Flat Feet

What is Flat Feet or Over-Pronation?

Flat Feet In Children

Flatfoot can be normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years.

With a healthy foot, the arch prevents the sole from lying flat on the ground while standing.

What are the Types of Flatfoot?

Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved.

Rigid flatfoot, however, can cause joint pain in the leg when walking or aching pain in the feet and usually requires intervention.

What are the Causes and Risk Factors for Flatfoot?

Pediatric flatfoot is a common condition that can run in families. It is often caused by loose connections between the joints and excess baby fat deposits between the foot bones which make the entire foot touch the floor when your child stands up.

A rare condition called tarsal coalition can also cause flatfoot. In this condition, two or more bones of the foot join abnormally causing stiff and painful flat feet.

What are Collapsed Foot Arches?

When a person's arch collapses upon weight bearing this condition is also referred to as Collapsed Foot Arches. The common biomechanical condition that occurs during standing or walking. 

Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called flatfoot because it is the most common type of flatfoot developed during adulthood.

Flat Foot in Children

A flat foot is normal in infants, most people's arches develop throughout childhood, but some people never develop arches.

Babies are born with flat feet, due to fatty pads filling out the sole portion of their feet. It isn’t until they are around the age of 3 that these fatty pads start to disappear when they are walking freely and confidently.

As these pads diminish, the natural arch starts to develop between the ages of 3 to 6. However, 1 out of 10 children never develop the arch and they have flat feet through their adult years.

Who is at Risk of Flat Feet?

Flat feet is a genetic disorder.

Age is also a risk factor for Flat Feet. Arches can fall over time. Years of wear and tear can weaken the tendon that runs along the inside of the ankle and helps support the arch.

Other factors are:

• Obesity
• Injury to your foot or ankle
• Rheumatoid arthritis
• Diabetes

What is the Impact of Flat Feet?

Flat Feet can cause aches and pains. Flat feet will often cause your legs to turn unnaturally inward and can contribute to injuries often associated with overuse and stress such as:

• Shin Splints
• Heel Spurs.
• Back Problems
• Swollen Ankles
• Knee Problems, Due To Misalignment
• Plantar Fasciitis
• Metatarsalgia,
• Tendonitis And/or Bunions. 

Flat Feet discomfort can also reduce a patient's active lifestyle leading to more health problems and weight gain. Flat Feet does not cause knock knees.

What are the Causes of Flat Feet?

There are many conditions that can cause flat feet and overpronation. Common foot deformities and flexible muscle structure are the most frequent causes.

The structure of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot.

Other conditions that can weaken the arch and lead to over-pronation include:

• obesity,
• pregnancy or
• repetitive pounding on a hard surface.

A rare condition called Tarsal Coalition can also cause flatfoot. In this condition, two or more bones of the foot join abnormally causing stiff and painful flat feet.

What are the Symptoms of Flat Feet?

Over-Pronation does not always cause discomfort immediately, and some never suffer from any discomfort at all.

When symptoms do develop that can include:

• Pain during walking,
• Pain in the foot, leg, knee, hip, or lower back,
• Pain in the heels causing difficulty with walking/running
• Feet and Calf Strain due to awkward alignment,
• Inside arch of the foot is flattened
• The inner aspect of the foot may appear bowed out
• Heel bone may be turned outward
• Heel or arch pain can worsen with activity, and
• Swelling along the inside of the ankle can also occur.
• Discomfort with wearing shoes
• Inability to bear weight on the affected foot
• Tired, achy feet with prolonged standing or walking

Stages of Flat Feet

If caught early enough Flat Feet can be corrected by treatments and supports.

• Stage 1 - there is pain along the posterior tibial tendon without deformity or collapse of the arch. The patient has the somewhat flat or normal-appearing foot they have always had.
• Stage II - a deformity from the condition has started to occur, resulting in some collapse of the arch, which may or may not be noticeable. The patient may feel it as a weakness in the arch. Many patients initially present in stage II, as the ligament failure can occur at the same time as the tendon failure and therefore deformity can already be occurring as the tendon is becoming symptomatic.
• Stage III - the deformity has progressed to the extent where the foot becomes fixed (rigid) in its deformed position.
• Stage IV - deformity occurs at the ankle in addition to the deformity in the foot.

How are Flat Feet Diagnosed?

When podiatrists look at the arch of your foot to see whether it’s touching the ground they can also assess whether the foot's position is 'neutral' or not.

Everyone's foot fits somewhere on an arch scale from extremely flat, neutral or highly supinated or 'high arched'.

Other signs that might indicate you have flat feet include:

• uneven shoe wear or shoes wearing out quickly
• regular pain in your feet and/or legs
• tripping or falling often, especially for children
• feet that are weak, numb or stiff

If pain is associated with Flat Feet, or if the arch does not form while standing on toes, then X-rays are ordered to assess the severity of the deformity.

A computed tomography (CT) scan is done if a tarsal coalition is suspected and if tendon injury is presumed a magnetic resonance imaging (MRI) is recommended.

Non-Surgical Treatment of Flat Feet

Over-Pronation can be treated conservatively with orthotic insoles that are designed with appropriate arch support to prevent the over-pronation.

Stability shoes that feature a firm heel counter and wide soles help reduce over-pronation.

Other approaches include:

• Resting
• Strengthening your foot muscles through toe curls, heel raises, and other exercises to improve foot support, stability and shock absorption.
• Not walking barefoot – Always wear proper fitting and supportive shoes
• Avoiding running or other high-impact sports
• Shoe modification: Wearing a well-fitting, supportive shoe can help relieve aching pain caused by flatfoot.

If you still experience foot pain, and your quality of life is affected by over-pronation you should seek the help of a podiatrist.

Surgical Treatment of Flat Feet

Surgery is rarely needed to treat pediatric flatfoot; however, if conservative treatment options fail to relieve your child’s symptoms, surgery may be necessary to resolve the problem.

Depending on your child’s condition, various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.

If conservative treatment options fail to relieve symptoms then surgery may be necessary to resolve the problem.

Depending on the condition, various procedures may be performed including:

• Tendon Transfers,
• Tendon Lengthening,
• Joint Fusion, and
• Implant Insertion

What if Flat Feet is Untreated?

If Over-pronation of the feet is left untreated, they become progressively more painful and debilitating.

Untreated and in its most severe form, the deltoid ligament on the inside of the ankle fails, resulting in the deformity in the ankle. This deformity over time can result in arthritis in the ankle.