Flat Foot

  What is a flat foot?

A flat foot occurs when the arch of the foot is lower than usual.

Some people naturally have flat feet and experience no symptoms. In others, the arch can progressively flatten because of problems affecting the tendons and ligaments that support the foot.

What symptoms and signs might I experience?

• Pain around the inside of the ankle or foot.
• Swelling around the inside of the ankle.
• The foot rolling inwards.
• The heel drifting outwards.
• Fatigue or aching with prolonged standing.
• Difficulty walking long distances.
• Difficulty performing a single-leg heel raise.
• Pain on the outside of the ankle in more advanced cases.
• Increasing difficulty with footwear.

How is it diagnosed?

Assessment includes examination of the foot while standing and walking.

Weight-bearing X-rays may be used to assess the alignment of the bones.

Other imaging, such as ultrasound or MRI, may be required to assess the tendons and ligaments.

How is it treated without surgery?

Treatment may include:

• Supportive footwear.
• Orthotics.
• Physiotherapy.
• Strengthening exercises.
• Calf stretching where appropriate.
• Activity modification.
• Weight management where appropriate.
• Bracing or an ankle-foot orthosis for more significant deformity.

When might surgery be considered?

Surgery may be considered when pain or functional problems continue despite appropriate non-operative treatment.

The operation depends on whether the foot remains flexible and the extent of tendon, ligament and joint involvement.

What might surgery involve?

Possible procedures include:

• Tibialis posterior tendon reconstruction.
• Tendon transfer.
• Heel bone osteotomy.
• Achilles or gastrocnemius lengthening.
• Midfoot correction.
• Ligament reconstruction.
• Fusion for severe or rigid deformity.

What is recovery like?

Flat-foot reconstruction can be a significant operation. Recovery commonly involves 6 weeks of non weight-bearing followed by progressive rehabilitation with physiotherapy.

Full recovery can take many months.