What is flatfoot? What are the symptoms of flatfoot?
Flatfoot (pes planus) is also known among the people as low ground. There are 26 different bones in the human foot and ankle and many joints that hold these bones together. In addition, tens of muscles, tendons and ligaments support the foot structure. When the foot of an adult person is viewed from the base, there are depressions which are located longitudinally and longitudinally called foot arches. The structure of the footbelts determines the load distribution of a person's foot and its effect on walking. The belts must be robust and flexible to accommodate stress and various surfaces. Cases with or without foot arches are defined as flatfoot. In the case of flat insoles, this feature of the foot, which distributes body weight from the three points to the ground, deteriorates and may cause problems due to biomechanical changes.
What are the symptoms of flatfoot?
The pes planus is generally not a problem in children and adults. Flatfooting, which usually does not interfere with sports or any activity, can last until children reach a certain age.
Symptoms of flatfoot:
pain
The most common symptom in the case of flatfoot is foot pain and calf pain caused by stretched muscles and ligaments. Abnormal stress in the knee and hip can cause pain in these joints
Pain;
Ankle in them
Toe belts
in calf
Knee joints
Hip joints
Belt can be felt.
Quick deformation of shoes
In particular, the inside of the shoes can be worn more quickly due to the deterioration of the pressing shape required in the flat shoe.
Quick fatigue of legs
Stiffness or numbness in feet
Swelling of the feet
Callus secondary to foot defect
Problems with walking or balance may also be encountered.
What are the reasons for flatfoot?
Congenital
Congenital anomalies due to genetic factors may lead to flatfoot. It is more likely to occur in families with flatfoot.
Vertical talus
Tarsal coalition
Diseases such as cerebral palsy, muscle dystrophy or spina bifida
Acquired
Previous foot trauma
Advanced age
Rheumatoid arthritis
Damage, dysfunction, or rupture of the posterior tibial tendon (failure of the posterior tendon of the tibialis)
Obesity and diabetes
Flatfoot in children
Flatfoot is one of the most common orthopedic problems in children; often when the foot is under load, that is to say, when the ground is not visible on the inside of the soles of the soles, the heel stands outward when viewed from the rear and the soles are completely in contact with the ground. Flatfoot is related to the tissues and bones of the legs and lower legs. This is normal in infants and young children.
All babies are seen as flatfoot when they are born. Therefore, flatfoot should not be feared at a very young age. However, after a certain age, especially if there is a family history, the probability of flexible flatfooting increases. The incidence in the community is around 20-25 percent in adults.
Flexible flatfoot, which is more common in children, usually does not cause a health problem. Parents should not be worried at the first 5 years of age, where foot development is faster, but they should consult an orthopedics and traumatologist for a firm or flexible flatfoot diagnosis.
Flatfoot treatment in infants and children
Hard flatfoot in infants and children; manifests itself at birth and leads to the formation of the image called the kayak foot. Most of the time, it is caused by the disorder of the posture of one of the ankle bones (vertical talus) and may be accompanied by other disorders. The definitive diagnosis can be made during the examination.
Although some stretching exercises and castings are applied in the newborn period; surgical treatment is usually performed at 6-12 months. Hard flatfoot may cause permanent disability if left untreated. When it is noticed that appropriate treatment should be done immediately. The sooner a hard flatfoot is recognized and the sooner it is started, the higher the chances of getting good results from the treatment. Treatments may be more complex in the flatfoot disorder beyond the initial stage. Flexible flatfoot, which is more common in the community, is often not a problem that needs to be intervened.
It is not possible to correct with flexible flatfoot treatment. If the flexible flatfoot is not too severe, it can spontaneously recover as the foot development is completed. Traditionally, treatment soles, orthopedic shoes and exercises were traditionally recommended. However, scientific research; The flexible flatness of the insoles, boots and exercises used shows no corrective effect. Insoles, orthopedic boots, exercises can only be used to prevent secondary problems such as pain and easy fatigue caused by flexible flatfoot. In addition, the severity of flexible flatfoot can vary. In severe cases, a protrusion may be seen on the inside of the foot. This area can hit shoes, calluses may be. To prevent these, insoles or orthopedic shoes can be used. When the child is diagnosed with flexible flatfoot, it is often sufficient to follow up until the age of 7-8 without any intervention.
The severity of flexible flatfoot may be higher in children with flexible flatfoot who have complaints such as pain and fatigue. In such complaints, it is necessary to use insoles. Although flexible flatfoot often does not require surgical treatment, surgery may be required in advanced patients. In addition to some soft tissue surgeries, bone surgeries can be performed in this treatment. These can be by lengthening and reshaping the bones, or in some cases by freezing the joints in the foot and shaping the foot. As a result of these treatments, daily life can be continued without pain.
What are the types of flatfoot?
Flexible (flat) insoles: This is the most common type of flatfoot. The foot belts are seen under the load, and when the ground is pressed, the floor becomes flattened. In flexible flatfoot, there is no problem with bone structure, but there is looseness in muscles and ligaments. If there is no genetic predisposition, this may resolve spontaneously after 8-10 years of age.
Rigid flatfoot: No footbelts are formed when the foot is idle or when it is stepped on the ground. It may occur as a result of impaired harmony between the foot bones and may cause permanent problems if left untreated. It is rare and may require further examination and treatment. Since there is no foot belt, when the floor is pressed, the ankle and heel are bent outward and the foot is bent inward.
Flatfoot caused by short Achilles tendon: Occurs when the Achilles tendon that connects the heel bone to the calf muscle is short. This causes heel to rise early and pain when walking or running.
Flatfoot caused by posterior tibial tendon dysfunction: It occurs when the tendon connecting the calf muscle to the inside of the ankle is injured or deformed. If the footbelt does not get the support it needs, flatfoot and pain may occur.
What is a flatfoot test?
If you suspect that you or your child is a flatfoot, you can do a simple 3-step test at home.
1 - Wet your feet.
2- Press your foot on a paper or concrete floor where your footprint will form.
3- When you lift your foot, if the footprint of your soles is completely on the floor or on paper, you may suspect flatfoot.
Since the development of foot arch in children takes time; children are held at their fingertips to look at the foot belt.
How is flatfoot diagnosed?
In flatfoot diagnosis, doctor examination is the first step. In the doctor's examination;
The patient examines diseases or traumas that may cause flatfoot.
Flatfoot shoes control the patient's shoes as they can cause abnormal wear.
Observes the feet and legs with simple movements such as lifting their toes.
It tests the strength of muscles and tendons, including other tendons in the feet and legs, such as the Achilles tendon or posterior tibial tendon.
An orthopedic and traumatologist can diagnose by examining the patient's feet and gait. However, imaging methods may also be used to support the examination.
Imaging methods
X-ray: Images of the bones and joints of the feet can be obtained with X-ray. It is especially useful in arthritis detection.
Computed Tomography (CT): Computed tomography can be used for further evaluation of bone structures.
Ultrasound: Used for detailed imaging of soft tissues in the body in case of tendon injury.
Magnetic Resonance (MR): More detailed images are obtained for both hard and soft tissues.
Flatfoot treatment
Treatment in flatfoot depends on the severity and cause of the problem. If flatfoot does not cause pain or other difficulties, treatment is usually not needed.
The foot arch supports (orthosis devices) may be useful to alleviate pain due to flatfoot. Specially designed supports that support footfolds can also be preferred. Devices that support the footbelt do not cure flatfoot, but only reduce complaints.
Stretching exercises. Especially in flatfoot due to short Achilles tendon, this tendon is useful for relaxing exercises.
Physical therapy may also occasionally be beneficial for flatfoot pain.
Rest and ice treatment are beneficial for pain. In particular, activities that increase complaints should be avoided. Instead of heavy sports, walking, cycling or swimming may be preferred.
Painkillers recommended by the doctor can be used for the pain.
Risk factors such as diabetes, high blood pressure and obesity that may make flatfoot worse, should be controlled.
Surgical treatment in flatfoot
In flatfoot; If the physician deems it necessary, one or more of the methods can be used together and the condition can be surgically corrected.
If the purl bone of the foot is different from the birth (vertical talus), it can be corrected surgically.
Some bones do not develop properly in childhood, which may cause flatfoot to continue from birth to adulthood. In these rare cases, surgical intervention is required to separate the fused bones (tarsal coalition).
Bone protrusions due to flatfoot can be treated surgically.
The foot can be shaped by cutting the bones (osteotomy / colon extension, calcaneal shift) and / or by freezing the joints (arthrodesis).
Swollen and diseased sheaths of tendons can be surgically removed. (Synovectomy)
A tendon in the body can be separated from the bone to which it adheres and fixed to another place, contributing to the proper shape of the foot. (tendon transfer)
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