Flat foot – from the Latin pes planus – is a dysmorphism that occurs with altered anatomical relationships of the foot, in particular with the characteristic reduction or total disappearance of the plantar arch with consequent enlargement of the support surface of the foot itself

With medial plantar arch or longitudinal vault, we mean that typical arched formation – characteristic of the foot of human beings – which detaches from the support on the ground.

The height of the arch obviously varies from person to person

When a person presents flat foot dysmorphism, the plantar arch – which must guarantee the correct distribution of body weight on the foot and a correct walk – is presented as partially or completely absent.

The foot of those who have, in fact, flat feet, rests completely on the ground, visibly altering the disposition of body weight which generally involves painful phenomena to the detriment of the knees, ankles and feet themselves.

Flat feet often present as a bilateral malformation, that is, involving both feet of an individual.

Flat feet in children and adults

Flat foot in children

When children present flat foot dysmorphism, the latter can present itself in two different clinical forms: infantile loose foot and evolutionary genetic flat foot.

Infantile loose foot occurs when foot muscle development does not coincide with the child’s chronological age.

If the foot is mobile, physiotherapy sessions and special insoles will not bring any benefit to what can easily be characterized as a paramorphism: a phenomenon that deviates from the normal but should still be considered normal because it is not symptomatic.

If, on the other hand, the child’s foot presents stiffness and pain, we are faced with evolutionary genetic flat feet that may need treatment or intervention.

Flat foot in adults

Only 5% of adults have dysmorphic flatfoot.

This, in the vast majority of cases is completely asymptomatic, and the patient lives a life without limitations or painful states.

Only some cases instead need to be treated following the appearance of painful states, generally to the detriment of the joints connected to walking: ankles and knees.

When present in the adult, the dysmorphism can be flexible flatfoot in the adult – i.e. an inadequately treated congenital flatfoot – or secondary flatfoot – dependent on dysfunction of the tibialis posterior muscle, fractures, tendon tears, rheumatoid arthritis, neuropathy or myopathy.

Symptoms of flat feet

As already widely explained, flat feet dimorphism often presents itself as asymptomatic and the patient, be it a child or an adult, does not feel any kind of painful manifestation.

The only sign present is the evident lack of a clearly visible and curved arch of the foot.

Nothing else.

In the rare cases in which the lack of plantar arch affects the patient’s posture, the symptoms of dysmorphism will be:

• severe pain in the feet, especially in the heel area or in the middle
• ankle pain
• lower leg pain
• knee pain
• hip pain
• lower back pain
• swelling on the inside of the ankles
• musculoskeletal problems in the feet
• calluses
• frequent loss of balance

Among the symptoms associated with the dysmorphism of flat feet there is often overpronation.

Pronation consists of the inward rotation of the foot as soon as it rests on the ground, the moment of “initial contact” within the complete gait cycle.

Overpronation or overpronation occurs when the foot rotates too much inward during initial contact, thus shifting the entire weight of the body to the inside or medial side of the foot and not to the entire sole as it should be.

This overload – in walking and especially in running – destabilizes the foot, which will try to balance the load with the movement opposite to overpronation with bio-mechanical movements at the knees and hips.

Flat feet: the causes

The dysmorphism of flat foot can be congenital, transmitted in a direct line from one of the two parents who suffer from it, or it can be adaptive, i.e. caused by the condition that favored its appearance.

Possible triggers include:

• trauma to the foot or ankle
• neurological or neuromuscular pathologies: spina bifida, cerebral palsy, muscular dystrophy
• connective tissue disorders: Ehlers-Danlos syndrome or joint hypermobility syndrome
• an incorrect intrauterine development that causes malformation of the bones of the foot
• obesity and overweight
• rheumatoid arthritis
• aging
• diabetes
• incorrect postural habits
• use of inappropriate footwear
• long periods of inactivity
• pregnancy: the effects are only temporary

The diagnosis of flat feet

As previously mentioned, in most cases, flat feet dimorphism is a condition that does not bring any symptoms.

Only in some cases, generally when the deformation of the plantar arch is really evident, can symptoms develop which require specialist consultation.

During the consultation, the specialist consulted will proceed with the creation of the anamnesis, focusing in particular on the patient’s family history: in fact, it is not uncommon for the dysmorphism of flat feet to be transmitted genetically.

Generally, the history and physical examination can already be sufficient to diagnose flat feet.

The latter consists of a series of diagnostic manoeuvres, performed by the specialist in order to detect or not the presence of the indicative signs of the pathology in question.

In the event that further investigations are necessary, the specialist will request the execution of X-rays, CT scans, ultrasound or magnetic resonance imaging to further investigate the patient’s clinical picture.

The treatment of flat feet

The correct way to treat dysmorphic flat feet depends substantially on the severity of the clinical picture. If the latter is not particularly compromised, the orthopedist will advise following non-surgical or conservative therapy; otherwise, surgical therapy may be required.

Non-surgical or conservative therapy

It includes the use of podiatry orthotics (insoles) specially modeled on the patient’s foot, muscle training exercises aimed at strengthening the leg muscles, use of special orthopedic shoes, physiotherapy exercises to improve the walking and running technique , if overweight, a dietary program for the loss of excess body weight, pain-relieving drugs, a rest period from sporting or tiring activities is foreseen.

Surgical therapy

Since conservative therapy has proved effective in relieving the patient of the painful symptoms of flat feet, the only alternative is to intervene surgically.

The operation will be modulated according to the deformities presented by the specific patient, and is therefore different from case to case.

The only constant will be the final goal: to create an accentuated plantar arch.

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Source

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