FLATFOOT RECONSTRUCTION

Having flat feet – or posterior tibial tendon dysfunction (PTTD) – means that the foot has little to no arch. While flat feet is typically not a serious condition, it may require treatment if it is painful. Additionally, having flat feet can be a risk factor for other ankle, foot, or lower leg conditions. David Larson, DPM, a fellowship-trained foot and ankle surgeon, specializes in Flat Foot Reconstruction. After an exam, Dr. Larson can determine your risk and make treatment recommendations. To make an appointment, call the office in Mesa or Phoenix, Arizona, or request an appointment online today.

What are Flat Feet?

Having flat feet – or posterior tibial tendon dysfunction (PTTD) – means that the foot has little to no arch. While flat feet is typically not a serious condition, it may require treatment if it is painful. Additionally, having flat feet can be a risk factor for other ankle, foot, or lower leg conditions. With flat feet, changes in the tendon impair its ability to support the arch and distribute the body’s weight effectively. People with flat feet often walk on the inner side of their foot as the foot may roll (pronate). This results in wearing through shoes faster on one side.

What are the Symptoms of Flat Feet? 

The most common symptom of having flat feet is ankle and arch pain. This happens due to strain on muscles and connecting ligaments. Stressors of the hip and knee may also worsen pain in these joints, notably if the ankles are inwardly turned. Pain related to flat feet can affect different areas of the body:

• Arch of the foot
• Calf
• Knee
• Hip
• Lower back
• Lower legs

Early on in the condition, the arch flattens and inward rolling of the ankle occurs. There is often pain on the inside of the foot and ankle. As the condition progresses, the foot will roll outward and the pain will typically shift to the outside of the foot below the ankle. Flat feet can increase the risk for developing ankle arthritis when the posterior tibial tendon has significantly deteriorated, if left untreated.

What Causes Flat Feet?

Adult Acquired Flatfoot 

When arches also fall over time due to wear and tear on the posterior tibial tendon running along the inside of the foot to the ankle, which helps support the arch, this type of flat foot is called “adult acquired flatfoot.” It is the most common type of flatfoot developed during adulthood. If not treated early, the condition will typically worsen. This form typically occurs in only one foot, although it’s possible to develop it in both feet.

Flexible Flat Feet 

Flexible flatfoot is another form of the condition, where a person has arches while they sit, but no visible arch when they stand. This condition is common in children and is often outgrown, but that is not always the case.

Genetics that Contribute to Flat Feet 

Most common, flat feet is a hereditary foot type, in which a parent may pass the genetic trait to their children, predisposing them to issues related to flat feet.

What are the Risk Factors for Flat Feet?

There are factors that can contribute to developing flat feet:

• Aging
• Diabetes
• Rheumatoid arthritis
• Obesity
• Injury of the foot or ankle
• Improper, ill-fitting shoes

How is Flat Feet Treated?

Treatment options focus on alleviating pain and include:

• Arch supports/Orthotic Inserts & Supportive Shoes – Wearing shoes with good arch support and/or over the counter or custom designed orthotics. 
• Stretching Exercises – Exercises that stretch the tendon may help reduce pain, as those with flat feet often have a shortened Achilles tendon. 
• Immobilization – Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal. A patient may need to completely avoid all weight-bearing for some time.
• Physical therapy (PT) – PT is often utilized in individuals who are athletes, especially runners as flat feet may contribute to overuse injuries.

When is Surgery for Flat Feet Needed?

Once conservative measures have failed, surgical treatment for flat feet is an option for pain relief. Surgical reconstruction is performed when the arch is collapsed, but still flexible.

An MRI (magnetic resonance image) or advanced imaging is ordered to assess the severity of the tendon damage. A surgical approach is then developed to achieve a successful outcome and rehabilitation. The goal is to improve the alignment and function of the foot. Most often, a combination of procedures is performed to repair the ligaments and tendons that support the arch and to reconstruct the flat foot through correcting deformities in the bones.

What are the Surgical Techniques for Flat Feet?

• Medializing Calcaneal Osteotomy – Used when the heel bone has shifted out from underneath the leg.
• Lateral Column Lengthening – Performed when the foot is outwardly rotated.
• Medial Cuneiform Dorsal Opening Wedge Osteotomy or First Tarsal-Metatarsal Fusion – Used when the arch collapse leads to the big toe side of the foot being raised above the ground.
• Tendon and Ligament Procedures – Used to correct a stretched and dysfunctional posterior tibial tendon
• Double or Triple Arthrodesis – In the later stages of flat feet, when the deformities are inflexible and arthritis may be present, this procedure may be used. It involves fusion of one or more of the foot joints.

To learn more about Flat Foot Reconstruction, make an appointment with David Larson, DPM, today. Call the nearest office to speak with a staff member or request an appointment online.