Treatment Options

Just as there are many different causes of flat feet, there are also many different treatment options. The most important aspect of treatment is determining the exact type or underlying cause of flat feet that you have. Foot and ankle specialists can determine this through thorough clinical examination and special imaging studies (e.g., x-rays, computed tomography, and/or magnetic resonance imaging). Conservative treatment is effective in the vast majority of flat foot cases, and consists of things such as insoles, splints, manipulation, or casting. Surgery is required much less frequently, and is reserved only for some of the severe types of flat foot that do not respond to conservative therapy.

Congenital Flat Foot Treatment: Pediatric flexible flat foot can be treated with simple conservative treatment if caught early enough. Although often asymptomatic, these children may be treated with some type of support, whether it is molded insoles, special shoes, or braces. The reason for this is that children's bones are in a somewhat soft, pliable state of development. Also, the ligaments that hold those bones in place are very flexible. Without support to hold the foot in the correct position, the bones can develop abnormally, leading to future problems. The key is to catch the problem early. Before the age of 2, and possibly until the age of 4, conservative treatment can have a lasting effect on the foot [4]. Many people, including some famous professional athletes, live their entire lives with flat feet.

The big question is whether or not to treat a flat foot at all. An infant's "flat looking" foot concerns many parents. Most of the time, the foot is completely normal; there is a natural fat pad in the arch of a newborn's foot that gives the allusion of a flat foot. Also, some practitioners believe that pronated feet (those with lower arches) are normal until puberty [5]. Problematic flat feet usually do not become painful until 6-12 years of age when conservative therapy is usually too late [4]. So the lesson to be learned here is that if you are a concerned parent, consult a foot and ankle specialist. He or she will probably have good news for you and be able to help your child avoid future problems.

Acquired Flat Foot Treatment: Acquired flat foot is an entirely different entity in itself. The best way to treat acquired flat foot is to never acquire it in the first place. This is where proper, well-made and well-fitting shoes come into play. A shoe specifically made for your foot type works wonders against the adverse effects of modern society. Many recent technical advances have been made in the footwear arena. In the past, the only form of motion control, or pronation prevention, was in the form of custom orthotic devices ( orthoses), which were inserted into the shoes. These days, many shoe companies have invested time and research into developing shoes with built-in support and motion/pronation control. The good news is that they don't even look like the Frankenstein clodhoppers of the 1960's like Forrest Gump had to wear. For well under $100, you can buy a good pair of shoes that actually look as nice as they feel and function-this investment can prevent priceless pain and suffering in the long run. A trained athletic store employee can direct you to these 'motion-controlling' shoes.

If you have already acquired flat feet, again the treatment is based on the exact type of problem that you have. If the specialist determines a tight Achilles tendon to be the cause, then he or she may prescribe some combination of stretching and strengthening exercises or possibly physical therapy and orthotic devices. If Posterior Tibial Tendon Dysfunction causes your flat foot, conservative measures may include rest, immobilization, shoegear modifications, orthoses, bracing, and anti-inflammatory medications [6]. Depending on the severity, your foot and ankle specialist may deem it necessary to cast your foot while the tendon repairs itself. Because Posterior Tibial Tendon Dysfunction is progressive (worsening over time), it is essential to seek medical attention early, as conservative measures tend to fail in the later stages of dysfunction.

Wonderful World of Orthoses: You may have noticed that one common element in the conservative treatment of all types of flat feet is orthoses. Many companies now manufacture semi-custom orthotic devices that not only improve comfort, but also seek to control abnormal motion of the foot. These over-the-counter inserts, in the $25 to $50 range, are an economical treatment that may help a majority of people. Unfortunately, these semi-custom devices will not fit everyone perfectly, and those of us who differ too much from the average may respond better to custom orthotic devices. Custom inserts are prescribed by your foot and ankle specialist and are made individually from either a physical or computerized impression of your feet. The only drawback of custom orthoses is their cost, ranging anywhere from $300 to $500. Many physicians recommend trying over-the-counter inserts first (and even keep them in stock) as they may save their patients large sums of money.

Surgery: Flat feet that do not respond to conservative therapies, remain painful, and/or continue to cause other problems, may require surgery. Again, the surgical procedure selected is entirely dependant on the type and severity of flat foot, as well as the age of the patient. In younger children, and in less severe cases of adult flat foot, procedures involving tendons and ligaments (i.e., soft tissue procedures) may suffice. These usually result in less recovery time and postoperative discomfort. However, if the problem is a more severe rigid deformity and arthritis has developed in the joints, then bone work may also be warranted. In these types of procedures, bones are realigned and fixed in position as to actually construct an arch in the foot-yes, a foot and ankle surgeon can reconstruct your foot. Often times, joints are fused in order to eliminate pain that results from movement of these joints. These procedures usually require more recovery time in order for the bones to heal in the correct position. Again, before surgery, conservative treatment options should always be exhausted. Surgery is only indicated when conservative measures fail.