Story by Randolph Sealey M.D., Foot and Ankle Specialist at OrthoConnecticut.
One of the most common patient consultations to my foot and ankle practice is a parent bringing their child in for evaluation of “Flat Feet." The referrals for this common condition come from a range of sources; pediatricians, family members, coaches, shoe salesmen, dance instructors, military recruiters and worried parents.
Although flat feet used to be a disqualifier for military duty, as it turns out, flat feet or pes planus is a normal variation in the spectrum of foot alignment. Most babies and toddlers will outgrow flat foot alignment. Like all things in life there is a normal distribution where a “normal” arch is in the middle and then flat and high arches are on the extremes. A flat foot is one of the most common foot variations or deformities that I treat.
More importantly, most people with flat feet have absolutely no pain! A slight amount of flattening or pronation is probably good to have in your foot alignment versus more of a high or cavus arch. A foot with slight pronation almost has built in shock absorption versus a foot with a high arch which tends to be more stiff during impact.
The World’s Fastest Man has Flat Feet
One of my favorite examples for worried parents and patients is Usain Bolt – the fastest man in the world. Google images of Usain’s feet and you will see that he clearly has flat feet or pronates. This fact doesn’t seem to have slowed him down as he dominated three straight Olympic games!
When Flat Feet Becomes Problematic
Flat foot alignment becomes problematic when it is accompanied by pain and activity limitations. The exact location of the pain and the degree of flexibility in the foot are two key factors when evaluating flat feet. The age of the patient also plays a role in the diagnosis and ultimate treatment. Young children who are active may develop pain from a congenital problem. Adults may develop pain from undiagnosed problems they have been carrying their whole lives. Patients can also develop a new or acquired flat foot because of tearing a tendon or ligament in their foot. Patient symptoms may include swelling, pain along the arch or outer border of the foot, difficulty fitting shoes, and fatigue from long periods of standing or walking. Most patients can be diagnosed in the office thru a history, physical exam and X-rays.
Non-Surgical Treatment Always the First Step
The goal of treatment is to prevent the deformity or flat foot from getting worse. An orthotic shoe insert can be used for mild or moderate deformity. An ankle brace may be needed for moderate to severe deformity. To calm the pain, other recommendations include low impact activity, calf stretching, rest, ice and anti-inflammatory medications. If conservative non-surgical treatment fails after 3 to 6 months we consider surgical options.
Experience is Key to Successful Reconstruction Surgery
Surgery involves reconstruction of the arch by either preserving or eliminating the mobility of foot joints. Experience with flatfoot deformity is critical to appropriately individualize a patient’s treatment plan. Although the recovery process can be lengthy, flatfoot reconstruction surgery enjoys extremely high success rates.
If you are experiencing painful flat feet, your next step should be an evaluation from our experienced team at the Foot & Ankle Center at OrthoConnecticut.
Dr. Sealey is the only fellowship-trained, board-certified foot and ankle specialist in the Danbury Region.