Flatfoot Deformity

Flatfoot deformity occurs when the arch of the foot appears absent or significantly reduced. In a normal foot, the arch provides structural support, absorbs shock, and helps distribute weight evenly during movement. When the arch collapses, it can alter walking mechanics and lead to excessive strain on the surrounding structures, including the ligaments, tendons, and bones of the foot and ankle.

Symptoms of flatfoot deformity vary depending on the severity and underlying cause of the condition. Some individuals remain asymptomatic, while others may experience the following:

• Pain and discomfort: Most commonly felt in the arch, heel, or along the inside of the foot, especially after prolonged standing, walking, or high-impact activities.
• Swelling: The inner side of the ankle may become swollen and tender due to increased strain on the posterior tibial tendon.
• Foot fatigue: Individuals may experience excessive tiredness in the feet, particularly after extended periods of activity.
• Altered gait: Changes in walking mechanics may occur due to loss of arch support, leading to an outward tilt of the heel (hindfoot valgus).
• Difficulty wearing shoes: As the foot flattens and widens, patients may find it uncomfortable to wear standard footwear.
• Knee, hip, and lower back pain: Poor foot alignment can contribute to biomechanical issues in other joints, leading to discomfort beyond the foot and ankle.

Flatfoot deformity can result from a variety of factors, including genetics, biomechanical abnormalities, and acquired conditions. Some common causes include:

1. Genetic predisposition: Many individuals are born with naturally low arches or an inherited tendency for ligamentous laxity, which can contribute to flatfoot development.
2. Posterior tibial tendon dysfunction (PTTD): The posterior tibial tendon plays a vital role in supporting the arch. It is a strong, rope-like structure in your foot and ankle that helps hold up your arch and keep your foot stable when you walk. It connects a muscle in your lower leg (the posterior tibialis muscle) to the bones on the inside of your foot. Overuse, degeneration, or injury to this tendon can lead to progressive flattening of the foot.
3. Tarsal coalition: This congenital condition occurs when two or more bones in the foot fuse abnormally, limiting movement and causing a rigid flatfoot.
4. Ligament laxity: Conditions such as Ehlers-Danlos syndrome or Marfan syndrome can result in overly flexible ligaments, making it difficult for the foot to maintain an arch.
5. Obesity: Excess body weight places additional stress on the foot’s supporting structures, accelerating arch collapse over time.
6. Arthritis: Inflammatory conditions such as rheumatoid arthritis or osteoarthritis can lead to joint damage, weakening the foot’s support system and contributing to flatfoot deformity.

Dr. Allison Boden, M.D., performs a comprehensive assessment that includes a clinical examination, functional tests, and imaging studies to develop an accurate diagnosis.

• During a clinical evaluation, Dr. Boden assesses the patient’s foot posture, flexibility, and alignment.
• A gait assessment helps identify abnormalities in walking mechanics, including excessive pronation (inward rolling of the foot) or compensatory movements in the knees and hips. 

To confirm the diagnosis and evaluate the severity of the condition, Dr. Boden may recommend imaging tests, such as:

• X-rays: Provide a detailed view of bone alignment, joint spacing, and signs of arthritis or structural abnormalities.
• Ultrasound: Used to assess soft tissue integrity, particularly the posterior tibial tendon.
• MRI: Offers a more detailed view of soft tissues, allowing for evaluation of tendon damage, inflammation, or joint involvement.
• CT: Allows for a more detailed view of the bony anatomy and possible arthritis, which may alter the surgical plan.