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by Polsdorfer R

Flat Foot

(Pes Planus; Pes Planovalgus; Fallen Arches)

Definition

Feet usually have an arch on the inside portion of the foot. A flat foot is a foot that has lost or never developed this arch. It is often associated with the lower part of the legs being angled outwards
Most flat feet are flexible. This type rarely causes problems and usually does not require treatment. Rigid flat feet can cause problems and should be treated.
Normal Foot Arch
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Causes

Infants and young children naturally have flat feet. The arch should develop over time. Sometimes, the arch does not develop. It is not always clear why this happens.
Flat feet may develop because of:
  • Ruptured or damaged tendon that supports the arch
  • Medical conditions that affect muscles or nerves in the foot
  • Degenerative changes in certain foot joints
  • Ligament damage in the foot

Risk Factors

Factors that increase your chance of flat feet include:

Symptoms

Flat feet may not cause any symptoms at all. Rigid flat feet may cause:
  • Pain
  • Calluses, blisters, or skin redness on the inner side of the foot
  • A stiff foot
  • Weakness or numbness of the foot
  • Rapid wearing out of shoes—worn shoes lean in toward each other
  • Difficulty or pain with activities like running—in the foot, knee or hip

Diagnosis

The doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. Doing simple tasks during the exam can help determine if the foot is rigid.

Treatment

If the flat foot is rigid and causing problems, treatment will be with a foot specialist. Flat foot treatment options may include:

Physical Therapy and Exercises

Physical therapy may relieve discomfort. A specific stretching and strengthening program may be used. Exercises can help with the strength of the surrounding muscles. They may relieve some of the pressure in the foot.

Orthotics and Support

Orthotics are shoe inserts that support the foot. These inserts may help to reduce pain and disability in some people. In mild cases, a well-fitting pair of shoes with arch support may be all that is needed.
Flat feet caused by nerve or muscle disease may need special braces.

Surgery

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

Prevention

Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.

RESOURCES

Foot Health Facts—American College of Foot and Ankle Surgeons
http://www.foothealthfacts.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Podiatric Medical Association
http://www.podiatrycanada.org
Nurses Entrepreneurial Foot Care Association of Canada
https://nefca.ca

References

Adult acquired flatfoot. American Academy of Orthopedic Surgeons Ortho Info website. Available at: http://orthoinfo.org/topic.cfm?topic=A00173. Updated December 2011. Accessed March 2, 2015.
Flat foot signs and symptoms. UCSF Children’s Hospital website. Available at: hhttps://www.ucsfbenioffchildrens.org/conditions/flatfoot/signs%5Fand%5Fsymptoms.html. Accessed March 2, 2015.
Pes planus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114291/Pes-planus. Updated April 6, 2016. Accessed September 29, 2016.
11/19/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114291/Pes-planus: Rome K, Ashford R, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;(7):CD006311.

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