Flat feet or collapsed arches are a common yet painful deformity. There are numerous causes of flat feet such a ligamentous laxity, tightness of the Achilles tendon, and weakness of the soft tissue support structures that hold up the arch of the foot. In adults, the most common cause of a collapsed arch is weakening of the posterior tibial (PT) tendon. This tendon is responsible for holding up the arch in the sole of the foot, and as this tendon becomes weakened or diseased, the arch begins to lower.
Conservative treatment is aimed at supporting the arch of the foot through orthotics or braces. These devices take stress off of the posterior tibial tendon so that it does not have to work as hard to suspend the arch. If orthotics and bracing fail and symptoms of arch pain and discomfort persist, then surgical management may be considered.
In very mild cases of flat feet when there is weakness of the posterior tibial tendon but no structural change or flattening of the arch, then repair of the tendon may be performed. However, as this condition progresses, the arch collapses and there is a visible deformity of the foot. In these instances, the goal of surgery is to reconstruct the arch of the foot. This is done by performing bone cuts referred to as “osteotomies” to form a new arch by repositioning the bones of the rearfoot, midfoot, and / or forefoot. At times, a bone graft may be inserted to help restore the arch of the foot. These types of procedures are often performed with a concomitant Achilles tendon lengthening procedure. This is because a tight Achilles tendon has been directly associated with flattened arches.
In severe cases that are associated with arthritis of the foot, fusion procedures of the hindfoot are performed. Because the foot is no longer flexible, reconstructing the arch by cutting and repositioning bones would fail in these more severe cases. Instead, the joints of the foot are fused together an into a proper position that restores the arch. Although this fusion surgery referred to as “arthrodesis” is more involved and has a longer recovery time, it is highly effective in restoring the arch of the foot.
There are numerous procedures that have been described to fix flat feet, and there is certainly no one size fits all approach. The surgeons of Advanced Podiatry will take time to evaluate, diagnose, and manage each case of flat foot deformity. We take into account the patient’s history, the level of deformity, and most importantly – the patient’s values, goals, and expectations. If you are having pain in your arches, do not hesitate to make an appointment at one of our locations!