Brief overview
- Treatment: appropriate footwear if discomfort is present, barefoot walking, orthotics and/or orthotics, physical therapy, surgery in certain less common cases; no therapy if no discomfort is present
- Symptoms: Not always present; pain that occurs with weight bearing, pain on the inner edge of the foot and on the sole of the foot, pressure points on the feet; in some circumstances, pain in the knee or hip.
- Cause and risk factors: Flexible flat foot (bent-lowered foot) in children normal (not pathological), otherwise due to loose ligaments, muscle weakness in the calf muscles, overweight, malalignment in the knee joint (knock knees or bow legs), trisomy 21 (Down syndrome), congenital diseases of the connective tissue.
- Prevention: Strengthening the foot muscles, e.g. walking barefoot on natural floors.
What is a flat foot?
In contrast to a healthy foot, the foot skeleton of a flat foot (lat. pes planus) lacks the longitudinal arch or the arch is too flat. Thus, the natural outward curvature from the heel to the ball of the forefoot is missing. As a result, the inner edge of the foot sinks, so that when standing, the entire sole of the foot lies “flat” on the ground.
A preliminary stage of the flat foot is the flat foot. In this form, the foot skeleton also loses its longitudinal arch, but the sole of the foot does not yet rest completely on the ground.
What are the different forms of flat feet?
A flat foot is either congenital (rare) or acquired, i.e. occurs later in life. The congenital form differs significantly from the acquired types, especially in terms of frequency, development and treatment.
Congenital flatfoot (usually rigid flatfoot) is rare and often occurs together with other malformations or diseases. Either one foot alone or both are affected. Affected babies show a very pronounced deformity of the foot. The foot not only loses its natural longitudinal curvature, but is even curved downward at the sole.
Acquired flatfoot (pes planus valgus)
Patients with an acquired (usually flexible) flatfoot are initially born with a healthy foot skeleton and only later develop the deformity. Depending on the age at which it occurs, a distinction is made between different types of acquired flatfoot:
- Acquired infantile buckling flatfoot : it appears around the beginning of the walking age.
- Adolescent flatfoot : develops in adolescence.
Acquired, infantile flatfoot must not be confused with natural (physiological) flatfoot in infancy: children have a different leg position than adults up to about the age of six. Because their femurs are aligned differently, they walk slightly x-legged, which also affects foot position. The result is a temporary bent flat foot.
What to do if you have flat feet?
There are various ways to treat flat feet. While acquired forms often do not require surgical intervention, surgery is usually unavoidable for congenital flatfoot.
Therapy for congenital flatfoot
Therapy for acquired flatfoot
If the symptoms do not improve with conservative measures, surgery may also be considered for acquired flat feet. In particular, flat feet caused by osteoarthritis or a torn tibialis posterior tendon are often operated on.
What are the symptoms of flat feet?
Symptoms of congenital flatfoot
Congenital flatfoot is noticeable immediately after birth. The malpositions of the foot – such as the outwardly curved sole of the foot, the bent heel and the outwardly splayed front section of the foot – are very pronounced here.
Symptoms of acquired flatfoot
Acquired infantile flatfoot usually progresses without symptoms. The children are only noticed because of the visible deformity of the feet. Depending on the cause, movement may be impaired.
Flat feet that occur in adolescence are usually accompanied by severe, sudden pain on exertion. Adolescents limp to rest the affected foot. Without treatment, adolescent flatfoot severely limits movement.
With a flat foot, the pain is usually on the inner edge of the foot and on the sole of the foot. However, the deformity sometimes also causes pain in the knees and hips. Due to the heavy load on certain parts of the foot, pressure points develop in some cases, which sometimes cause additional pain and make walking difficult. In many cases, however, flat feet do not cause problems when walking.
How do you recognize a flat foot?
In most cases, the doctor palpates the foot and checks the joints for mobility.
Another procedure is the footprint (pedography) on an electronic measuring plate or a suitable modeling clay. Here, the weight distribution of the sole of the foot can be easily traced. If the flat foot cannot be determined with certainty externally, an X-ray is taken. In the case of congenital flatfoot, this is always done for diagnosis.
Flatfoot: causes and risk factors
Congenital flatfoot appears to be primarily hereditary, as it is often present in several members of a family. However, this does not mean that a child is necessarily born with flatfoot if one parent is affected. Only the probability increases. The exact causes of congenital flatfoot are not yet known.
There are many causes for acquired flatfoot. The most common include:
- Overweight
- Connective tissue and muscle weaknesses. Acquired infantile buckling flatfoot is often due to muscle weaknesses.
- Diseases of the connective tissue (e.g. Marfan syndrome)
- Inflammation of the joints (rheumatoid arthritis) often occurs in older age, but also affects young people.
- Injuries after accidents or wear and tear (osteoarthritis)
- Nerve diseases and paralysis
- The pathological growing together of several foot bones
In older people, a pathologically altered tendon in the lower leg (tibialis posterior tendon) is sometimes the cause. If the tendon is subjected to heavy stress throughout life, it regresses or tears, resulting in a unilateral flat foot.
In addition, the risk for flat feet is greater in people with trisomy 21 (Down syndrome).
Prognosis
The very rare congenital flatfoot disturbs the walking development and mobility of the child. However, the malposition can usually be corrected with the help of timely surgery.
Prevention
Flat feet cannot be prevented completely. Especially for congenital pes planus, there is no possibility of prevention.
