Flat Foot

  • Flat foot

    Flat feet is a common condition. Flat feet are extremely common in children, but they tend to become normal over time. Flat feet can remain beyond teenage group, when they require treatment. Sometimes there can be extra bones in the foot of a child, causing flattening of the arches of the foot.

    Flat Foot Flat Foot

    Treatment hinges on use of proper footwear, exercises, physiotherapy and surgery to correct the arches and the bones to produce a good arch.

    Flat Foot

    Pictures showing before & after flat foot surgery

    Causes and treatment of flat feet in children:

    There are several reasons for flat feet in children.

    • Extra bones in the feet: called accessory navicular, or extra bone near the arch. Also normal bones fusing together called 'tarsal coalition' can cause flat feet due to loss of flexibility.
    • Congenital flat arches
    • Unknown cause

    Many children have flat feet at birth. The Good news is that most flat feet disappear by the age of 5-6 yrs. The arches tend to develop over this period of time. If flat arches continue after that time then treatment is required. It might be associated with tight tendoachilles, which might require release.

    When flat arches cause foot pain, the child might require definitive treatment.

    Flat Foot

    Flat foot in a teenager

    Treatment is permanent and will involve placing a screw called HYPROCURE in the sinus tarsus during surgery under X ray guidance control.

    Flat FootFlat Foot

    Treatment of adult flat feet

    The causes of flat feet in adults are different and many. As one ages, and also due to diabetes and obesity, arches in the feet tend to flatten and can cause pain and dysfunction of tibialis posterior tendon, an important tendon that maintains normal arch of the foot.

    • Arthritis: Arthritis may result in flat foot. Arthritis also causes ligament and tendon dysfunction causing flat foot. Charcot's joint occurs in diabetics particularly and causes a rapid and very severe, loss of the arch.
    • Tibialis Posterior dysfunction: Primarily the important hind foot tendon called Tibialis posterior is responsible for maintaining arches. When the tendon gets damaged, TP tendon dysfunction (or TPPD) occurs, causing aching pain on standing and sometimes at rest, on the inside of the heel or ankle. This is an important cause of adult flat foot.
    • Polio: lax ligaments also cause flat feet.
    • Severe acute ligamentous rupture can cause rapid flat feet - Spring Ligament rupture.

    Treatment includes bracing, analgesia and injections to reduce inflammation and improve function.

    If non-surgical means fail, then surgery is the definitive treatment of choice.

    Surgery depends on several factors like weight of the patient, associated arthritis in the joints surrounding the ankle.

    Flat Foot

    X-ray showing sub-talar arthritis

    Patients who have flat feet that are rigid and painful, require surgery.

    • FDL tendon transfer in place of the damaged TP tendon, and fixed with a bio-screw.
    • The heel bone is displaced inward and held in the new position with plate or screws.

    Flat Foot
    Normal tip-toeing
    Flat Foot
    Abnormal tip-toeing
    Flat Foot
    Ankle facing outward in flat feet

    Surgical correction of adult flexible flat feet involves:

    • Debridement and possible repair of torn and damaged TP tendon
    • FDL tendon transfer in place of the damaged TP tendon

      Tendon transfer for damaged TP

      Tendon transfer for damaged TP
    • Inward displacement of the heel bone and fixation with screw/plate

      Heel bone moved inside and fixed in new place

      Heel bone moved inside and fixed in new place
    • Use of footwear/surgical boot for 6-8 weeks after surgery.

     Flat foot before correction
    Flat foot before correction
    After correction
    After correction
     X ray before correction
    X ray before correction
    X ray after correction
    X ray after correction

    Results for flat foot correction are good. A light weight cast and then a boot will be required in all cases.

    Right ankle with sub-talar arthritis
    Right ankle with sub-talar arthritis
    X ray showing sub-talar arthritis
    X ray showing sub-talar arthritis
    X ray showing sub-talar fusion
    X ray showing sub-talar fusion

    In cases of sub-talar arthritis, a triple fusion is done.