Flatfoot diagnosis does not necessarily mean ugly shoes

Flatfoot diagnosis does not necessarily mean ugly shoes

A diagnosis of “flatfoot” once meant wearing special—but not necessarily fashionable—shoes. Another treatment involved a bar positioned between the shoes to hold the feet in the “correct” position. Back then, physicians thought that the shoes could change the bony architecture of the foot.

Today, physicians understand that if a child or adult is not experiencing any pain or having difficulty walking or wearing shoes, treatment may not be required.

During a media briefing yesterday, Steven L. Haddad, MD, joined his colleagues, Robert B. Anderson, MD, and William C. McGarvey, MD, to discuss current perspectives on caring for flatfoot. According to Dr. Haddad, conservative treatment works for a large percentage of those with flatfeet. “Many patients do very well in an athletic-type shoe with an orthotic insert,” he said Conservative treatment is used almost exclusively with children, though some children with severe flatfeet require surgical reconstruction to improve their quality of life.

If the foot becomes painful and/or it becomes difficult to wear shoes, some type of treatment is appropriate. Dr. Haddad cautions that not all adult patients with flatfoot experience foot pain. Patients may experience back, hip, or knee pain related to their flatfeet. The lack of an arch in the foot causes the foot to roll inward. This pronation causes the individual’s gait to change, which can then produce problems elsewhere in the body or locally within the foot itself.

Pain that does not respond to conservative care (such as orthotics, physical therapy, and medication) is the indication for surgical reconstruction of a flatfoot. Patients who are experiencing these symptoms should seek the advice of an orthopaedic surgeon.

Acquired flatfoot (those who are not born with a flatfoot) may be the consequence of a traumatic injury to the ankle, according to Dr. Haddad. “Adults can rupture or injure their posterior tibial tendon, which is the primary tendon supporting the arch. This can occur in sports that require pivoting—like soccer or football—and may be mistaken for a severe ankle sprain. This type of trauma can lead to a flatfoot deformity in up to 25 percent of all acquired flatfoot patients,” he said.

Dr. Haddad admitted that this type of injury is hard to prevent. If there is a congenital abnormality, a fracture or dislocation, torn or stretched tendons, or degenerative or systemic conditions, surgery may be indicated for persistent pain and/or significant deformity from acquired flatfoot.

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