Adult Flatfoot
Are your feet flat as a pancake—or at least have arches that seem a lot lower than average? You’re not alone. Estimates vary, but it’s believed that anywhere from 20 to 30 percent of Americans have flat feet to some degree.
There are many reasons for flat feet. For some people, arches simply never developed in the first place. For others, they collapsed over time due to wear and tear.
Flat feet don’t always require treatment, particularly if there is no associated foot pain or mobility issues. However, if you or a child are experiencing any pain that’s keeping you from your favorite activities, you should definitely get your flat feet evaluated.
The good news is that we can usually resolve your pain non-surgically, especially if you seek our help early!
Weakened Foot Arches—Adult Flatfoot
There are various reasons a normal foot arch might collapse later in life.
For most people with the condition, the posterior tibial tendon weakens due to age, obesity, or even overuse during athletic participation. This large tendon, located along the inside of the ankle, is one of the most important sources of support for the arch, so if it becomes weakened or thickened, the arch begins to sag. Pain, especially during activity, is a common consequence.
In other cases, arthritic conditions attack the joints, causing them to move out of position, which changes the shape of an affected foot and causes severe pain. Yet another reason for arch collapse is ligament injury, and even dislocated or fractured foot bones can be responsible.
Individuals who have diabetes are particularly at risk for arch collapse in their feet. The associated nerve problems accompanying the disease means a fractured bone or pulled ligament might not be felt. With continued use, the condition worsens until the entire foot is misshapen and causes severe issues.
These causes can potentially result in flat feet, significant pain, and reduction in mobility and activity. Over the longer term, you increase your risk for developing foot deformities such as bunions as well.
Pediatric Flatfoot
Most very young children have flatfoot, since the muscles of the midfoot are underdeveloped and not strong enough to hold a permanent arch. The arch may also be visible when not bearing weight, but disappear when the child stands. Most kids will develop a permanent arch by around age 5, but a sizeable percentage simply never do.
In general, if your child is not experiencing any pain or developmental delays relating to their flat feet, they may not need immediate treatment. However, flat feet should always be carefully examined by a professional, as certain forms of it can lead to pain and deformity later in life.
Our goal with kids who do need flatfoot treatment is to catch the problem as early as possible, and then begin the appropriate conservative treatment. This can help your child avoid the need for surgery, or at least delay it as long as possible.
Custom orthotics are typically the treatment of choice. The great news here is that both Medicaid and some insurance providers will cover two pairs of orthotics per year, which may be necessary since feet grow so fast in childhood. We are happy to work with you to make sure this important and necessary care for your child is affordable for your family.
Conservative Treatment Options for Collapsed Arches
There are several conservative measures we will recommend or prescribe to relieve the pain and restore mobility previously caused by a flatfoot condition. They include:
- Changes in shoe gear. Often a better pair of shoes with more depth, support, and features like a rocker bottom sole can greatly reduce discomfort.
- Arch supports, orthotics and/or bracing. We carry a variety of premade arch supports in our office that you can try on during your appointment, and can also make you a high-quality set of custom orthotics if necessary. Soft braces that provide stability to flexible or unstable joints may also greatly help.
- Temporarily protecting the foot with a walking boot. This will give your body time to reverse the tendon and/or ligament inflammation and repair injured tissues that are contributing to the collapse of your arch.
- Physical therapy. In many cases, following a specific program of stretching and exercises for the feet can help increase muscle and tendon strength, which can ease pain and help you prevent continuing arch collapse.
In many instances, these options help patients resume their normal activities. If you begin treatment early enough, you can usually keep the flatfoot from worsening to a more severe stage.
When these treatments do not deliver the results we hope to see, however, we may recommend surgery as a way to achieve the relief you need.
Rebuilding the Foot Structure
When necessary, we are able to perform surgical procedures to properly realign foot bones. Typically, we will use pins, bars, or screws to secure them. We might also repair damaged or weakened ligaments and tendons to further hold the bones in place.
Common surgical procedures to relieve adult-acquired flatfoot pain include:
- Cutting part of the heel bone (calcaneus), sliding the bone back into the correct position, and then securing it into place.
- Inserting wedges of bone in the outside edge of the heel bone to restore the proper outward rotation of the foot.
- Using a bone wedge inserted into the cuneiform bone to lower it (used when the arch collapse along the outer edge and forces the inner edge higher).
- Fusing metatarsal bones into proper position and then securing them with plates or screws.
- Repairing, or even removing, the posterior tibial tendon, lengthening the Achilles tendon, or transferring another tendon to hold up the bones in the foot arch.
- Fusing several bones together in order to bring relief from pain caused by stiffened deformities, particularly those caused by diabetes or arthritis.
Recovering from Flatfoot Surgery
When surgery is used to address a case of adult-acquired flatfoot, the procedures will be performed with the patient under general or regional anesthesia. This means you may need to be in the hospital overnight. You will also need to wear a cast to immobilize the repaired area and keep the affected foot elevated for the first couple of weeks.
After we have removed the stitches, you will receive another cast or boot. It is important to keep weight off the area for about 6-8 weeks following surgery, so be sure you plan accordingly. We will also likely prescribe physical therapy so you can regain function of your foot.
Expert Oklahoma City Foot Care
Our staff at Foot & Ankle Center of Oklahoma is ready to help you overcome any foot or ankle issue causing you problems, including adult-acquired flatfoot. Call us at (405) 418-2676 and our staff will be glad to answer any questions and assist you with scheduling an appointment. If you’d prefer, simply request your appointment online today!
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