Adult Acquired Flatfoot Deformity
One in four adults in the U.S. has adult acquired flatfoot deformity, which may begin during childhood or be acquired with age. The foot may be flat all the time or may lose its arch when the person stands. The most common and serious cause of flat foot is Posterior Tibial Tendon Dysfunction, in which the main tendon that supports the arch gradually weakens.
Patients with adult acquired flatfoot deformity may experience:
- Heel or ankle pain
- Tired feet
- Foot or ankle deformities
- Knee or back pain
Some patients may not experience any symptoms from this condition. However, flatfoot tends to worsen over time, especially in patients with a tight Achilles tendon or those who are obese. Athletes are also at a higher risk of developing flatfoot.
Treatment for flatfoot often begins with conservative life changes such as changing shoes, wearing orthotic devices and taking anti-inflammatory mediation to relieve pain. Applying ice to the foot and performing physical therapy exercises are also usually helpful for many patients. In severe cases, or those that do not respond to conservative treatments, surgery may be needed to relieve symptoms and correct the problem. Surgery for flatfoot may involve removing or reshaping a bone or bone spur, or fusing one or more of the bones in the foot together.
Some patients are born with an extra bone in their foot, known as an accessory navicular bone, which may become enlarged or injured and cause irritation or pain, especially when walking or playing sports. While treatment is not needed for an accessory navicular bone that does not cause pain, those that do may require treatment.
The Kidner procedure is the most common surgical treatment for accessory navicular bones that cause pain. This procedure involves detaching the bone from the posterior tibial tendon and then removing it entirely from the foot. The tibial tendon is then reattached and the incision is closed with stitches. Patients will likely need to use crutches after surgery and should be able to resume all physical activity after six weeks.
Tarsal Coalition is a disorder of the hindfoot in which the joint has not formed correctly. Instead, bones or tissues hold the bones of the hindfoot together. This results in a fixed positioning of the foot with little mobility, often in a flat-footed stance. In some cases, there are no symptoms relating to tarsal coalition and the patient is unaware that they even have the condition. However, in most people, there is foot pain and noticeable flatfoot disorder that appears around adolescence. This condition is typically diagnosed upon examination and X-rays of the foot and ankle. Occasionally, more detailed imaging through an MRI or CT scan will be necessary.
Conservative treatments are often effective for tarsal coalition, including activity restriction, taking anti-inflammatory medications, using an ankle brace and switching to more supportive shoes. If these therapies do not relieve symptoms, surgery may be required. When only a portion of the joint is problematic, a resection may be performed to remove just that area. When the symptoms are severe or the entire joint is affected, a subtalar fusion may be performed to fuse the joint together.
Flat Feet in Children
Most children are born with flat feet and develop arches as their bodies grow. However, in some children, the arch never develops, leaving the child with inward-turning ankles. While this condition is not usually serious, parents should seek medical attention for flatfoot, as it may cause pain. Some children also experience flexible flatfoot, a condition in which the arch disappears while standing, and then reappears when the child sits or is on tiptoes.
To ensure that your child’s flat feet aren’t associated with any other problems, the doctor will check for warning signs such as arch inflexibility, calluses, tight Achilles tendons, tarsal coalition (fusion of bones in the feet), pronation (leaning-in of the ankles) and pain or weakness in the feet or ankles. He or she will also examine the child’s shoes and ask whether there is a family history of flat feet or neurological or muscular disease. If the condition persists and begins to cause pain, arch supports, physical therapy or casting may be recommended to relieve pain and correct the condition.
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