Remember the kid in your class who had to wear those ugly orthopedic shoes? Worse yet, perhaps you were that child. Those days are long gone as is the understanding of what flatfoot is and how to fix it. It was once thought that the bony architecture of the foot could be changed with shoes or positioning a bar between the shoes to hold the feet in the "correct" position. Research has shown that assumption is not true, according to the American Academy of Orthopaedic Surgeons (AAOS). Great strides have been made in understanding and treating flatfoot.
People with flat feet lack the proper "arch" in the foot. If a child or adult is not experiencing any pain, having difficulty walking or wearing shoes, treatment may not be required.
If the foot becomes painful and/or it becomes difficult to wear shoes, some type of treatment is appropriate. Patients may even experience back, hip, or knee pain related to their flatfeet. According to Steven L. Haddad, MD, an orthopedic surgeon with the Illinois Bone and Joint Institute, Ltd., and a spokesperson for AAOS, conservative treatment works for a large percentage of those with flatfeet.
"Many patients do very well in an athletic-type shoe with an orthotic," Haddad said. Conservative treatment is used almost exclusively with children, though some children with severe flatfeet require surgical reconstruction to improve their quality of life.
Haddad cautioned that not all adult patients with flatfoot experience foot pain. "Sometimes a patient presents with lower back pain, or pain in the hip, leg, knee or ankle." It is the lack of an arch in the foot that causes the foot to roll inward. This pronation causes the person's gait to change, which can then produce problems elsewhere in the body or locally within the foot itself. Pain refractory to conservative care, i.e., orthotics, physical therapy, and medication, is the indication for surgical reconstruction of a flatfoot. If you are experiencing these symptoms, it is important to seek the advice of an orthopedic surgeon.
Acquired flatfoot (those who are not born with a flatfoot) may be the consequence of a traumatic injury to the ankle, according to Haddad. "Adults can rupture or injure their posterior tibial tendon, which is the primary tendon supporting the arch. This can be the result of sports that require 'pivoting'--like soccer or football--and are often mistaken for a severe ankle sprain. This type of trauma can lead to a flatfoot deformity in up to 25 percent of all acquired flatfoot patients."
Haddad admitted that this type of injury is hard to prevent. If there is a congenital abnormality, a fracture or dislocation, torn or stretched tendons, or degenerative or systemic conditions, surgery maybe indicated for persistent pain and/or significant deformity from acquired flatfoot.
Haddad was joined by his colleagues, Robert B. Anderson, MD, and William C. McGarvey, MD, for a media briefing February 16--"Care of the Flatfoot"--at the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego, California.
For more information on flatfoot, visit www.aaos.org/oko/pediatrics/flatfoot/pathophysiology/classification.cfm; for more information about the American Academy of Orthopaedic Surgeons, visit www.aaos.org/about/about.asp
