Flat Foot Problem - Pes Planus
Having a flat foot (a condition called pes planus) generally does not affect walking, but can play a part in feet, ankle and knee problems.
 Also called ‘fallen arches,’ or ‘over pronation,’ flat-footedness is a condition in which the foot’s arch collapses so that the entire sole comes into near-complete (sometimes complete) contact with the ground. Flat feet are linked to overpronations, when the ankle bones lean inwards – abnormally – to the center line.
A flat foot is generally harmless, but it can cause the foot to be unstable – it can roll downward and inward abnormally.
Signs and Symptoms
Spotting a flat foot is easy – the patient’s foot has no longitudinal arch when he/she is standing.
A patient with flat feet or overpronations may also experience pain in the lower legs or on the inside of the ankles as the heel slants away from the body’s midline more than it should.
Causes & Risk Factors
Flat feet and overpronations are fairly common. In fact, all infants and toddlers have flat feet because their longitudinal arches have not yet developed.
It is when the arch does not develop during childhood that the condition becomes a problem. This is because a flat foot may be inflexible and can hamper foot activities. When flat feet become painful, the patient may require medical attention. Flat-footed children, for example, may experience a condition called tarsal coalition when two or more bones in their feet fuse together, restricting motion.
Adults can also develop flat feet as years of wear and tear cause the arches to become weak. The posterior tibial tendon, which is the principal support to the arch, also deteriorates. When this tendon is overloaded, it can swell (a condition called tendinitis) and in some cases, even tear. A damaged tendon cannot support the arch of the foot effectively, and over time, the arch can flatten.
Ongoing stress from routine activities such as walking in high heels can cause over pronation and flat foot. Weight also weakens the arches, so overweight people are more prone to flat feet. Existing health conditions such as diabetes and rheumatoid arthritis also seem to predispose patients to flat feet.
Tests and Diagnosis
The doctor usually only needs to administer a physical exam to diagnose a flat foot. In most cases, though, the doctor will make the patient undergo several other tests to pinpoint the underlying cause or causes of the flat foot or over pronation.
In most cases, a flat foot remains flexible and no treatment is needed. But if an arch does not manifest even when the patient stands on his or her toes, the doctor will likely ask for an x-ray. Once the doctor suspects a tarsal coalition, a CT scan may be necessary. If the doctor suspects posterior tibial tendon injury, an MRI may be required.
Flat Foot Treatment Options
Most cases do not require any treatment, but severe conditions may require flat foot surgery.
The doctor may also advise the patient to wear arch supports or orthotics, usually custom designed to follow the natural foot contours. Patients with posterior tibial tendon injury may be advised to use wedges designed to take some of the pressure off the tendons. Some patients are also required to wear ankle braces or walking boots until the swelling of the tendon subsides.
A patient may also be required to rest and avoid activities that tend to worsen the condition. If the flat foot is painful, over-the-counter pain relievers may be prescribed.
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