Flat feet (platfus) is a pathological lowering of the transverse and / or longitudinal arch of the foot. Flat feet may be accompanied by toe deformities, e.g. hallux valgus, hammer-like and clawed toes. Pain while walking and the problem with choosing comfortable footwear are the main reasons for visiting an orthopedist, physiotherapist or podiatrist. Professional diagnosis of flat feet and regular control of the condition of the feet allow us to take appropriate steps to slow down the development of the deformity, correct the defect or treat the painful effects of flat feet.
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How to cure flat feet in children?
A flat foot in a child is a common cause of concern for parents. In most cases, flat feet do not require treatment as it is physiological in young children. The foot of a child learning to walk and run is subjected to loads that stimulate the muscles supporting the vaults to work. Moreover, the position of the hips influencing the way the feet load changes within a few years from the moment the child takes its first steps. In three- and four-year-olds, the foot has the right to still be flat, but at the age of 5-6 you should watch if the arches of the feet rise and the heels straighten symmetrically. At the age of 7-8 years, the foot should have a corrected hindfoot axis and fully developed arches.
A warning signal is a situation in which the child, instead of growing out of the flat feet, becomes more and more deformed heels and knees, and the foot, even when relieved, is deprived of the contours of the vaults. Also, when climbing on toes, the heels should turn with the plantar side toward you. If one or both heels remains valgus, it may indicate pathology. Chronic foot pain reported by a child is also an alarming symptom that cannot be ignored.
Suspicions of abnormal development of the feet should be supported by detailed orthopedic and, if necessary, neurological diagnostics. The most important in the diagnosis of children's flatfoot is to distinguish the physiological flexible flat foot from the pathological rigid deformation. Treatment of flatfoot in children is initiated if the defect progresses very quickly, is not corrective, and if it is the direct cause of pain in the foot or knee.
How to treat flat feet in adults?
Valgus heels and flat feet can cause many overloads in the locomotor system. The aim of the procedure in adults is to improve the function of the foot in its current position and to treat the symptoms and effects of flat feet, e.g. pain associated with degenerative changes.
Treatment of flat feet - methods
The choice of treatment methods depends on the cause, severity and correctness of flat feet:
Strengthening the internal muscles of the feet - especially in the case of generalized ligamentous laxity,
Elimination of the contracture of the triceps calf muscle,
Normalization of muscle tension disorders,
Treatment of inflammation of the ankle and foot joints,
Orthopedic insoles - correction of the foot position, relief of painful structures,
Treatment of diseases in the area of the hip joint (complications of hip dysplasia or aseptic necrosis of the femoral head in children),
Surgical treatment of flat feet:
implantation of a subtalar implant (correction of a flexible flat valgus foot),
calcaneus osteotomy with lengthening of the lateral column (correction of longitudinal flatfoot),
triple arthrodesis, i.e. stiffening of the foot joints (correction of advanced fixed longitudinal flatfoot and stabilization of the correction in the stiffening),
complex reconstruction of the forefoot with hallux valgus (correction of transverse flatfoot),
surgical treatment of congenital foot defects in children, e.g. tarsal coalition, congenital vertical position of the calcaneus.
Flat feet exercises
Exercises on flat feet in children are designed to facilitate the outgrowth of the physiological flat valgus foot. Moreover, exercise is an important element in the rehabilitation of children and adults with pathological flat feet. The degree of difficulty of the exercises depends on the age and ability of the person to focus on a specific movement task. Exercises include stretching the calf muscles and strengthening the foot muscles that support the arch of the foot. Exercises should involve not only the foot muscles, but also the muscles of the lower limb and the muscles responsible for stabilizing the torso. The most important thing is that the squamous foot exercises are performed regularly.
Flat foot inserts
Orthopedic insoles for shoes correct the position of the foot, relieving painful structures. For people with a corrective flat valgus foot, the so-called hindfoot supination inserts, having a wedge located under the medial side of the heel. In flat feet, orthopedic insoles stabilize the arches of the foot, protecting the joints and muscles against overload. The transverse inserts are designed to reduce the pressure under the places of callus formation in the forefoot. The treatment of flat feet is most effective when the insoles are made individually, after taking the foot measurement from the patient.
Special footwear
An important feature of footwear for people with flat feet is high resistance to deformation and bending of the sole. Children with significant flat feet should give up wearing sneakers and sneakers in favor of sneakers or orthopedic slippers. The best choice for adults is sports or trekking shoes. In the case of large deformations with secondary instability of the ankle joint, a special foot orthosis stabilizing the ankle may be useful.
Surgical treatment of flat feet
The aim of the surgery is to permanently correct the foot defect, relieve the structures exposed to overload aggregation and reduce pain. Correction of flat feet in an adult is possible only through surgery.
The type and scope of the operation depends on the type of deformity, the degree of degenerative changes in the joints of the foot and the patient's age. Corrective deformities of the flat valgus foot are operated with minimally invasive methods involving the hindfoot, which significantly shortens the recovery time after the procedure. If the longitudinal flatfoot is associated with the transverse flatfoot, the correction of the hindfoot is completed using reconstructive techniques of the forefoot. The result of the surgical treatment depends mainly on the surgeon's competences - the correct qualification for the procedure, selection of the appropriate technique and operating experience. In addition, the patient's compliance with postoperative recommendations and involvement in the rehabilitation process after surgery are also important.
Surgery for squamous valgus - subtalar arthrosis with an implant
In the case of a corrective flat valgus foot, the procedure for inserting the implant into the tarsal sinus is performed. The nested implant inhibits excessive movement of the talus in relation to the calcaneus, thanks to which flat feet correction is achieved without undesirable stiffening of the foot. The procedure is minimally invasive - access below the lateral ankle does not exceed 15 mm - enough to introduce small measures and finally an implant between the ankle and heel bone.
The flatfoot correction procedure with the use of an implant usually takes about 20 minutes. The patient can walk freely 2-3 weeks after the operation. The final adaptation of the bone system, ligaments and muscles to the new relationship of the hindfoot bones takes up to several months. During this period, you may experience temporary discomfort in the feet and lower limbs. It is worth noting that the recovery period after the implant surgery is much shorter than in the case of classic methods of flat feet correction.
Surgical treatment of flatfoot with an implant is performed in children over 3 years of age and in adults who can actively correct the position of the hindfoot. After the treatment, the foot remains mobile, which is a big plus of this method. In addition, by placing the implant in the tarsal sinus, there is no direct interference with the bones of the foot, so that the child's foot can grow properly.
Heel osteotomy
Heel medializing osteotomy involves cutting the calcaneus and shifting its posterior part medially. Thanks to this, we obtain more medial support for the entire lower limb, which reduces valgus forces acting on the ankle joint.
Ankle arthrodesis
Fixed flat feet, e.g. in the course of rheumatoid arthritis, are corrected and stabilized by stiffening the subtalar and / or ankle joint with possible stiffening of the remaining joints of the foot. Read more about ankle arthrodesis.
Complex reconstruction of the forefoot with hallux valgus
The problem of painful transverse flatfoot with deformations of the fingers (bunions, hammer fingers) can be effectively solved by performing a forefoot reconstruction procedure. It is a method that allows you to permanently change the shape of the foot, i.e. straighten the hallux valgus and other toes and reduce the width of the foot.
Very severe pain in the sole of the forefoot and selected radiological parameters are indications for shortening the middle metatarsal bones. This procedure reduces the participation of the medial part of the forefoot in the dislocation, shifting the dislocation point to the first metatarsal bone and the big toe. Foot pain is reduced so that the patient can walk more freely.
The use of modern surgical treatment techniques allows for effective correction with minimal use of anastomoses in the form of plates or screws.
Rehabilitation after flatfoot surgery
The rehabilitation program after flatfoot surgery is selected individually for each patient. The differences in the procedures result from the surgical technique used, the extent of the procedure, age and level of patient activity.
The correction of the squamous-valgus foot, involving the implantation of a subtalar implant, is a minimally invasive procedure. Rehabilitation is designed to shorten the adaptation time of the locomotor system to new biomechanical conditions. For this purpose, the physiotherapist may perform myofascial mobilizations and the mobilization of adjacent joints.
In the case of transverse flatfoot surgery with hallux correction, the patient wears a special shoe that relieves the forefoot (the so-called baruka shoe) for the first 6 weeks. After bone fusion visible on the X-ray of the foot, confirmed by the doctor, the patient may begin to gradually load the entire surface of the foot.
The main goal of physiotherapy after surgery on flat feet is to achieve a painless gait and symmetrical loading of the lower limbs. The rehabilitation program should include: postoperative scar massage, mobilization of selected joints of the foot, isometric exercises, range of motion exercises, exercises paving the way for correct gait patterns and balance exercises. It is important that the physiotherapist is in constant contact with the orthopedist, because a given surgical method determines the choice of physiotherapeutic techniques that can be applied to a specific part of the foot.
Important information
| Duration of the procedure (depending on the method) | 20 - 120 minutes |
| Tests required for surgery |
basic - preparation for surgery tab |
| Anesthesia | periosteal or subarachnoid block |
| Hospital stay | 2 - 6 hours after surgery |
| A period of significant dysfunction | depending on the method, several days to 3 weeks |
| A period of limited dysfunction | 3 - 12 weeks |
| Removal of stitches - first visit | 12 - 16 days |
| Change of dressings | every 3 - 4 days |
| Contraindications to the procedure | individual |
Frequently asked questions about the methods of treatment of flat feet:
In children up to 7 years of age, there is physiological flat feet, which means that children's flat valgus foot is a natural stage in the development of the lower limbs. In order to stimulate the outgrowth of physiological valgus, give the child plenty of exercise, and especially allow the child to walk barefoot on a variety of surfaces - this stimulates the foot muscles to work. Flat feet should always be monitored, especially in cases where there are aggravating factors: excessive joint laxity, overweight, muscle tone disorders or abnormalities in the hips. The final decision as to treatment is made by the orthopedic surgeon after thorough diagnostics. Conservative treatment includes exercises to strengthen the feet, exercises to stimulate the correct positioning of the lower limb and the possible wearing of orthopedic insoles. The indication for surgery is painful flat feet, rapidly progressing and not amenable to conservative treatment.
The type of treatment depends on whether the flat feet are still flexible (can be actively corrected) or the defect has already been fixed. If we are dealing with flexible flatfoot, one of the methods used is to place a small implant in the tarsal sinus. The tarsal sinus is the space between the ankle bone and the calcaneus, felt through the skin as a depression in the foot in front of the lateral ankle. The procedure is a minimally invasive one, therefore the return to walking is much faster compared to classic correction methods. The implant placement procedure can be performed in children over 3 years of age and in adults with corrective flat feet. Fixed flat feet with degenerative changes in the foot and ankle are operated using other methods, the choice of which is up to the surgeon.
Relief in ailments caused by transverse flat feet is provided by the use of individually made orthopedic insoles. The inserts on the transverse platform relieve the forefoot and normalize the pressure distribution under the feet, thanks to which the foot is less painful. The insoles work when worn in shoes. Permanent improvement in ailments and correction of accompanying deformities of the fingers can be achieved through surgery. The surgical procedure allows you to straighten the bunion, hammer or claw toes and change the shape of the foot to improve comfort while walking.
The length of convalescence depends on the extent of the procedure and the surgical technique used. For the first 6 weeks, the patient should wear a special shoe that relieves the operated part of the foot. Return to full activity is usually possible in the third month after the procedure, but it may be shortened if the procedure was performed using a minimally invasive technique.
