Flat Feet

What is it?

When the inner aspect or 'arch' of the foot is absent we call this a flat foot.

What causes it?

Flat feet are common and normal in young children and the arch of the foot develops between ages 3 and 10. Sometimes the flat foot continues in to adulthood, and is often considered normal.

Very rarely a congenital problem (something you are born with), results in two bones being fused together from birth. This produces a very stiff and flat foot in childhood.

A more common cause of flat feet in children and adults is loose ligaments, which causes the foot to roll inwards. When one stands on tip toes, the arch usually returns and this is a good sign indicating that the foot is probably normal. It tends to run in families.

Some patients who have loose joints and others that present in adulthood with a painful flatfoot, often have a ruptured or dysfunctional tibialis posterior tendon. This tendon is the main supporting structure for the arch and tends to stretch out over a period of time when the foot is flat. If the foot suddenly becomes flat, this is often related to an injury to this tendon.

What are the symptoms?

Most people have no problems. Some people with flat feet get aching in the arch, around the ankle or down the outer side of the foot. Walking long distances becomes difficult.

How is the diagnosis made?

If your foot is flat and painful, you should seek the help of an Orthopaedic Foot and Ankle surgeon. The diagnosis is based on a full clinical assessment, including watching you walk and stand up on tip toes. Plain X-rays are organised to assess the degree of flattening, and to rule out arthritis. Further tests such as an MRI scan are often organised to assess the tibialis posterior tendon

What is the initial treatment?

This involves seeing an orthotist who will make you an insole, and physiotherapy to strengthen and stretch the muscles supporting the foot.

If initial treatment doesn't work, what's next?

Surgery is indicated if the above measures fail, and will depend on the degree of your flat foot problem and if you have arthritis. Generally we prefer to perform an operation that preserves movement, and this is possible if you have a flexible foot without wear and tear. The most common procedure we undertake, involves cutting the heel bone and sliding it inwards, and transferring a tendon to undertake the work that the tibialis posterior tendon is now unable to do. You are required to be in a plaster cast for 6 weeks, non-weight bearing and then begin rehabilitation in an aircast boot thereafter. It takes 9-12 months to fully recover. If you have arthritis we generally perform a fusion procedure, putting the foot in a better position permanently.

Our practice covers the following hospitals:

Parkside Hospital
For appointments phone : 0208 971 8026

St Anthony's Hospital
For appointments phone : 0208 335 4678

Ashtead Hospital
For appointments phone : 01372 221441

New Victoria Hospital
For appointments phone : 0208 9499000

Clock House Hospital
For appointments phone : 01372 840837