A NRI lady from the Middle East visited India to seek treatment for her swelling and pain in the ankle joint. She was investigated for various diseases; TB, Rheumatoid arthritis, gout etc but was not getting better. She was finally diagnosed with a flat foot because of a torn tendon in her lower leg. She had surgery to reconstruct this tendon. The swelling and pain disappeared and her foot shape came back to normal. If the correct diagnosis would have been earlier surgery could have been avoided.
For many, flat feet have been present since their teenage years and it may simply be the way their foot is shaped. This is entirely normal. In these cases both feet are often the same. There are many doctors who may tell you that your arches have “fallen”. It is important that any such advice is given to you by a suitably qualified foot and ankle specialist /professional who can tell what is normal from abnormal. Having a longstanding flat foot can be okay.
The question that first comes about the ‘flat foot’ problem is what causes an abnormal flat feet? Dr Pradeep Moonot, an orthopedic surgeon specialising in knee, foot and ankle surgery in Breach Candy Hospital, Mumbai explains that there are lots of reasons behind flat feet such as tendon tear in foot due to overuse, inflammation or obesity. The other reasons are; excessive laxity in the joints and this can be related to weight gain, sometimes a childhood condition that is an abnormal fusing of some foot bones which makes the foot stiffer and quite flat, one of the major reasons could be foot arthritis as well, arthritis in the back or middle of the foot is usually painful. It can be caused by an injury or develop with no real explanation. It shows with different symptoms depending on the case, some people may find walking painful especially along the inside border of the foot and ankle. Running can be very difficult due to pain. There can also be some swelling in the inside of the ankle. Sometimes tingling or numbness can develop on the inside or sole of the foot because the nerve along the inside of the ankle may be slightly stretched or compressed.
The diagnosis is based on an accurate history or story of symptoms from the patient. Examining the foot for pain and swelling can differentiate a normal and abnormal flat foot. X-Rays can display the overall shape of the flat foot. They can also diagnose arthritis as a feature of the flat foot. An MRI scan is useful to determine whether the tendon is working normally and also if there are any abnormal bony fusions.
Dr Monoot also states that if the timely treatment is not given then the problem can get worse. If the cause is a simple tendon abnormality causing the foot to flatten then it can be helped with insoles and physiotherapy as the arch can be restored fairly easily. If the foot is left untreated then the foot can become arthritic and the flat foot can be quite stiff and impossible to correct with insoles. It is vital to get assessed as soon as possible as solutions to your problem can change a lot and become more difficult over time. He concludes that the key is to get assessed by a foot and ankle specialist (podiatrist). If the foot is flat but flexible then you may be able to have treatment with simple insoles and physiotherapy. The idea is to support your foot to stop it getting worse but unfortunately the arch would be permanently flat without the insoles. For a more active person this treatment may not be satisfactory. In this case surgery to re-create the arch can be performed, a flat foot correction.
Surgery is sometimes required if the condition is more severe. The procedures that may be considered are the calcaneal osteotomy, Sometimes known as the ‘heel shift’, A tendon transfer in this a tendon is taken from one of the lesser toes, which is then transferred to run behind the medial malleolus. This does not affect the function of the toes and patients make a full recovery and Fusion, It is recommended in late stages of adult flat foot, the fusion of joints needs to be considered in order to effectively eliminate pain.
Deciding whether surgery is necessary
If you have an abnormal flat foot it will never be made “a normal shape in a normal shoe” without surgery. You can manage it with special insoles and physiotherapy but it can still get worse. Specially made shoes can be an attractive option, if your lifestyle is less active than others. Surgery is successful in over 80 percent of patients and worth discussing with your surgeon, says Dr Monoot.
