Flatfoot is a congenital or acquired deformity of the foot . The affected foot lowers at the medial inner edge of the foot and rises at the lateral outer edge. Foot exercises are usually used for correction.
What is a flat foot?
Subjectively, patients with flat feet often have no symptoms. Pain is rather rare and, if at all, occurs mainly in the area of the inner ankle or the inner longitudinal arch.
Foot deformities can be congenital or acquired, such as flat feet. Over time, other foot malpositions can develop from these malpositions. One of them is the so-called flat foot. This is a misalignment in which the medial inner edge of the foot sinks while the lateral outer edge rises. See AbbreviationFinder for abbreviations related to Flat Foot.
In small children, this picture is considered a physiological stage of development and is therefore not associated with disease. Adults with flat feet can, but do not have to, suffer from the deformity. For example, bow legs or knock knees can develop from a flat foot. Other complications and pain are also conceivable. In principle, any kind of flat foot impairs the statics of the body.
Nevertheless, the malposition does not necessarily have to be treated if the patient decides against the therapeutic intervention despite being aware of the possible consequences. The flat foot or pes valgus is not only common among humans, but also in the animal kingdom. Large dog breeds, for example, often suffer from the phenomenon. A growth disorder of the lower fibula epiphyseal plate is usually responsible for this. The skewed foot can be associated with a fallen arch or a flat foot.
Between the ages of eight and ten, a child’s foot hardens to such an extent that the foot hardly bends inwards. If this is not the case, there is a pathological flat foot. Flat feet can not only be acquired in the course of life, but can also be congenital. Most commonly, acquired pes valgus develop from congenital or acquired flatfoot, trauma to the foot bones, spastic paresis of the foot, or as a result of infection.
Rheumatism, overuse damage with ligament instability or obesity can also contribute to the development of a flat foot. The head of the ankle bone is pressed downwards in the case of a flat foot and is thereby displaced medially so that the heel bone is in a pronated position. The image of a double ankle arises because the ankle bone clearly protrudes from under the ankle.
Due to the changed position of the ankle bone in the ankle yoke, the foot places itself at an angle against the lower leg, with the inner edge of the foot lowering. Apart from this development process, the pes valgus can be the symptom of a congenital malposition or even malformation syndrome.
Symptoms, Ailments & Signs
Subjectively, patients with flat feet often have no symptoms. Pain is rather rare and, if at all, occurs mainly in the area of the inner ankle or the inner longitudinal arch. This is especially true for patients who suffer from a pes valgus and a drop of the foot at the same time.
In later stages, the ankle pain can spread along the side of the leg and thus radiate to the hip. Since the inner ankle protrudes strongly in the skewed foot, the lower ankle joint shifts and the heel bone deviates outwards. It is only in extremely rare cases that pronounced flat feet cause pain in the lateral malleolus due to a collision with the calcaneus.
The statics of the body is always affected by a skewed foot. In most cases, however, patients with a congenital valgus foot are not even aware of this impairment. Only when knee problems, bowlegs or knock knees develop from the pes valgus do many of those affected seek medical advice.
Diagnosis & course of disease
To diagnose the pes valgus, the doctor looks at the patient who is standing barefoot. In this position, the patient shows an approximately five-degree angle between the axis of the lower leg and the heel from behind. In the case of a skewed foot, this angle is significantly increased. The varus position of the heel is often reduced when standing on toes.
The sole of the foot may show calluses on the medial heel. Imaging procedures can be used to confirm the diagnosis. X-ray shows increased eversion in the area of the subtalar joint. However, even if such an eversion cannot be detected, a valgus foot can be present, so that X-rays are often not taken.
A flat foot does not always have to result in special complaints, limitations or complications. In many cases, sufferers with a flat foot can lead an ordinary life. However, pain can also develop in the ankles and spread to other regions of the leg or even to the hip.
The skewed foot can also restrict the patient’s movement. The patient’s sense of balance and coordination are also significantly impaired by this disease. If the pes valgus occurs in childhood, crossed legs can still occur in adulthood. Many patients also suffer from aesthetic complaints.
Especially in children, the skewed foot can lead to teasing or bullying. In this case, treatment is only necessary if the person concerned is suffering from symptoms. Various therapies or interventions can correct the misalignment. Psychological treatment may also be necessary. The life expectancy is usually not reduced by the valgus foot.
When should you go to the doctor?
A flat foot does not always have to be treated by a doctor. Often people with flat feet can live a normal life without experiencing pain or other problems. A doctor’s visit is necessary if the flat foot causes symptoms. Pain, malpositions or signs of joint wear and tear must be medically clarified and treated. If the pes valgus significantly impairs the quality of life, medical advice is also required.
Furthermore, if you have a flat foot that is caused by a serious illness, you should see a doctor regularly. Rheumatism and obesity patients must consult closely with the doctor responsible. If the ankle pain intensifies and radiates down the leg or even to the hip, medical advice is required. Knee problems, bowlegs or knock knees as well as joint problems are other reasons to see a doctor if you have flat feet. The family doctor can put you in touch with an orthopedist or rheumatologist. In the event of severe symptoms, the medical emergency service or the nearest hospital should be contacted immediately.
Treatment & Therapy
In most cases, flat feet do not require any further therapy. This is especially true when the patient does not notice any subjective symptoms. However, if pain, knee problems or even bowlegs or knock knees become apparent, further development can be counteracted with treatment. As a rule, insoles are sufficient as a treatment measure. Surgery is only performed in extremely rare cases.
This applies, for example, when the posterior tibialis muscle and its tendon are unstable. In this case, a tendon transfer in combination with a heel bone osteotomy can be arranged. The invasive treatment must be assessed by the doctor in advance in terms of its benefits and risks for the patient. When the risks outweigh the benefits, foot exercises are more likely to be prescribed than surgery.
In the gymnastic sessions, at least an improvement in the symptoms can usually be achieved, since the muscles and tendons become more stable through the movement. If knee misalignments are already present, a high tibial plateau osteotomy or a supracondylar femoral osteotomy can be performed to correct it. If the misalignments have affected the spine, attending a back school is advisable.
Outlook & Forecast
The prognosis is favorable for most patients. Often there are no other symptoms, so the optical change has no medical significance. Therefore, no treatment measure is taken in these cases. The quality of life is not further impaired and the disorder does not result in a reduction in life expectancy either.
If there are physical impairments, individual treatment steps are initiated. A treatment plan is drawn up depending on the extent of the symptoms. This can fall back on conservative methods or provide for a surgical intervention. The aim is to improve mobility. Normally, the desired optimizations are achieved if the patient adheres to the specifications and no further complications arise. Nevertheless, when making a prognosis, it must be taken into account that every operation is associated with risks and side effects.
In rare cases, the visual changes can also lead to emotional and mental stress. Although there are no physical complaints from the pes valgus, the stresses can have a negative effect on the patient’s overall condition. There is a risk that psychological sequelae will develop and manifest themselves. These lead to a worsening of the prognosis, as they are usually lengthy and have a strong negative impact on the well-being of those affected. It can lead to anxiety disorders or attachment problems that impair lifestyle.
If a toddler still has a foot deformity up to the age of seven, measures such as foot exercises can be used to prevent a permanent pes valgus. In addition, walking barefoot on uneven floors can stabilize the unstable foot.
Children and adolescents who are affected by a foot malposition – such as pes valgus – should be looked after by a specialist on a permanent basis. This can document the course and provide a prognosis for further development. This is particularly important during the growth phase.
The specialist, in most cases an orthopaedist, will also decide whether an operation is necessary and will provide ongoing medical care to those affected. If an operation has been performed on the foot, it is advisable to continue to have an annual check-up with an orthopedist. In addition, wearing orthopedic shoe adjustments or insoles is usually necessary.
In some cases it is necessary to make a bespoke shoe. Their accuracy of fit can also be confirmed by a medical specialist. This can also give hints when choosing a specialist shop. Physiotherapy and the application of ointments can also be prescribed. In physiotherapy, foot exercises are taught, which the patient should also use regularly at home.
Due to the improved, now minimally invasive surgical methods, the aftercare periods have been significantly reduced. As a rule, walking without support is already possible after eight weeks. Any signs of paralysis or other sensory disturbances that may occur vary among the patients. Their intensity lengthens or shortens the duration of aftercare and determines the support methods chosen. Those affected should only start exercising again after at least four months.
You can do that yourself
In many cases, a flat foot does not need to be treated. Treatment is only necessary if the patient has pain or other symptoms. The medical therapy can be supported by the patient by resting the affected foot. At the same time, the doctor’s instructions should be followed.
It is usually sufficient to wear the prescribed insoles and not to put any further strain on the foot. In addition, regular check-ups by the doctor are indicated. This will ensure that the pes valgus doesn’t get worse and there are no complications.
If an operation is necessary, further self-help measures should be avoided. It is advisable to follow medical advice and not to put unnecessary stress on the foot or tendons. After an operation, the surgical wound must be carefully tended to avoid bleeding, infection, and other postoperative complications. However, should symptoms arise, a doctor should be consulted. In the case of acute pain, problems with movements or signs of paralysis, it is best to speak to the doctor responsible immediately. After the treatment, in consultation with the doctor, light stretching exercises and sporting measures can be started to support the healing process.