What to do in case of “flat foot”

The use of orthotics, orthopedic shoes and muscle strengthening exercises are the measures normally practiced in case of “flat foot”, which is followed, in the most serious cases, by surgery.

We speak of “flat foot” when there is a reduction or a complete flattening of the plantar vault, that is, when the lower surface of the foot touches more or less completely the ground.

In people without this anatomical alteration, in fact, the central and internal part of the foot does not rest on the ground, ensuring a better distribution of body weight.

Another characteristic often associated with the flat foot is the valgus-pronation of the calcaneus or the rotation of the bone inwards.

In fact, all of us from the first months to 3-4 years of age have flat feet (in this case we speak of physiological flat foot) due to the overabundance of adipose tissue in that area and excessive mobility of the connective tissue still in the maturation phase.

This situation usually tends to resolve within 6-7 years of age, a limit beyond which, if the flattening persists, we speak of pathological flatfoot.

It is therefore a condition that generally affects childhood, but can also occur in adulthood by involving both feet or, more rarely, only one of the two.

The causes

The factors that lead to flat feet are many and of different nature. The main ones are:

• congenital (malformations of the foot bones, short Achilles tendon, etc.)
• neuromuscular (dystrophies, cerebral palsy, etc.)
• post-traumatic (foot or ankle injury)
• chronic inflammatory diseases (juvenile rheumatoid arthritis)
• connective tissue disorders (joint hypermobility syndrome, etc.)
• diabetes
• overweight or obesity
• aging.

Symptoms

Rarely a person with flat foot experiences particular symptoms. In cases of more pronounced flattening, on the other hand, pain in the feet, ankles or knees may be complained of, especially after a walk or after a long period in an upright position.

Sometimes, standing still in the same position involves pain in the back and hips.

Diagnosis

The medical history and physical examination by the podiatrician, expert in plantar disorders, or the orthopedist are often sufficient to diagnose flat feet.

The visit is generally based on the observation of the patient during the walk, the shape of the feet and how their conformation changes under load.

A particularly helpful tool in this phase is the podoscope, or a glass platform that allows, through lights and mirrors, to accurately evaluate the footprint of the feet.

If calcaneus valgus is also suspected, the lifting test on the tips is usually also practiced.

When the patient experiences severe pain and discomfort, further diagnostic tests such as X-rays, CT scans, resonance scans or ultrasound are used.

Treatment

Although it is not a condition that is usually of particular concern, children who are affected are more likely to suffer later in age from secondary conditions such as hallux valgus or osteoarthritis of the knees and/or ankles.
The treatment, in most cases, is therefore conservative and includes:

• Insoles modeled on the patient’s foot
• orthopedic shoes
• physiotherapy exercises based on muscle strengthening and stretching and improving walking
• correction of modifiable predisposing factors.

In severe cases, minimally invasive corrective surgery can be performed between the ages of 9 and 14. Among the most practiced procedures we find arthrosis, or the insertion of a small screw between the calcaneus and talus to raise the arch.

When to consult your doctor

It is especially recommended to consult your doctor, orthopedist or podiatrician, when:

• Despite the use of orthotics, the discomfort in feet and legs continues
• The shoes wear out quickly on the inside, a sign of excessive rotation of the foot
• complete absence of the arch of the foot is observed
• There is an altered sensitivity and motility of the feet.