Flat Feet

Flat feet can be divided into two categories, pediatric and adult onset. 

Pediatric flat foot   
In many cases a flexible or low arch foot type is considered normal and requires no treatment.  However, frequently the flat foot is a result of another problem, commonly a congenitally tight calf muscle.  To compensate for this tight muscle, the foot adapts by collapsing.  Often the first sign of problems in the infant is “toe-walking”.  As the child begins to walk a bouncing gate is noticed with the heels minimally touching the ground.  As the child’s weight increases, the compensation begins and the foot is forced to collapse.  As an adult this may result in a multitude of problems from arthritis in the foot to knee and lower back problems.  Early detection and appropriate treatment can result in a complete correction of the problem.  Initial management usually involves molded arch supports, and physical therapy, but if this fails minimally invasive surgical procedures can have a dramatic effect.

Adult onset flat foot syndrome
Adult onset flatfoot is a very different problem.  The condition usually results from a failure of a major tendon supporting the feet.  The syndrome usually develops in mid life and more commonly in women.  The syndrome usually begins with swelling and tenderness just below the inside ankle bone.  In early stages the tendon thickens but over time the tendon fiber begins to stretch out like a piece of taffy.  In this second stage one notices the arch beginning to flatten and if untreated, completely collapsing.  This can result in substantial foot, leg, hip, and lower back pain.  Again early detection and appropriate treatment is critical.  Initial evaluation usually requires weight bearing x-rays to check arch integrity as well as an ultrasonic exam to visualize the tendon.  Often, if the tendon appears to be damaged, an MRI or weight bearing CT scan will be ordered.  Depending on the stage of injury, treatment may include temporary immobilization followed by braces, molded arch supports, and physical therapy.  If these fail there are a number of reconstructive procedures that our surgeons are skilled in performing.