Flexible Flatfoot: Diagnosis & Treatment



Flexible Flatfoot: Diagnosis & Treatment

A hallmark feature of a flexible flatfoot is a fully collapsed medial arch during stance phase of gait and an immediate return of the arch when not weightbearing.

The term flexible is used to refer to the level of qualitative stiffness of the foot during dynamic loading and physical examination.

Abnormal kinematics of the rearfoot (such as excessive rearfoot eversion) and foot and ankle kinetics (such as abnormal loading forces) are observed in this condition.

The subtalar joint pronation that ensues, causes the midtarsal joint to be unlocked, making it unstable and leading to various degrees of transverse plane abduction.

In adults, flexible flatfoot could be either unilateral or bilateral.

While typically idiopathic in nature with hereditary tendencies, one of the most common causes of the condition is a contracted Achilles muscle-tendon complex. Other causes include a skew foot, any kind of joint malformation, bone abnormality or arthrosis. 

Hypermobility is also frequently associated with the condition.

A patient with flexible pes planus will often complain of calcaneal pain at heel strike, muscle spasm of plantar fascia, frequent ankle sprains, or pain in the lower back, knee or hip.

Since there is an increase in energy consumption as a result of altered physical function, the patient will also experience an increase in lower limb fatigue.

Diagnosis for the condition can be made with a foot examination in both open-chain and closed-chain posture under weightbearing. 

Radiological studies can provide further detail regarding the degenerative impact of the deformity. It is imperative though that only weightbearing X-rays be used to evaluate the condition, since there many joints in the foot that could be responsible for the subluxation.

Treatment regime for flexible flat foot will include weight loss consulting if required, lower limb strengthening and stretching programs and proprioceptive balance board training.

The MASS4D® custom orthotic provides the structural support needed to correct this postural abnormality when in use, addressing issues such as the collapse of the arch and the eversion of the heel.

The inclusion of such an orthotic intervention in an active rehabilitation program will yield positive results, providing a more holistic treatment for the patient’s condition.

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References:

  1. Michael S. Lee, John V. Vanore, James L. Thomas, Alan R. Catanzariti, Geza Kogler, Steven R. Kravitz, Stephen J. Miller and Susan Couture Gassen (2005) Diagnosis and Treatment of Adult Flatfoot. The Journal of Foot & Ankle Surgery: March/April 2005, Vol. 44, No. 2, pp. 78-91

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