Overview

Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA. If you've ever seen your footprints in the sand and they looked more like bricks than feet, then you probably have flat feet. Simply stated, a flat foot is a foot that does not have an arch when standing. In the medical world, flat feet are associated with "pronated" feet. Pronated is merely the term used to describe the position of the foot when it is flexed upward (dorsiflexed), turned away from the body (abducted), and the heel is rolled outward (everted), all at the same time. A certain amount of pronation is required for normal walking, but too much pronation is often considered a foot's "worst enemy." Over time, excessive pronation can lead to many unpleasant problems including heel pain, bunions, hammertoes, shin splints, and even knee, hip, or back pain. In fact, one orthopedic surgeon discovered that 95% of his total knee replacement patients and 90% of his total hip replacement patients had flat feet. An easy way to tell if you pronate too much is to take a look at your athletic shoes-excessive wearing of the inside heel (arch side of the shoe) as compared to the outside is a classic indication of excessive pronation.

Causes
If you tend to pronate, roll your foot and ankle in when you walk or run you may cause your arch to fall. Pronating your foot and ankle interferes with the normal movement of your foot. You should land on your heel first and roll through the middle of your foot. Landing on the inside of your foot stresses foot and ankle bones, tendons and ligaments. This can lead to many problems including flat feet. Your podiatrist can examine the way you land on your foot and then design orthotics to help you move correctly. It is important to wear the right shoes for an activity, to provide necessary arch support. Making these corrections can relieve symptoms.

Symptoms
Symptoms that should be checked by a pediatrician include foot pain, sores or pressure areas on the inner side of the foot, a stiff foot, limited side-to-side foot motion, or limited up-and-down ankle motion. For further treatment you should see a pediatric orthopedic surgeon or podiatrist experienced in childhood foot conditions.

Diagnosis
If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.

Non Surgical Treatment
If you have fallen arches, but you are not experiencing any symptoms, then you probably do not need to seek treatment. If you are experiencing discomfort due to fallen arches, there are several treatment options. These treatment options include elevating the feet and applying ice to ease discomfort and reduce swelling, rest, exercises to stretch the feet, physical therapy, medication, such as anti-inflammatories, steroid injections and orthotic devices or customised arch supportsto wear in the shoes. If you have fallen arches and periodically experience pain related to that condition, it is a good idea to get orthotic devicesor custom arch supports, to wear in your shoes. The other treatment options, like medication and ice, will help to ease pain from fallen arches after you have already begun to experience pain. However, orthotic devices or(custom arch supports)can help to prevent pain from occurring at all. This preventative measure helps many people with fallen arches to avoid pain and prevent worsening of their condition. In severe cases of fallen arches, surgery may be required to correct the problem. You can also help to prevent pain and exacerbation of fallen arches by reducing your risk factors. If you are overweight, try to lose weight. Even a small weight loss can reduce the pressure on your feet significantly. If you are diabetic, manage your blood sugar as best as possible. Losing weight often also improves the condition of diabetics. You should also avoid high-impact activities, like running on the road, tennis, and sports that involve jumping. Try a gentler form of exercise, like swimming, instead. If you have fallen arches, orthotic devices or(custom arch supports)are an important component of your treatment and can help to prevent pain.

Surgical Treatment

Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies. The treatment of a rigid flatfoot depends on its cause. Congenital vertical talus. Your doctor may suggest a trial of serial casting. The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually. However, this generally has a low success rate. Most people ultimately need surgery to correct the problem. Tarsal coalition. Treatment depends on your age, extent of bone fusion and severity of symptoms. For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast. For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot. Lateral subtalar dislocation. The goal is to move the dislocated bone back into place as soon as possible. If there is no open wound, the doctor may push the bone back into proper alignment without making an incision. Anesthesia is usually given before this treatment. Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently. About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.

After Care
Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients How do you treat a sore Achilles tendon? not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.