Flat Foot Deformity

Flatfootedness is so common in the general population that it is typically regarded as a simple variation on normal, and this is certainly a reasonable interpretation when the “deformity” is associated with no symptoms and fails to impact on normal foot function!

There are many causes, and the management depends on the exact pattern of the deformity, its severity and its flexibility. In childhood, a pathological flatfoot present from birth usually has a neurological cause and tends to be severe and rigid. Childhood neurological disorders occasionally lead to a flat foot, but the most common cause in older children is what’s known as a tarsal coalition, when two bones of the hindfoot fail to separate normally during development, leaving a tethering band of tissue which can be fibrous, cartilage or bone.

In adults, a flatfoot is commonly caused by loss of normal function of the tibialis posterior tendon, one of the structures responsible for supporting the arch of the foot. This can be due degeneration (a bit like “wear and tear”) or inflammation. Others causes in adults include arthritis of the hindfoot or midfoot joints and trauma.

First-line management of a flexible flat foot is the use of firm arch-supporting insoles (orthotics), worn in firm-soled shoes or boots. Weight loss can be helpful, as can the treatment of general health co-morbidities such as diabetes.

An operation to address a flat foot deformity can be considered when there is disabling pain which is not adequately controlled by non-operative measures, and it can take many different forms depending on the underlying cause. With complex or severe deformity, a reconstruction may need to target bones, joints, ligaments and/or tendons.

Learn more about Tibialis Posterior Tendon Dysfunction