Go flat out against flat foot

Dr Maninder Shah Singh

Flat foot is one of the commonest problems among children and adults. People with flat feet tend to have a medial arch lower than normal or completely touching the ground. In India, about 20 to 25 per cent of the population is flat-footed.

Children have two types of flat foot. If the arch appears when the child is not walking and flattens out when he is, it usually indicates a flexible or correctable flat foot. It usually causes little problem. If the inside arch appears flat whether the child is walking or resting, it is usually a rigid or non-correctable flat foot, which is a cause for concern and requires assessment and treatment early in childhood.

Why children have flat foot

Majority of the flat foot cases in children are developmental, meaning they are a normal occurrence from birth and improve as the child grows. Children who have flat feet into their teens and have symptoms like pain on running may require treatment.

Other causes

n Tarsal coalitions: A condition where foot joints grow together, restricting or prohibiting the movement of that joint.

n Genetic factors: You are more prone to flat foot if your parents or somebody else in your family have it.

n Those with neurological or muscular disease such as cerebral palsy, muscular dystrophy are more prone to the condition.

In adults

If you have developed flat foot late in life, this is a cause for concern. This problem is more common in middle-aged women and is usually due to the weakness of the tibialis posterior muscle on the inside of the ankle, which is the main muscle supporting the arch. The muscle weakness is aggravated by weight gain, hormonal changes, pregnancy and diabetes. Sometimes it is brought on by an injury to the foot. You need to consult an orthopaedic surgeon for advice and assessment.

Common symptoms

The first symptom of flat foot is generalised foot fatigue. Patients often complain about not being able to keep up with others while walking. Activities such as running and jumping are more difficult. Another prominent symptom is pain. It starts from the foot and spreads to different parts of your body, including the arch of the foot, calf, knee, hip, lower back and lower legs.

Treatment

Flat foot responds well to treatment. Initial treatment includes strengthening and stretching exercises and supportive and well-fitted shoes. These shoes relieve pressure on the arch and reduce pain if the feet roll too far inward. People with posterior tibial tendonitis might also benefit from getting a custom-fitted insole with a medial arch support into their footwear.

n Losing weight is a great intervention for symptomatic flat foot and should complement other treatments.

n Wearing an ankle brace may also be beneficial until inflammation reduces. Sometimes, doctors also suggest a period of rest if the pain aggravates.

If these do not work, surgery may be necessary. Surgery includes procedures for re-aligning the bones of the foot into normal shape. This normalises pressure on weight bearing joints and patients can lead a normal lifestyle following the corrective surgery. Children with rigid flat foot will require early surgery.

Footwear

Flat-footed people should go for shoes:

n Structured, which means they should neither too cushioned nor too hard

n Shoes with arch support. Ask for pronation correcting shoes.

n Shock-absorbing soles

— The writer is chief of Foot & Ankle Services, Indian Spinal Injuries Centre