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Foot Disorders : Flatfoot

Flatfoot is a common condition, it is defined as an abnormal depression of the medial longitudinal arch. These feet appear collapsed with excessive turning out of the heel, and the inside of the foot contacting the ground, this is the pronated foot type.  It often has a genetic component, and is more common in certain human populations and races.  Flatfoot is usually bilateral and apparent at an early age. It may be initially asymptomatic, but often becomes progressively symptomatic with age.  Some flat feet never become bothersome. Adult acquired flatfoot may develop due to trauma or degeneration of  major tendons ankle & foot.  Weakness or paralysis of leg muscles can also create a flatfoot deformity. The medial arch is unstable in flexible flatfoot, this creates stress on the surrounding soft-tissues and joints creating tired, sore arches.  The instability of the foot can create abnormal stress up the kinetic chain - resulting in pain in the legs, knees, hips and lower back. Patients with flat feet often present to the podiatrist with problems that are indirectly caused by their foot structure.

Flatfeet suffer from inadequate support of the bones and joints, and abnormal joint motion during gait.  Fortunately,  foot orthotic devices can correct these problems and reduce the occurrence of painful symptoms..  Generally, custom-made rigid functional posted orthotics are most effective for this foot type.  These devices are prescribed based on a thorough biomechanical examination by a qualified podiatrist. Over-the-counter arch supports may be helpful for mild cases, but often prove ineffective to relive symptoms associated with flatfoot.




Symptoms

  • Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot
  • There may be associated discomfort within and near the ankle joint
  • The knees, hips, and lower back may be the primary source of discomfort
  • Feet may often feel tired and achy
  • Painful shin splints may develop with activity
  • Gait may be awkward and apropulsive
Causes
  • Genetic predisposition
  • Faulty foot mechanics, e.g. excessive pronation
  • Abnormal bony architecture
  • Laxity of ligaments
  • Neuro-muscular disease
  • Trauma to the leg muscles or major tendons
  • Inflammatory diseases of the joints e.g. Rheumatoid arthritis
  • Surgical procedures on the leg and ankle
  • Limb length inequality
  • Tight Achilles tendon
What you can do
  • Wear shoes with a good fit in the arch
  • Keep active and fit to strengthen leg and foot musculature
  • Control body weight to decrease load on the feet
  • Avoid prolonged periods weight bearing with bare feet
What the doctor may do
  • Apply orthopedic taping to support strained ligaments and joints
  • Prescribe physical therapy modalities
  • Prescribe functional foot orthotic devices to stabilize the foot and control motion
  • Prescribe an ankle-foot orthosis when greater control is required
  • Surgically correct a severe symptomatic flatfoot 
Complications of flatfoot
  • Severe heel pain from plantar fasciitis and Achilles tendonitis
  • Chronic strain and pain in the arch and lateral side of the mid-foot
  • Metatarsal stress fracture 
  • Early degenerative joint disease (osteoarthritis) of lower extremity joints
  • Flatfeet are more prone to conditions such as bunions, hammer-toes, and Morton's neuroma
  • Painful corns and calluses
  • Structural changes may create areas of abnormal pressure resulting in chromic ulcers of the foot
  • Chronic foot pain may lead to inactivity and diminished well-being




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