Most people with flat feet have a condition that is referred to as a flexible flat foot. This is caused by excessive flexibility within the joints and ligaments of their foot and is often hereditary. This results in an over pronated (rolled in) position and is exaggerated by mechanical misalignment of the foot. This can be a very destructive position for the foot to function in and can cause a wide variety of foot, leg and lower back conditions. The appearance of flat feet may vary from foot to foot. Generally there is a collapse of the medial (inside/middle) long arch of the foot. This may occur mildly where the arch height drops slightly or can be a large movement that results in the entire length of the arch resting on the ground. The twisting and misalignment of the foot that occurs with arch collapse can cause excessive wear and tear of the foot joints and eventually pain.
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
In more difficult cases of plantar fasciitis you should see your foot health professional for a thorough examination. They will find out why your arch or heel pain occurred in the first place and devise a treatment plan to relieve your pain and prevent it from reoccurring. They will evaluate your feet, walking pattern (gait), shoes, activities, exercise methods, and other relevant information and then devise your treatment plan.
Non Surgical Treatment
The adult acquired flatfoot is best treated early. There is no recommended home treatment other than the general avoidance of prolonged weightbearing in non-supportive footwear until the patient can be seen in the office of the foot and ankle specialist. In Stage I, the inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up treatment with custom-molded foot orthoses and properly designed athletic or orthopedic footwear are critical to maintain stability of the foot and ankle after initial symptoms have been calmed. Once the tendon has been stretched, the foot will become deformed and visibly rolled into a pronated position at the ankle. Non-surgical treatment has a significantly lower chance of success. Total immobilization in a cast or Camwalker may calm down symptoms and arrest progression of the deformity in a smaller percentage of patients. Usually, long-term use of a brace known as an ankle foot orthosis is required to stop progression of the deformity without surgery.
Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.
Early in the treatment of arch pain, consideration needs to be given to the cause and strategies put in place to prevent it happening again. Advice should be sought on the adequacy of footwear. Stretching exercises should be continued long after the symptoms are gone. Foot orthoses should be used if structural imbalances are present. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.