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Meaning
When the medial, longitudinal, and transverse arches of the foot are collapsed and the entire sole makes full or nearly full contact with the ground, the condition is referred to as a flat foot. Genetics usually play a role in flat feet. In some circumstances, though, trauma and excessive foot activity can cause the arch to collapse. The posterior tibial tendon, which supports the arch, is a powerful tendon. The arch gradually starts to fall if this tendon is injured, weakens, or tears, resulting in discomfort and dysfunction. Another significant deforming factor contributing to a collapsed arch is a tight Achilles tendon. When the Achilles is tight, the heel lifts off the ground more frequently, which forces the foot to flatten to compensate and touch the ground. Flat feet might also result from carrying more weight or wearing the wrong footwear.
Causes
Biomechanical causes
Congenital
- Infantile or physiological
- Congenital vertical talus
Acquired
- Occupational
- Postural
- Secondary to anatomical defects elsewhere, e.g., external rotation of the limb, genu valgum, varus deformity of the foot, equines deformity of the ankle.
Others
- Paralytic: flaccid flat foot
- Arthritic: rheumatoid arthritis
- Spasmodic: peroneal muscle spasm
- Traumatic fracture of calcaneum
Types of flat foot
- Flexible flat foot
- Flexible flat foot with short Achilles tendon
- Rigid flat foot
- Adult acquired flat foot
Flexible flat foot
When we are young, this happens. The footrests are entirely on the ground when one is carrying one’s full weight. The arches return when the foot is not bearing any weight. This is the most prevalent kind of flat foot, and most of the time it doesn’t cause any pain or long-term issues, even in adults.
Flexible foot with a short Achilles tendon
The heel lifts off the ground normally with each stride because of a short Achilles tendon that runs down the back of the ankle and joins the calf muscle to the heel bone. This could turn into an uncomfortable condition.
Rigid flat foot
This particular form of flatfoot results from bone abnormalities or fusions that stop the arch from developing during development. An inflexible flatfoot may be the result of a displaced talus bone at the upper arch. This can happen at any point in life.
Adult acquired flatfoot
Adults who have this type of flatfoot typically have a posterior tibial tendon injury or damage, such as inflammation or overstretching. From the calf muscles, this tendon travels up the inside of the ankle and foot before coming to rest at the arches. The tendon plays a key role in supporting the arch. It is known as posterior tibial tendon dysfunction and often affects one foot; however, it can affect both. It is a crippling condition that becomes worse if it isn’t addressed right away.
Changes
- Overstretching of the ligaments on the medial side of the ankle and foot.
- Lengthening of the muscles in the medial side
- Shortening of the ligaments of the lateral side of the ankle
- Shortening of the muscles, particularly the peronei group of muscles.
- The medial malleolus appears more prominent than the lateral malleolus.
- A posterior view of the foot shows that the toes are splayed more toward the lateral side. This condition is known as the too many toes sign.
- The Achilles tendon is deviated toward the medial side.
- Pronation of the foot.
Symptoms
- Pain around the foot and ankle joint is the most common symptom seen in flat feet.
- The pain may radiate along the calf muscles.
- Feeling of weakness and instability.
- Due to the pronation of the foot, pain can be felt at the knee joint.
- Misalignment of the tarsal bone can cause hyperextension of the knee joint along with grinding of the meniscus.
Diagnosis
- A wet test is done to determine the flat foot of a person. The person’s foot is dipped in a colored liquid, and a print is taken on white paper. If the print shows that the foot is covering a maximum area, then it is regarded as a flat foot.
- An X-ray can be taken to determine if any underlying bony deformity is present.
- An MRI is helpful to determine any tendon dysfunction.
Treatment
The main aims of the treatment of flat foot are
- Strengthening of the weak muscles
- Stretching of short structures
- Restoring the arches of foot
Exercises for flat foot
- Wear shoes which have arch support. It is one of the most effective foot exercises to cure flat foot. Don’t wear high heel for a long period of time.
- Walking barefoot on the tip of the toes is also a very good exercise for flat foot. Walking barefoot on sand is also helpful.
- Sit on the floor and place feet flat on the floor. Slowly lift the feet’s toes and foot except the heel. Hold this stretch for 10-15 seconds then relax. Repeat the exercise for 5 times.
- Sit on the floor with knees bend and hands in the back for support. Separate the foot from the floor whilst keeping the heel on the floor. Cramp the toes and hold it for 15 seconds.
- Lift the left upper foot and rest it on the other. It is like criss-cross foot position/foot over foot. Rest the middle of the foot on the other foot and exert little pressure. Hold it for a minute and then repeat with for the other foot.
- Spread the feet and join the soles of the heels. Hold the feet just above the ankles. Try spreading the toes much further till a stretch is felt. Make a curve by cramping the feet and letting the toes touch the floor.
- Sit with legs straight touching the floor. Lift one foot and try touching the last toe of the other foot. Repeat the same for the other foot. This exercise is an effective stretching to build an arch.
- Join the feet together and then spread the heels on both the sides with toes joined. For better results this exercise should be done in sitting position. Hold the stretch for few seconds and repeat again after break.
- Put the flat feet heels on tennis ball or hand ball and big toe touching the floor. Hold a rod or an object to balance the body weight. Put the body weight on one heel and then breathe in and out. Shift the pressure to the other heel. After 2-3 minutes shift the ball toward the front foot, heels touching the floor and repeat again. Breathe in and out during this flat foot exercise as it encourages stretching and relaxation of the leg and foot muscles.