Flat feet

What is flat feet and where is it found?
Flatfoot is a condition in which there is a reduction in the height and/or complete disappearance of the arch of the foot. It can occur in adulthood due to:

prolonged stress on the foot
disturbance of biomechanics
the normal ageing process.
The incidence of the condition in the general population is high and can reach up to 30%. It is predominantly observed in women over 40 years of age.

Known risk factors include:

obesity, hypertension, obesity, diabetes
Flat feet can also occur in pregnant women as a result of temporary increased elasticity during pregnancy.

Flatfoot categories
Flatfoot is classified into 2 categories: Loose flatfoot and Stiff flatfoot.

Flexible or loose flatfoot is when an adult exhibits flattening of the foot arch in an upright position, but the arch reappears when the foot flexes the distal leg or extends the toes.

It is worth noting that this is not true arch flattening and the clinical picture is due to excessive pronation of the foot.

Muscle strengthening of the toe muscles is useful and often leads to an increase in the height of the arch regardless of age.

Stiff flatfoot is less common and is caused either by bone loss in the foot bones or by another neurological problem. It is characterised by the complete absence of the arch of the foot and is accompanied by pain. It is recognized on plain radiographs and should be treated immediately in adolescence. It is due to factors such as:

possible fractures of the heel or ankle
inflammation of the ankle
How is the diagnosis made?
The diagnosis of flatfoot is easy and can be based on an overview of the elimination of the arch of the foot in the upright position.

If the patient stands on the toes, the deformity will be corrected when it is a loose flatfoot or in a child with loose joints. This correction is not seen in adults with stiff flat feet.

An easy and traditional clinical test is the “wet footprint” test, performed by wetting the patient’s feet with water. The patient then stands on a smooth, flat surface such as smooth concrete or thin cardboard. Usually, the larger the footprint left by the foot, the more severe the flatfoot is. On a plain x-ray of the feet in an upright position, flatfoot can be diagnosed and classified according to the severity of the disease.

In most patients loose flatfoot is asymptomatic and does not cause pain. In these cases, there is usually no cause for concern. In the past, flat feet was a reason for exemption from military service. However, it has since been shown that there is no clinical difference with normal adults.

How is it treated?
Treatment of flatfoot is indicated if it causes pain in the legs or feet or if the condition affects the knees or lumbar region. Treatment may include specific leg limb exercises.

In cases of severe flat feet, special insoles to support the medial arch or splints may be used to reduce discomfort.

Surgical intervention
In some cases, surgery can provide definitive relief and even create a foot arch where none existed before.

Surgical techniques include the triple arthrodesis, in which an arthrodesis is performed:

the ankle joint
the subtalar joint
the subtalar joint, the tarsal joint, the subtalar joint, the subtalar joint, the tarsal joint
In this way, the stability of the foot is increased and orthosis and gait are facilitated.

If the flatfoot is due to a deficiency of the posterior tibial tubercle, a heel osteotomy with tendon transfer of the long flexor of the big toe and ligamentous reconstruction may be performed.

It is therefore clear that specialised knowledge is required for the treatment of flat feet. Orthopedic Surgeon Antonios Pettas has many years of experience and is well trained in this particular condition. Watch an interview with him and contact him for a detailed diagnosis and consequently a personalized treatment and rehabilitation plan.