Recently I performed a flat foot reconstruction on a pediatric patient and it made me realize that this problem is common among all age groups and also a variety of body types. In my experience, seven year old patients who weigh 120 pounds can have just as severe symptoms when compared to their adult counterparts. That being said, no one is safe from developing symptoms of flat feet and we should all realize that the sooner we start trying to prevent it the better.
What causes flat feet ?
There are many reasons why people develop flat feet. It typically is a result of hyper-pronation coupled with other biomechanical problems. When I examine a patient with flat feet I look for what is called the “planal dominance” of their foot structure. What this means is that I analyze the flat feet very critically and try to find what is the most exaggerated deformity of the foot. Sometimes it is the fallen arch, the heel bone could be tilted, and often times the toes are pointed away from the patient’s midline. These three planes of deformity all have their role in creating flat feet and it is up to the surgeon to determine what to fix and how much correction is required for each individual component. After I determine the planal dominance then I start to devise a plan on how to fix your flat feet problems.
Do I have to have surgery?
No one has to have surgery unless it is a dire situation. The pain of flat feet and fallen arches is significant but people are able to live with it with minimal intervention. Our first tool we utilize to help reduce symptoms of flatfeet is the custom orthotic. This device is simple in design but very powerful in correcting deformities of the foot. Recently a 6’3” male with severe bilateral flatfeet presented to the office with complaints of arch pain, ankle pain, knee pain, hip pain, and back pain. The patient was fabricated a pair of custom orthotics that were very rigid and before he left the office I made sure that his ankles, knees, and hips were aligned so that he would attain maximum benefit from the device. The patient came back to the office three weeks later requesting that his orthotics be adjusted and informed us that his symptoms have reduced and that his pain has been alleviated. The patient will most likely need adjustments periodically but he completely avoided surgery with our advanced method of making customized orthotics in the office. While orthotic fabrication seems simple only using a piece of plastic, the science and art behind the device is extensive. The time and effort we put forth into creating custom orthotics for each individual has proven beneficial for the majority of our patients and we will continue to offer this service as a first line of defense for patients suffering from flat foot pain. Physical therapy can also be coupled with the orthotic in order to strengthen the muscles that hold the arch of the foot up and also stretching the posterior muscle group of the leg to help aid in flexibility of the extrinsic and intrinsic musculature.
Another option which is used for patients with significant pain is our pre-fabricated ankle foot orthosis brace (AFO). This brace, which we started using about 2 months ago, has proven its effectiveness patient after patient. The brace is very sturdy and can be used for a variety of problems of the foot and ankle. With regard to flat foot, we use the brace to stabilize and support the foot to prevent over pronation of the foot, thus preventing symptoms that aggravate the patient. The AFO is very light weight and can fit in most shoes. A supportive athletic shoe is ideal, but we have also used them in certain types of dress shoes. This option is a very easy solution and can be used as needed based on the patient’s symptoms.
What if conservative therapy fails?
Hyprocure ResultSometimes the conservative methods of custom orthotics, AFOs, physical therapy, and modifying shoe gear does not alleviate all the symptoms and so more aggressive solutions are entertained. For specific patients a device called a HyproCure subtalar joint stent is the solution to the problem. In my experience I have place this device into many patients and the results are very good. Again, this device is not for everyone and also it does require a minimally invasive procedure. Essentially the stent is implanted into the patient utilizing a very small incision and is deposited into the subtalar joint. When it is placed properly it stops the movement of the subtalar joint so that the arch of the foot does not collapse. Some refer to this device as an internal orthotic but it is really just a titanium stent that prevents abnormal hyper-pronation of the subtalar joint. The procedure takes roughly 20 minutes to complete and can be done in the office with just local anesthetics. The patient is able to weight bear immediately after the surgery and full recovery is very fast.
Is flat foot reconstruction for me?
Flat foot reconstruction is reserved for patients that ultimately fail all conservative measures and have no choice other than surgical intervention. Flatfoot reconstruction requires 3-4 different procedures performed to the foot and leg in order to correct the aforementioned planal dominance. The surgeon must be skilled in these procedures so that he/she can obtain the optimum result for the patient. Recovery is approximately 12 weeks and the patient is typically non-weight bearing in a cast for that period of time. The process is not easy and full understanding of the procedure by the patient is paramount when even considering reconstruction. The patient must endure the recovery process which can be painful but nonetheless in the end is ultimately improved. The transformation of the quality of life is amazing after this type of surgery but it is not without the burden of a lengthy recovery.
At Advanced Podiatry our surgeons are highly trained individuals who pride themselves on the betterment and enrichment of peoples lives through alleviating symptoms of all different pathologies. If you have back, hip, knee, ankle, and/or foot pain please make an appointment immediately so that we may assess your problems and find the proper solution. If you know you have flatfeet please call and make an appointment so we can try to help you alleviate your pain and possibly slow down the progression of the deformity. We will always try to find the solution that is easiest for the patient so that we can continue to live our lives to the fullest without any interruptions. Please call today to make an appointment and let us help you get back on the road to pain free living.
Dr. Jairo Cruz Jr.
2919 W. Swann Ave #203 Tampa FL 33609