Flat feet

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Types of flat feet

 There are two types of flat feet: longitudinal and transverse flat feet. In most cases, both types of flatfoot occur together because a disturbance in the biomechanics of the longitudinal arch of the foot adversely affects the transverse arch.

Longitudinal flat feet

Longitudinal flat feet is the collapse of the longitudinal arch seen from the medial side of the foot. The space between the foot arch and the ground is reduced. In advanced longitudinal flat feet, the sole of the foot adheres to the ground with its entire surface. Longitudinal flat feet in combination with too much valgus of the heel is called a flat valgus foot. Then, the longitudinal arch is lowered, and looking from the back of the feet, the heel is excessively inclined towards the center and the medial ankle is too much emphasized. Longitudinal flat feet is also referred to as the overcapacing foot.

The flat-valgus foot is a three-dimensional deformation of the foot - the position of the bones in flatfoot conditions changes:

the head of the talus slides excessively concentrically in relation to the valgus heel,
overloading the medial column of the foot in combination with ligamentous insufficiency can cause subluxation in the joints of the foot and dorsal displacement of the first metatarsal bone (collapse of the longitudinal arch of the foot),
abduction of the forefoot.
The above changes significantly disturb the foot biomechanics, leading to joint overload and faster development of degenerative changes.

Transverse flat feet

Transverse flatfoot is the lowering of the transverse arch extending between the first and fifth metatarsal bones too much. The first metatarsal moves dorsally, so that the foot transverse the second and third metatarsal bones. As a result, there is an increased load on the middle part of the forefoot. Symptoms of a transverse platform are painful skin imprints (calluses) on the foot pad below the toes. A person with transverse flat feet feels as if they are walking on pebbles that stick into the center of their forefoot. Transverse flat feet are very often accompanied by halluxes (valgus hallux) and distortions of the remaining fingers (e.g. hammer toes).

Transverse flatfoot can occur not only in people with longitudinal flatfoot (with accompanying dorsal dislocation of the first metatarsal bone), but also in people with a hollow foot and clubfoot. Clubfoot in adults is an expression of muscle tension disturbances in the lower extremities. Clubfoots are characterized by a limited support area and a reduced ability to cushion. In addition, the accompanying contraction of the triceps calf causes an overload of the forefoot, increasing the risk of developing a transverse platform. As a rule, the fifth metatarsal bone is subjected to increased stress, as a result of which a bunionette deformity develops and the little finger tucks. Disturbance of II-V finger muscles in the clubfoot causes their claw-like positioning, which deepens the hyperextension in the metatarsophalangeal joints and increases the painful adhesion of the metatarsal heads to the ground. Transverse flatfoot can occur not only in people with longitudinal flatfoot (with accompanying dorsal dislocation of the first metatarsal bone), but also in people with a hollow foot and clubfoot. Clubfoot in adults is an expression of muscle tension disturbances in the lower extremities. Clubfoots are characterized by a limited support area and a reduced ability to cushion. In addition, the accompanying contraction of the triceps calf causes an overload of the forefoot, increasing the risk of developing a transverse platform. As a rule, the fifth metatarsal bone is subjected to increased stress, as a result of which a bunionette deformity develops and the little finger tucks. Disturbance of II-V finger muscles in the clubfoot causes their claw-like positioning, which deepens the hyperextension in the metatarsophalangeal joints and increases the painful adhesion of the metatarsal heads to the ground.

Flat feet in children

Flat feet in young children who are just starting to walk are apparent. The medial arch of the foot is filled with fat, making the foot appear flattened. In preschool children, the presence of squamous valgus feet is most often physiological and results naturally from the position of the hips - e.g. from increased anthroat of the femoral neck. The forces affecting the preschooler's foot while walking cause an increased load on the medial part of the foot, which translates into a valgus position of the hindfoot and a low longitudinal arch. As the anthorosis of the femoral neck decreases, the biomechanics of the lower limb changes, so that heel valgus is naturally corrected to 5 degrees. Only at the age of 7-8 years, the child's feet have fully developed arches, and the shape of the foot becomes the same as in an adult.

This does not mean that every child's feet will, by definition, develop normally. The risk of flat feet not self-correcting occurs in children with:

- genetically conditioned generalized ligamentous laxity - ligaments are more prone to stretching, after some time they may become excessively elongated and insufficient,
- triceps muscle contracture of the calf - calf contracture causes compensatory valgus position of the heel,
- neurological disorders - imbalance of muscle tension disturbs the active stabilization of the arches of the foot.
In addition, the orthopedic surgeon should always assess the child's feet for ligamentous capacity and rule out congenital defects (e.g. tarsal fusion).

How to prevent flat feet in children?

To allow the proper development of the feet, the child should be given plenty of spontaneous movement, especially free walking. Loading the leg with body weight while the body is upright allows the hip to rotate in the appropriate position of the pelvis, which causes the desired changes in the biomechanical axis of the limb. As a result, the load on the feet changes and the baby naturally grows out of the valgus hindfoot. Walking barefoot on soft and unstable ground not only strengthens the foot muscles, but also improves the baby's equivalent responses, which has a positive effect on the gait pattern.

Avoid constantly transporting your baby in a stroller and leaving him / her in an uncomfortable seated position, as this slows down the natural changes in hip position and deprives the foot muscles of training. It is also worth paying attention to the way the child is seated - the "W" type (sit between the heels or the frog type) is not recommended for children with flat feet, as it perpetuates the unfavorable internal excessive rotation of the hips and knee valgus. It should be ensured that this type of sitting does not become a habit for the child. The preferred seating position is to sit in a chair with your feet resting on the floor or sit cross-legged.

Flat feet in adults

Longitudinal flat feet in adults may be a consequence of the lack of an outgrowth of a children's flat valgus foot. In addition, it can have a form acquired as a result of an injury, excess weight on the feet, complications of the diabetic foot syndrome, inflammatory diseases of the motor system affecting the feet (e.g. rheumatoid arthritis), neuromuscular diseases, as well as weakness and atrophy of the foot muscles due to a long-term lack of it. loading. Transverse flat feet is most often a consequence of disturbances in the longitudinal arch of the foot, and deformation is also favored by walking in inappropriate footwear with narrow toes and high heels.

A common mechanism of acquired longitudinal flatfoot in adults is tendon failure of the posterior tibial muscle. This muscle acts as a dynamic stabilizer of the longitudinal arch of the foot, limiting the valgus of the hindfoot by eccentric work (lengthening, inhibiting heel valgus). Moreover, thanks to the activity of the posterior tibia muscle, the foot stiffens at the right moment before it is lifted from the big toe, enabling efficient walking and running. The posterior tibial tendon failure leads to excessive valgus of the heel and secondary collapse of the longitudinal arch of the foot.

Pain in the course of flat feet

In adults, the main problem is the effects associated with a disturbance in the biomechanics of the foot. Walking causes overload of muscles, tendons and joints and faster development of degenerative changes. Pain can appear not only in the foot area, but also in the higher levels of the musculoskeletal system, e.g. in the knee or hip. This is because bad foot alignment affects the alignment of the rest of the body.

Within the foot, the pain symptoms resulting from flat feet most often appear:

- on the medial part of the hindfoot behind the medial ankle - overload and degeneration of the tendon or tendon sheath inflammation of the posterior tibial muscle,
- under the lateral ankle - a conflict between the fibula and the calcaneus,
- metatarsal pain on the dorsal side of the foot - degenerative and productive changes in the bones of the foot,
- in the ankle joint - heel valgus may secondary to valgus of the ankle joint and degenerative changes within it,
- on the sole of the forefoot under the metatarsal heads.

Longitudinal or transverse flat feet increase the risk of:

- plantar fascia,
- Achilles tendinopathy,
- tarsal canal syndrome,
- Baxter's neuralgia,
- hallux valgus (halux valgus),
- limited big toe (halux limitus),
- symptomatic transverse flatfoot (metatarsalgia),
- Morton's neuroma.

Treatment of flat feet

Treatment of the squamous-valgus and transverse flatfoot should be preceded by thorough orthopedic, physiotherapeutic and, if necessary, neurological diagnostics. The evaluation covers the results of functional tests, imaging tests (e.g. X-ray of the feet under weight load), computer examination of the feet and determination of blood parameters for rheumatoid diseases.

Treatment for flat feet includes:

- exercises to strengthen the muscles of the foot - preventing and slowing down the progression of flat feet,
- stretching the calf muscles - preventing compensatory overpronation and overloading of the forefoot,
- orthopedic insoles - correction of flat feet or relief of overloaded structures,
- modification of footwear (footwear with increased thickness and a stable sole) - improved comfort and stabilization of the joints,
- treatment of inflammation of the joints of the foot - slowing the progression of deformation,
- effective glycemic control in patients at risk of diabetic foot - slowing down the progression of deformities,
- flat foot surgery - permanent deformation correction.

Frequently asked questions about flat feet: