Flatfoot (pes planus) is an overpronation of the foot, resulting in a lower or absent arch. Patients with flatfoot fall into two groups: adult and pediatric (child). While both groups exhibit flatfoot, the causes and treatments may differ.
Diagnosing and Treating Adult Flatfoot
Adults may develop flatfoot due to failure of the posterior tibial tendon. This is a large tendon originating in the leg and attaching to the navicular bone in the foot. This tendon helps support the arch and helps propel a person forward when they walk. Over time, the tendon can stretch and even tear, allowing the arch to fall.
With flatfoot, simple actions – standing on your tiptoes, walking, traveling up and downstairs, or standing – can start to become painful. Adult flatfoot is also accompanied by swelling and weakness when trying to turn the ankle inward.
X-rays can display change in the foot structure such as a fallen arch, but they often show no change at all. Patients with long-standing posterior tendinitis may show signs of arthritis. MRI can help determine if tendinitis is present and the severity of the condition.
90 percent of patients with flatfoot can be successfully treated with non-steroidal anti-inflammatory drugs (NSAIDs), changes in shoe gear, arch supports, and in some cases, physical therapy. Patients experiencing severe pain may need a walking (CAM) boot.
For patients showing no improvement with any of the above treatments, surgical correction may be an option. The goal of surgery is to restore the strength and integrity of the tendon and improve the structure of the arch.
Diagnosing and Treating Pediatric Flatfoot
Most children are born with flatfoot and the arch begins to develop over time; however, some children never develop an arch. Pediatric flatfoot may develop due to hypermobility (double-jointedness). A lump may also develop inside the foot, indicating an accessory navicular bone.
Although many pediatric patients are asymptomatic, some may experience foot, ankle, and leg pain. Pain is particularly noticeable during running and playing.
X-rays can help determine the severity, the type of flatfoot, and the presence of an accessory navicular bone.
Asymptomatic children benefit from over-the-counter support, while symptomatic children benefit from a custom orthotic. Children who have activity restrictions due to severe pain and have failed conservative treatment may benefit from surgical correction. Surgical correction includes bone grafting, lengthening a tight heel Achilles tendon, and removing an accessory navicular.
If you are interested in learning more, contact Dr. Benjamin R. Proto at TPMG Orthopedics:
(757) 327-0657 – Newport News
(757) 345-5870 – Williamsburg
About Benjamin R. Proto, DPM, FACFAS
Benjamin R. Proto, DPM, FACFAS, joined TPMG Orthopedics in 2007, and has established himself as one of the Peninsula’s leading foot and ankle specialists, offering his patients the latest advancements in foot and ankle care. In his surgical practice, Dr. Proto utilizes minimally invasive techniques and specializes in partial and total joint replacement of the foot and ankle, ankle arthroscopy, and ankle fusion to address painful and dysfunctional joints.
