Flat Foot, medically known as Pes planus, is a condition in which the medial longitudinal arch (MLA) which runs the length of the foot is flattened out or lowered. Flatfoot may affect one or both feet, and it can not only increase the load acting on the foot structure, but also interferes with the normal foot function. Therefore, individuals with flat feet experience discomfort while standing for long periods of time and exhibit a distinctive flat-footed gait. Typical flatfoot symptoms include a tenderness of the plantar fascia, a laxity of the ligaments, a rapid tiring of the foot, pain under stress, and instability of the medial side foot structure. Over time, the mechanical overloading resulting from the flattened MLA is transferred to proximal areas such as the knees, hips, and lower back. Flatfoot is recognized as a contributory factor in a wide variety of medical conditions, including lower limb musculoskeletal pathologies such as plantar fasciitis Achilles tendonitis, and patella-femoral joint pain.
Flatfoot deformities are commonly treated using some form of orthotic device. Such devices are designed to provide stability and to realign the foot arch, and have a demonstrable success in alleviating patients’ symptoms
Anatomy
Flatfeet are an anatomical alteration which can occur in one foot or in both feet. The most common structural difference in flatfeet is found to be rear-foot varus which in turn causes excessive pronation of the foot. In addition, deepened navicular cup, widened talus articular surface, proximally faced talus, and higher positioned navicular articular surface can be seen. These alterations cause the MLA to collapse resulting in a loss of arch height. When this loss of arch height is observable in both non-weight bearing and weight bearing positions, it is termed as rigid flatfeet. Contrarily, when a normal MLA height is present in non-weight bearing condition and collapses with weight bearing is identified as flexible flatfeet.
Symptoms
The most identifiable symptoms and characteristics of flat feet are the decrease or lack of arches in the feet (especially when weight bearing) and pain / fatigue along the inner side of the feet and arches.
Some issues caused by flat feet include:
• Inflammation of soft tissue
• Foot, arch, and leg fatigue
• Heel, foot, and ankle pain
• Knee, hip, and lower back pain
• Rolled-in ankles
• Abnormal walking patterns
• Shin splints
• Bunions
• Hammertoe
• Arthritis
• Plantar fasciitis
• Posterior tibial tendon dysfunction (PTTD)
Causes
Flatfeet is not unusual in infants and toddlers, because the foot’s arch hasn’t yet developed. Most people’s arches develop throughout childhood, but some people never develop arches. People without arches may or may not have problems.
Some children have flexible flatfeet, often called flexible flatfoot, in which the arch is visible when the child is sitting or standing on tiptoes but disappears when the child stands. Most children outgrow flexible flatfeet without problems.
People without flatfeet can also develop the condition. Arches can collapse abruptly after an injury. Or the collapse can happen over years of wear and tear. Over time, the tendon that runs along the inside of the ankle and helps support the arch can get weakened or tear. As the severity increases, arthritis may develop in the foot.
Diagnosis
The observation of the feet mechanics from the front and back and also toes stand. The strength test in the ankles and locate the main area of pain. The wear pattern on the shoes also may reveal information about the feet.
Tests
Imaging tests that can be helpful in diagnosing the cause of foot pain may include:
• X-rays. A simple X-ray uses a small amount of radiation to produce images of the bones and joints in the feet. It’s particularly useful in evaluating alignment and detecting arthritis.
• CT scan. This test takes X-rays of the foot from different angles and provides much more detail than a standard X-ray.
• Ultrasound. Ultrasound may be used when a tendon injury is suspected. Ultrasound uses sound waves to produce detailed images of soft tissues within the body.
• MRI. Using radio waves and a strong magnet, MRIs provide excellent detail of both bone and soft tissues.
Treatment
Many people with flat feet don’t have significant problems or need treatment. However, if foot pain, stiffness or other issues occur health provider might recommend nonsurgical treatments. Rarely, people need surgery to fix rigid flat feet or problems with bones or tendons.
Treatments include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs), rest and ice to ease inflammation and pain.
• Physical therapies to stretch and strengthen tight tendons and muscles, improving flexibility and mobility.
• Supportive devices like foot orthotics, foot or leg braces and custom-made shoes.
Exercises
Toes elevations: Start by standing with your feet shoulder-width apart and flat on the ground. Slowly raise your toes off the ground as high as you can, while keeping your heels on the ground. Hold this position for a few seconds, then lower your toes back down to the ground. Repeat for several repetitions.
Toes scrunches: Begin by sitting in a chair with your feet flat on the ground. Scrunch your toes together as tightly as you can, then relax them. Repeat for several repetitions.
Double/Single leg raises: Start by lying on your back with your legs straight out in front of you. For double leg raises, raise both legs off the ground at the same time, keeping them straight. For single leg raises, raise one leg off the ground while keeping the other leg straight and on the ground. Hold the raised leg in the air for a few seconds, then lower it back down to the ground. Repeat for several repetitions on each leg.
Standing single leg balance: Stand on one foot with your knee slightly bent. Hold this position for as long as you can, up to 30 seconds, then switch to the other foot. For a greater challenge, close your eyes or stand on a pillow or unstable surface.
Toes walks: Start by standing with your feet flat on the ground. Slowly walk forward on your toes, keeping your heels off the ground. Walk for a few steps, then lower your heels back down to the ground. Repeat for several repetitions.
Heel walks: Begin by standing with your feet flat on the ground. Slowly walk forward on your heels, keeping your toes off the ground. Walk for a few steps, then lower your toes back down to the ground. Repeat for several repetitions.
Calf muscle stretch: Start by standing facing a wall with your hands on the wall at shoulder height. Take one step back with one foot, keeping your heel on the ground. Bend your front knee, keeping your back leg straight, until you feel a stretch in your calf muscle. Hold this position for 15-30 seconds, then switch legs and repeat.
Prevention
Although flat feet are often hereditary and cannot be completely prevented, there are strategies that can be put in place to help reduce the risk of developing flat feet symptoms. Here are some preventative measures:
Footwear:
Choose supportive footwear with good arch support and cushioning and try to avoid shoes with flat soles.
Consider using orthotic insoles or arch supports that are designed to provide additional support and alignment for the feet.
Foot Exercises:
Perform exercises to strengthen the muscles of the feet and lower legs. This may include toe curls, heel raises, and toe taps. Consult with a healthcare professional or a physical therapist for guidance on appropriate exercises.
Maintain a Healthy Weight:
Excess body weight can contribute to the flattening of the arches. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce stress on the feet.
Avoid Prolonged Standing:
If your job or activities involve prolonged periods of standing, take breaks to rest and stretch your feet. Consider using supportive mats or insoles in areas where you stand for long durations.
Stretching Exercises:
Perform stretching exercises to maintain flexibility in the Achilles tendon and calf muscles. This can help prevent excessive pronation and contribute to better foot alignment.
Avoid High Heels:
Limit the use of high-heeled shoes, as they can contribute to foot misalignment and increase stress on the arches. Opt for shoes with a moderate heel height.
Gradual Changes in Physical Activity:
If you are starting a new physical activity or exercise routine, make changes gradually. Sudden increases in intensity or duration can place additional stress on the feet.
Proper Body Mechanics:
Pay attention to your body mechanics and posture. Maintain good posture while standing and walking and be mindful of how you distribute your weight on your feet.
Consult with a Specialist:
If you have concerns about your foot structure or experience symptoms of flat feet, consult with a podiatrist or orthopaedic specialist. They can provide a thorough evaluation and recommend appropriate interventions, such as orthotics or physical therapy.
Consider Arch-Supporting Activities:
Engage in activities that naturally support the arches, such as swimming or biking. These activities can be less stressful on the feet compared to high-impact sports.
It’s important to note that preventive measures may vary based on individual factors, and what works for one person may not be suitable for another. If you have specific concerns about flat feet or foot health, seeking advice from a healthcare professional is recommended. They can provide personalized recommendations based on your unique circumstances.
