  When the doctor evaluates the imaging he/she is looking for causes of the flatfoot such as a torn ligament/tendon or even a bone deformity that occurred at birth was never diagnosed.  It is important that the doctor checks the range of motion of the joints when examining the foot in order to rule out any tarsal coalitions (abnormal fusion of bones) in the foot.  These abnormal fusions can causes a severe flatfoot which is very painful especially in adulthood.  
 

How do we treat flatfoot?

We at Advanced Podiatry truly believe that conservative measures can solve almost every foot problem and therefore we try to avoid surgery.  The doctors will fabricate a pair of custom orthotics for the patient in order to correct the deformities of the foot. The orthotic is a custom device that corrects the shape of the foot so that symptoms can improve.  The idea is simple, if we are able to make the flatfoot have an arch then the symptoms should improve.  A brace is sometimes needed in order to control the motion of the ankle and also the foot.  We can make custom braces for all ages and the devices will typically fit in your current shoes.  Casting is sometimes necessary when dealing with pediatric patients and is not used in adults unless there is some kind of trauma.  Oral anti-inflammatories can be used to help decrease inflammation of the foot and ankle but this will not fix the problem.  Below knee fiberglass cast and crutches are typically reserved for patients with extreme pain.  If the pain is severe enough then staying off of the painful limb will help heal the area more rapidly rather than walking on it everyday and prolonging the healing process. Below knee walking boot can also be used if the patient can tolerate weight bearing. When the pain is severe surgical intervention is the proper course.   

What are the surgical options for flatfoot correction?

Surgery is saved as a last resort and is typically proposed for patients who are in chronic pain and can no longer perform their daily activities of life.  Flatfoot reconstructions is a surgical procedure that moves the bones back into a proper shape.  This is accomplished by performing a variety of bone cuts and fusion of the foot bones.  In simple terms the doctor will use pins and screws to reconstruct the arch of the foot so that the patient’s foot is no longer flat.  Surgeries are lengthy and require six months to a year for a full recovery.  Soft tissue correction may also be utilized if there are ligamentous or tendinous issues.  The doctor will review the MRI imaging so that a proper surgical plan can be carried out.  
 
If you or a loved one suffer with a flatfoot then please do not hesitate to call our office today at 813-875-0555.  The doctors of Advanced Podiatry are all well versed in treating both adult and pediatric flatfoot and will exhaust all conservative measures to fix your foot problem.