FLAT FEET. CAUSES, SYMPTOMS, TREATMENT
What is the foot arch? What is its function?
In a healthy regular foot, there is a gap beneath the inner part of the foot that we call the foot arch. Usually, when the person is not standing, this arch appears to be higher or more accentuated, and when the person is standing, the arch might decrease a bit. This is entirely normal and even desirable because the foot arch acts as a natural spring, making the foot flexible, absorbing impacts when walking or running, and adapting to irregularities of the ground.
What is a flat foot? What does cause it?
In a flat foot, the arch previously mentioned is decreased or sometimes even wholly collapsed. This situation creates a non-dynamic foot, unable to move, adapt, and absorb forces and pressure.
When they are standing or walking, some flat feet may roll the ankle and internal aspect of the foot into the inner side. It usually creates a "rigid" very opened gait (where the tip of the feet are pointing outwards). This is called over-pronation; although this is intimately linked with flat feet, it is not the same concept. In fact, some over-pronated feet may not be flat, whereas almost all flat feet are pronated.
Common causes of flat feet include genetic component, accidents that affect foot and ankle, arthritis, weak arches where it is present when the person is sitting or lying, but it disappears when standing up (although this is generally related to other genetic problems such as laxity where joints, muscles, ligaments, tendons are too flexible and unable to support a correct foot structure), burns that affect the foot, obesity, nervous system or
muscle diseases. The most common cause of adult acquired flat foot is the damage of the posterior tibialis tendon (which is one of the most critical and active structures on supporting a correct foot arch)
It is worth mentioning that children and infants may often appear to have a flat foot, but not always it's the case. It is usual for the infant's foot to have an extra amount of plantar fat during their early development, which might be misdiagnosed with a flat foot. In any case, it is expected that a child or infant will develop a normal foot arch as the lower limb develops accordingly.
What are the symptoms of a flat foot?
Some flat-footed people might not have any pain or evident problems; however, most of the flat-footed population will experience foot pain and stiffness, abnormal stress on the knees, hip, or lower back. This is caused by the abnormal lower limb alignment that follows a flat foot, where it is common to see valgus of the knee. (knees in X) Patients with flat foot usually have lower back problems, especially those with an asymmetric flat foot (one foot can be flat and the other can be normal, or one foot can be flatter than the other) might develop a pelvic tilt (one hip higher than the other) and the consequent lower back issues.
Additionally, several complications are directly associated with flat feet and are likely to happen among people with this problem. These complications are bunions, Achilles and tibialis posterior tendonitis, metatarsal pain, hammertoes, arthritis in the foot and ankle, plantar fasciitis, and injury ligaments of the feet and shin splints.
How can a flat foot be treated?
In the particular case of infants and children, they usually develop a regular foot with a normal arch as they grow and develop; however, if the arch is not present when the children are around 3-4 years old, it is necessary to get it checked. When treated soon enough, the prognosis of a pediatric flat foot (when there aren't congenital issues associated) is excellent; in fact, by using proper custom-made insoles and proper shoewear, it is perfectly possible to achieve correction of the flat feet over time if the parents are consistent with the treatment.
In the case of adults with a flat foot, the treatment prognosis using custom-made insoles and proper shoes is also very favorable. When appropriately treated, a painful flat foot usually becomes asymptomatic, and further complications are prevented or at least slowed down. The main difference between adult flat feet and pediatric flat feet is that correction is impossible since the bone, joint, and other musculoskeletal structures development is finished. A small percentage of severe cases of rigid adult flat foot that fails on improving with custom-insoles and proper shoe-wear might require a surgical correction.
Muscle strength plays a crucial role in both the development and treatment of a flat foot. Weak leg muscles will worsen a flat foot; therefore, it is essential to be active and keep a right leg muscle tone. In the Achilles tendon's particular case, it is necessary not only a good muscle tone but also to stretch this tendon frequently to achieve good flexibility since a short-non-flexible Achilles tendon might worsen a flat foot.