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March 5, 2018

Flatfeet by Dr. Leroy James

Can you be affected by flatfeet in your silver years? The unfortunate answer to this question is yes. An individual is said to have flatfeet when they lose the normal support along the inner aspect of the sole of their feet. Flatfeet is one of the most common foot and ankle condition affecting women over the age of 40 years but men are not immune.

The first thing a person with flatfeet might notice is a change in the shape of their feet. This may lead to abnormal wear of their shoes or difficulty in getting properly fitting shoes. Individuals may also experience pain in the inner or outer aspect of their feet. It is widely felt in the orthopaedic community that flatfeet may play a role in an individual developing bunions (hallux valgus).

Outside of the expected symptoms in the foot and ankle region, individuals may also experience pain in their knees, hips or lower back. This is thought to be due to theoverall alignment of the person being thrown out of whack. Individuals can alsoexperience functional impairment such as struggling or being unable to stand on their toes. The most common reason for acquired flatfeet in the non-paediatric age group is dysfunction of one of the main supporting structures of the foot called the tibialis posterior tendon. Predisposing factors for acquiring the condition include diabetes,obesity and hypertension.

Your surgeon can typically diagnose the condition by performing a clinical examination. S/Hewill inspect the foot to assess the severity of the deformity and determine if there is any functional impairment. An investigation in the form of x-rays is usually performed. Depending on the clinical findings, more specialized investigations such as an ultrasound scan or a CT/MRI scan may be required.

The treatment options are varied and dependent on the clinical findings. The non-surgical options include: accommodative shoes with wide toe box; orthoses (insoles) to support medial arch; weight loss and exercises; Achilles tendon (heel cord)stretches. The surgical options include: Achilles tendon lengthening; Calcaneal osteotomy to realign the hind foot; Tibialis posterior tendon reconstruction; Triple fusion of the foot; Subtalar arthroereisis.