What is Flatfoot
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Flat feet is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. It is also called flatfoot, pes planus or fallen arches. The feet of people with fallen arches may roll over to the inner side when they are standing or walking, known as overpronation. The feet may point outward.

The main function of the foot is to bear weight. The arch provides an elastic, springy connection within the foot. This helps to bear the full body weight and not transfer it to the long bones of the leg and thigh (and the back in obese people).[1]

Causes of Flat Feet

Flat feet in adults can arise from a variety of causes. Here are the most common:

  • An abnormality that is present from birth e.g. Tarsal coalition.
  • Foot or Ankle injury
  • Damage or inflammation of the Achilles tendon (posterior tibial tendon), which connects from your lower leg, along your ankle, to the middle of the arch
  • Broken or dislocated bones
  • Some health conditions, such as rheumatoid arthritis
  • Nerve problems cerebral palsy, muscular dystrophy, or spina bifida

Other factors that can increase your risk include:

What are the different types of flatfoot?

1. Flexible flatfoot and

2. Rigid flatfoot.

Flexible flatfoot: This is said to occur when an arch that is present while a person is sitting or standing on their toes disappears when they stand with the entire foot on the ground. Changing shoes and Muscular training of the feet is helpful and will often result in increased arch height regardless of age.

Rigid Flatfoot: This is said to occur if there is no arch, whether sitting or standing, they have a “rigid” or “true” flatfoot.

Flexible flatfoot is sometimes called “pediatric flatfoot” because it is first apparent in childhood. Of note, almost all infants appear to have a flatfoot due to the fat pad on the sole of their feet and that the arch does not develop until 5 or 6 years of age. Congenital or rigid “true flatfoot” (talipes planovalgus) is much less common in children.

Problems of Flatfeet and fallen Arches

Many people have flat feet — and notice no problems and require no treatment. But others may experience the following symptoms:

  • Feet tire easily
  • Painful or achy feet, especially in the areas of the arches and heels
  • The inside bottoms of your feet become swollen
  • Foot movement, such as standing on your toes, is difficult
  • Calf, back and leg pain

Other problems include:

· Shoe heels wear out more rapidly and more on one side than the other.

· Abnormal gait.

Test Yourself for Flat Feet

You can easily test yourself to see if you might have fallen arches or flat feet. Follow these three steps:

  1. Get your feet wet.
  2. Stand on a flat surface where your footprint will show, such as on a colored tile surface.
  3. Step away and look at the prints. If you see complete imprints of the bottom of your feet on the surface, then you’re likely to have flat feet.

Many young children have flat feet, a condition referred to as flexible flat feet. When the child stands, the feet look flat. But when the child rises to his or her toes, a slight arch appears. In most cases, as children grow older, the arches develop.

Pathophysiology

The main function of the foot is to bear weight. There is a functional relationship between the structure of the arch of the foot, the biomechanics of the lower leg and it’s weightbearing functions. The arch provides an elastic, springy connection between the forefoot and the hind foot. This association safeguards so that a majority of the forces incurred during weight bearing of the foot can be dissipated before the force reaches the long bones of the leg and thigh.[3]

In pes planus, the head of the talus bone is displaced medially and distal from the navicular. As a result, the Plantar calcaneonavicular ligament (spring ligament) and the tendon of the tibialis posterior muscle are stretched, so much so that the individual with pes planus loses the function of the medial longitudinal arch (MLA). If the MLA is absent or nonfunctional in both the seated and standing positions, the individual has “rigid” flatfoot. If the MLA is present and functional while the individual is sitting or standing up on their toes, but this arch disappears when assuming a foot-flat stance, the individual has “supple” flatfoot. This latter condition can be correctable with well-fitting arch supports.[4]

Just some extra Info

Throughout history, people with flat feet were rejected in the military and were said to perform poorly in sporting events. According to AAP news and journal gateway, flexible flatfoot does not impede athletic performance.[5] With standard running shoes, sporting professionals claim that a flatfooted person is more susceptible to shin splints, back problems, and tendonitis in the knee.[6] Running in shoes with extra medial support or using special shoe inserts, orthoses, may help correct one’s running form by reducing pronation and may reduce risk of injury.

I once heard of a fable that people with flat feet have no place in the military. It also said that they perform poorly in sporting events. Three studies (see citations below in military section) of military recruits have shown no evidence of later increased injury, or foot problems, due to flat feet, in a population of people who reach military service age without prior foot problems. However, these studies cannot be used to judge possible future damage from this condition when diagnosed at younger ages. They also cannot be applied to persons whose flat feet are associated with foot symptoms, or certain symptoms in other parts of the body (such as the leg or back) possibly referable to the foot.

Treatment for Flat Feet and Fallen Arches

Treatment for flat feet and fallen arches depends on the severity and cause of the problem. If flat feet cause no pain or other difficulties, then treatment is probably not needed. In other cases, your doctor may suggest one or more of these treatments:

  • Rest and ice to relieve pain and reduce swelling
  • Stretching exercises
  • Pain relief medications, such as nonsteroidal anti-inflammatories
  • Physical therapy
  • Orthotic devices, shoe modifications, braces, or casts
  • Injected medications to reduce inflammation, such as corticosteroids

If pain or foot damage is severe, your doctor may recommend surgery. Procedures may include the following:

  • Fusing foot or ankle bones together (arthrodesis)
  • Removing bones or bony growths — also called spurs (excision)
  • Cutting or changing the shape of the bone (osteotomy)
  • Cleaning the tendons’ protective coverings (synovectomy)
  • Adding tendon from other parts of your body to tendons in your foot to help balance the “pull” of the tendons and form an arch (tendon transfer)
  • Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening)
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