A flatfoot deformity refers to a condition in which the arch of the foot is lowered or collapsed, causing the entire sole to touch or nearly touch the ground.
The condition can be further classified in two ways: flexible (or non-rigid) and rigid.
Flexible ( or non-rigid) flatfoot deformity is the more common form and is characterized by a flexible arch that can change depending on whether the person is standing or not.
Key Characteristics:
- The arch appears flat when standing, but the arch is visible when the person is sitting or when the foot is not bearing weight.
- The deformity is correctable when the foot is not weight-bearing (e.g., the arch reappears when sitting).
- Occurs in both children and adults. In children, flexible flatfoot is often normal and may resolve with growth.
- Pain: Typically, there is little to no pain, but some individuals may experience discomfort due to overuse or muscle/tendon fatigue, especially that of the posterior tibial tendon.
Causes:
- Developmental: Many children have flexible flat feet, which can improve as they grow.
- Tendon or ligament weakness: the posterior tibial tendon, which supports the arch, may weaken, allowing the arch to collapse, though the condition is still flexible.
- Excessive pronation: the foot tends to roll inward excessively when walking or standing, causing the arch to flatten.
Treatment:
- Often non-surgical and focuses on strengthening the foot’s arch and improving flexibility.
- Custom or over-the-counter orthotics may be used to provide support and alleviate discomfort.
- Stretching and strengthening exercises, as well as proper footwear, may be helpful in managing symptoms.
The rigid flatfoot deformity is the more severe form where the foot’s arch is permanently collapsed and does not return when not bearing weight.
Key Characteristics:
- The arch remains collapsed even when the person is not standing or bearing weight, making it “rigid.”
- There is often significant pain, particularly with movement, and the condition can affect walking or standing.
- This form is typically more associated with degenerative conditions or neuromuscular disorders, leading to permanent structural changes.
Causes:
- Tarsal Coalition: a condition where two or more bones in the foot are abnormally fused together, preventing normal movement and causing the arch to collapse.
- Arthritis: degenerative arthritis, particularly in the ankle or subtalar joint, can lead to rigid flatfoot.
- Posterior tibial tendon dysfunction: when the tendon that helps form the arch becomes torn or too weak to support the foot properly, causing the foot to flatten.
- Neurological or muscular disorders: conditions like cerebral palsy, Charcot-Marie-Tooth disease, or stroke can lead to rigid flatfoot due to muscle imbalance or nerve dysfunction.
Treatment:
- Treatment may be surgical if the deformity is severe or if the individual experiences chronic pain or disability.
- In some cases, custom orthotics and bracing may provide some support, but surgery is often needed to correct the deformity itself as the orthotics are unable to fully correct the deformity due to its rigidity.
- Surgery may involve tendon transfers, bone realignment, or fusion of joints in the foot and ankle.
Here is a table the summarizes the main dierences between the two types of flatfoot deformity:
The distinction between the two is crucial for treatment planning where the more flexible form usually requires less intervention particularly surgical, while rigid flatfoot may necessitate more complex treatments, including surgery.
If you are experiencing symptoms from flat feet, come see us at District Foot & Ankle so we can work together to properly diagnose what type of flatfoot deformity you have and what treatment options would serve you best!
Schedule here today.