Many consequences to flatfoot deformity

Genetics are a funny thing, a veritable role of the dice. Who’s jawline will you inherit? How tall will you be? What is your shoe size? These and many other related questions are primarily a function of genetics. How about the important question of what is your foot type? In many ways, this is asking about the arch of your foot.

A minority of the population have a “normal” arch type. This is a foot that will work properly and is less prone to deformity. The other possibilities are to have a higher arched foot type or a lower arched one, with the latter being more common. When the deformity is sufficiently severe, it is termed a flatfoot, technically called pes planus (literally translated to “foot flat”). As you might expect, there are many permutations and variations on the theme, and numerous classification systems.

For many individuals who inherit pes planus, various problems tend to develop. But these complications are not confined to the foot. This should be understandable since the feet are the foundation for the musculoskeletal system. Many people aren’t aware of the intimate connection between the feet and the rest of the body, especially the knees, hips, spine, etc. A flatter foot type will cause changes above the feet, and various painful conditions tend to develop in these structures over time as a result.

As you might expect, arch problems are very common for those afflicted with this pedal architecture. This foot type is less stable and does not function well as a rigid lever, allowing push off, moving the body forward. Many of the muscles, tendons and ligaments on the bottom of the foot are getting stretched excessively on a daily basis, with each and every step.

Knee problems are extremely common with a ‘planus’ foot type. Because of the alignment of the arch, one which is collapsed places greater stress on the knee. There is a pulling of the ligaments on the inner side of the knee and compression on the outer surface of the joint, both of which can cause chronic pain. This situation often leads to degenerative changes of the joint. The result is that eventually removal of the joint is required, replaced with an artificial one because of the degree of degeneration. Through it all, no one makes the connection between their knee pain and their foot type.

Another common finding with this arrangement is increased rotation of the leg. This will commonly lead to a small change in alignment of the pelvis. But over time, this requires the musculature of the low back to over-work. Too many Americans suffer from chronic low back pain. This explains why those prescribed custom arch supports frequently see a reduction of their back pain.

Toe deformities may be produced by pes planus because it changes the orientation of the tendons and ligaments running out to the toes. Over the years, the altered pulling of these structures results in an abnormal bend in the toe (e.g. one example being a hammertoe). In the presence of a flatfoot deformity, the incidence of hammertoes and bunions is significantly greater, occurring more often to those with this foot structure.

Predictably, when the arch is lower than normal, the heel bone will be less inclined, less angled, and so putting less tension on the Achilles tendon. Over the years, this will lead to shortening of this structure, the largest tendon in the body. This shortening has innumerable consequences, from greater stress to the knee joint, shin splints, even spine and disc problems.

A thorough discussion of the therapies and treatments utilized are beyond the scope of this article. As the reader may have surmised, various supportive devices are used, from a simple pad under the arch to a complex, prescription foot-ankle-leg orthosis. For the most severe cases, surgical reconstruction is possible, where various bones are moved or shortened, certain joints fused, all with the goal of creating more of an arch.

Although these operations can result in a more supportive foot, these are complex procedures with many opportunities for problems and complications. And predictably, the recovery period is lengthy and difficult. For most, a combination of stretching and strengthening exercises with on-going use of prescription foot orthotics (in conjunction with appropriate shoe gear) provide for weight bearing activity without pain.

A flatfoot deformity is a common occurrence, with estimates claiming roughly a third of the human population possessing some degree of pes planus. Many will develop symptoms, obviously arch pain being typical. Or they will experience structural changes, like thinning of cartilage in some nearby joint, with the passage of years a key element.

Early in the process, intervention tends to be less invasive and less complicated. But the consequences of the pes planus condition take years to manifest and, too often, damage occurs while they simply live with the aches and pains. Don’t wait until you need that knee replacement: seek out care before the more significant problems related to pes planus develop. Prevention can be a wonderful thing!

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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