1455 Golf Road
Des Plaines, IL 60016
(847) 390-7666

Flatfoot Treatment and Correction

What are flatfeet?
The term "flatfeet" is a non-medical term and is intended to describe the position of the foot while standing. We have all heard about soldiers being discharged from the military because of their "flatfeet" or "fallen-arches." Actually, some of these individuals had normal feet that were crammed inside "one-size fits all" boots that created significant pain and inability to function.There are many reasons why a foot may look flat. The height of our foot arches varies from person to person. Sometimes it is an illusion created by enlarged muscles or increased fat padding on the inside of the foot. Another is a supple, flexible foot which looks flat while standing but returns to normal posture while walking. These types of feet rarely cause problems. It is the deviation from "normal" that leads to various foot problems. Damage to the major tendons and ligaments which support the arch can cause significant problems. Other causes are injury, rheumatoid arthritis, and neuromuscular disease.

What are the symptoms?
The severity of the deformity may not correlate to the degree of pain. For example, a foot that looks severely flattened may have no pain; while a mild looking flatfoot may be incapacitating.

Pain usually develops in the inside arch of the foot at the level where one would tie their shoelaces (the "instep"), and/or the inside of the ankle where the main tendon that supports the foot is located. Related pain may occur in the ankle region, calf muscles, hips, or lower back due to improper alignment of the feet, legs, and hips.

The pain is most commonly due to increased stress on the posterior tibial tendon, the main tendon which supports the arch and aligns the foot under the leg. Problems with this tendon usually occur in stages and begin with inflammation of the tendon itself. As time goes on, the tendon begins to wear and becomes stretched-out or frayed, filling with scar tissue which is much weaker than the normal tendon and easily damaged further. Once this happens, increased stress is placed on the small muscles and ligaments which support the foot bones and other muscles are recruited to help support the arch. This creates swelling, pain, and eventually arthritis in the foot and ankle joints. If left untreated, the tendon can rupture and the foot may turn out under the leg resulting in a stiff, painful foot and ankle. The Achilles tendon and calf muscles often lose flexibility and become tightened over time, further placing stress on the arch.

What are the treatment options?
When flatfeet are causing mild pain, the simplest solution is to try a better shoe which has a good supportive arch or an over-the-counter arch support inside. A slightly higher heel (like those found in a good, name brand running shoe) can be helpful. This allows the foot to lean forward, taking tension off of the Achillies tendon, and helps to curl the arch higher which takes stress off of the posterior tibial tendon. If these simple measures fail to relieve the symptoms and the foot is still flexible, a custom made arch support ("orthotic") or special low-profile brace may be prescribed for you. These help realign the foot and ankle joints and take stress off of the posterior tibial tendon. Modern orthotics or low-profile braces allow you to wear a modest normal shoe, and are not unsightly and enormous as in years past. Anti-inflammatory medication, ice water soaks, and topical medications like BenGay may also provide some relief but should only be started after checking with your podiatric physician.

When the flatfoot is painful despite the conservative therapy or you cannot find shoes that are comfortable, consultation with a podiatric physician is advised to discuss surgical options. The longer surgery is delayed in a symptomatic flatfoot, the greater the amount of arthritis that may develop and the more complicated the surgery becomes.

What does surgery involve?
The goal of surgical correction is to restore normal alignment and function of the foot and to repair any tendon damage. The posterior tibial tendon is inspected and, if necessary, repaired using a small portion of a nearby tendons. The Achillies tendon may be lengthened and the heel bone realigned in proper position with the use of either a small implant or held in place with a screw. If the foot is too stiff or if the joints are destroyed by arthritis beyond repair, it may be necessary to fix the joints in proper position with screws and/or small pins.

After surgery, the foot is usually placed in a cast for 4-6 weeks followed by a removable walking boot for an additional 4-6 weeks. Once the skin and bones are nearly healed, an athletic shoe with good support is worn until healing is complete. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as time goes on and in consultation with your surgeon.

Des Plaines
1455 Golf Road . Des Plaines, IL 60016
(847) 390-7666 • e-mail • http://www.weil4feet.com