• 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.
    Most flat feet are flexible. This type causes no problems, and do not require treatment. Rigid flat feet can cause problems and are best 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. It may be associated with
    • Congenital problem—condition present at birth
    • Family history—conditions that cause flat feet (loose joints) may run in families
    Flat feet may develop because of:
    • Ruptured or damaged ankle tendon that supports the arch
    • Foot injury
    • Medical conditions that affect muscle balance

    Risk Factors

    Factors that increase your chance of flat feet include:
    • Familial tendency
    • Foot injuries
    • Conditions of the feet that can injure foot tissue such as osteoarthritis
    • Diseases that cause muscle or nerve damage, such as diabetes, cerebral palsy , spina bifida , or muscular dystrophy

    Symptoms

    Flat feet may not cause any symptoms at all. Rigid flat feet may cause:
    • Pain
    • Calluses , blisters, or skin redness on the innerside 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 with activities like running—may indicate that the foot is having trouble doing its job

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.

    Treatment

    If the flat foot is rigid and causing problems, you will be referred to a foot specialist. Talk with your doctor about the best treatment plan for you. Options include the following:

    Physical Therapy, Exercises, and Orthotics

    Physical therapy may relieve discomfort. They may help you with a specific stretching and strength program. They may also apply treatment to help manage the discomfort.
    Exercises can help with the strength of the surrounding muscles. It 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 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

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American College of Foot and Ankle Surgeons http://www.footphysicians.com/

    CANADIAN RESOURCES

    Canadian Podiatric Medical Association http://www.podiatrycanada.org/

    Nurses Entrepreneurial Foot Care Association of Canada http://www.nefca.ca/news.php/

    References

    Flat feet. American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00173 . Accessed December 28, 2012.

    Flat foot. UCSF Children’s Hospital website. Available at: http://www.ucsfhealth.org/childrens/medical%5Fservices/ortho/foot/conditions/flatfoot/signs.html Accessed December 28, 2012.

    Pes planus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 12, 2010. Accessed December 28, 2012.

    11/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Rome K, Ashford R, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;(7):CD006311.

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