The flat foot or flat foot is, next to the splayfoot, one of the most common foot deformities. Especially the longitudinal arch of the foot is here strongly flattened, so that the foot as a whole almost completely rests on the ground when walking. Mostly, the flat foot is congenital, but can also occur due to orthopedic misalignment in the course of life.
What is flat foot?
Schematic diagram showing the anatomy, structure of the foot as well as the footprint in a flat foot. Click to enlarge. Many children are already born with a flat foot. Since flat feet, or technically speaking flat feet, mainly occur in childhood, a pediatrician or orthopedic specialist can recognize the predisposition at an early stage. Other sufferers of this deformity of individual foot bones have acquired this abnormality in the course of their lives. The foot lies flat on the subfloor when the affected person stands. The arch of the foot, which normally has a hollow shape, is absent or barely present in flat feet, so that the foot can be pushed through and the normal static arching from the ball of the forefoot to the heel is missing. The symptoms of flat feet are an accompanying flat foot, a change in the edge of the foot in the form of an oblique position and painful phenomena that appear in the feet themselves, in the calves and the other elements of movement up to the back.
Causes
A so-called congenital flatfoot usually occurs in conjunction with other malformations of the bony areas and may have genetic causes. Acquired flatfoot has many causes, which include excessive body weight and improper footwear. In addition, abnormalities in flatfoot consist not only in the bony changes themselves, but also in insufficient stability and performance of the so-called supporting apparatus. This concerns in particular insufficiently strong and impaired tendons, muscles and baths, which cannot maintain a normal arch of the foot. In addition, a predominantly sedentary posture, long periods of standing, little movement and extremely reduced walking of children without shoes, for example in sand, contribute to the fact that a flat foot can develop due to an underuse of the holding units. In addition, diseases such as rickets, poliomyelitis and diseases from the neurological and rheumatic areas are possible causes of a flat foot.
Symptoms, complaints and signs
When the longitudinal arch of the foot is flattened, it is called flat foot. Click to enlarge. Symptoms of congenital flatfoot can be seen shortly after birth. The foot shows a deformity in which the outwardly curved sole of the foot, as well as the bent, raised heel, are already clearly pronounced. In addition, the forefoot is splayed outward. As a result, the children learn to walk relatively late. Movement is restricted. With increasing age, pain often occurs. Further complaints, especially pain, do not occur. The symptoms are different in the case of flat feet occurring in adolescence. Here, as a rule, more severe pain from exertion occurs. As a result, the affected adolescents develop a relieving posture and limp as a result. Without therapeutic measures, a considerable restriction of movement with increasing pain can develop. In adults who develop flat feet, discomfort occurs after more severe weight-bearing. These are primarily felt when the arch of the foot is lowered. When the sole of the foot rests completely, the pain subsides. The pain occurs mostly on the sole of the foot as well as on the inner edge of the foot. However, due to the deformity, pain can also occur in the knee and hip areas. Due to the intensive load on certain areas of the foot, pressure sores and pressure ulcers can form, especially in overweight people. These additionally impair the ability to move and increase the sensation of pain.
Disease progression
In the case of an acquired flatfoot, a flatfoot develops from individual retaining elements that are actually responsible for supporting, stabilizing and maintaining the anatomically normal arch of the foot and are only insufficiently developed. This leads to the tension in these segments decreasing and the arch of the foot lowering over time if these parts are not strengthened and stressed.As a result, there is an insufficient cushioning effect, so that all subsequent and surrounding bones and joints are subject to constant compression and this manifests itself in pain or changes in the foot. This manifestation is called a buckling flat foot and can be treated.
Complications
Flat foot can cause several complications. First, the foot deformity is associated with rapid foot fatigue. Often, there is pain and wear and tear on the bones and joints. If the valgus deformity remains untreated, it can lead to permanent joint damage and deformities. This is accompanied by pain and deformities, which in turn are associated with complications. Also affected are the knees, hips and spine, which are increasingly overstressed due to the malposition of the feet. This can promote postural deformities, overstretching of ligaments and tendons, and arthritic changes in the tarsal bones. In general, the risk of osteoarthritis increases with a flat foot. Possible sequelae are headaches and chronic complaints. In the long term, a so-called marching foot may develop, or other deformities such as a bent flat foot or a splayfoot may develop. Complications can also arise during the treatment of a flat foot. Surgery carries the typical risks and can cause bleeding and scarring. In rare cases, other deformities may occur. Prescribed pain medications can cause side effects and interactions. Therapeutic measures such as insoles can promote sweating and, if used improperly, trigger further discomfort.
When should you see a doctor?
Flatfoot can exist at birth or develop later in life. However, in both cases, going to the doctor is advisable. With surgery and subsequent follow-up care, an existing flat foot can be completely eliminated. If the affected person decides against such treatment, significant complications are to be expected. Flatfoot can disrupt the entire range of motion, causing the affected person to complain of severe pain. If medical treatment is steadily dispensed with, permanent consequential damage can also result. The visit to the doctor can no longer be avoided, because only then can a cure or a complication-free recovery take place. If the foot is not treated, there is also a risk that the foot will become malpositioned. The result: stabbing pain with even the smallest movements, so that normal movement is not possible. Only with appropriate treatment can these symptoms be alleviated and permanently eliminated.
Treatment and therapy
Treatment of flatfoot or fallen arches is always possible and ideally consists of both passive and active treatment. Active therapy is based on regular healthy use of the foot muscles and specifically performed physiotherapeutic exercises. These help to strengthen the supporting apparatus and can both support freedom from pain and ensure partial regression of the flat foot and the accompanying deformities. In the passive treatment of a flat foot, the orthopedist uses the possibilities that can be implemented through suitable footwear to realize an artificial stabilization of the arch of the foot. This therapy usually involves wearing orthopedic insoles. Some affected persons who complain of a massive flat foot with pain extending into the back as a result of diseases they have overcome are treated by means of a surgical method. This is usually considered after the age of eight and shows good results.
Follow-up
There is usually no need for follow-up care for a flat foot. This is either because the flatfoot exists but is not a limitation or could be surgically repaired. Since no symptoms are apparent, there is no need for scheduled examinations. Instead, the patient presents with acute signs. Sufferers can make an active contribution to preventing a recurrence of flatfoot or counteracting the further development of a diagnosed deformity. They are informed about suitable measures in a consultation. In most cases, patients have to wear insoles to prevent complications.In severe cases, doctors also prescribe orthopedic shoes and physiotherapy to strengthen the muscles. In everyday life, affected persons should refrain from putting too much strain on their feet and prefer varied movement patterns. If people with flat feet have to use orthopedic aids on a permanent basis, they will need new prescriptions on a regular basis. The doctor then takes the opportunity to ascertain the status of the deformity. An assessment is usually sufficient for this purpose. In certain cases, the situation can also be analyzed using a modeling clay, an electronic measuring plate or an X-ray. The doctor and patient can agree on an individual rhythm for further presentations, depending on the severity of the condition.
What you can do yourself
To live better with a flat foot in everyday life, there are shoe insoles that are specially adapted to the shape of the foot. They support the arch of the foot and distribute the load. Depending on the extent of the symptoms, custom-made orthopedic shoes help even more to cope with everyday life despite flat feet. In addition to these commercial aids, simple exercises that can be easily incorporated into everyday life also help. A few minutes of regular exercise are enough to alleviate the discomfort. In general, all physiotherapeutic exercises that strengthen the lower leg and foot muscles and the structure of the arch of the foot are helpful. In order to achieve the best effect with the training, the exercises are performed barefoot. However, as soon as the execution becomes painful, it is essential to stop it. Below are two sample exercises. Toe stand:
In this exercise, the person stands hip-width apart with knees not fully pushed through. Then both heels are pushed off the floor, this position is held for ten seconds and then slowly rolled back down to the floor. The process is repeated three to five times. Different firm surfaces increase the training effect. Cloth gripper:
Here, a cloth, such as a dish towel, is spread out on the floor. While sitting or standing, the patient clamps the towel between the toes and the ball of the foot. It is then held in the air for five seconds. This exercise is performed with each foot up to ten times. With consistent practice, the weight of the sling is progressively increased.