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Flat foot deformity

The shape of the foot varies significantly between individuals, and having “flat feet” does not automatically mean there is a problem. Many people with flat feet remain completely asymptomatic and function normally without any issues.

A flat foot becomes clinically relevant when it is associated with pain, dysfunction, or progressive structural change. This can occur for several reasons, most commonly due to degeneration of the tibialis posterior tendon, which runs along the inside of the ankle and helps support the arch of the foot. When this tendon becomes weak or damaged, the arch can gradually collapse.

Other causes of flat foot deformity include:

  • Tarsal coalition (abnormal connection between foot bones)
  • Arthritis of the hindfoot joints
  • Previous trauma or injury
  • Congenital (present from birth) foot structure differences

As the deformity progresses, the foot may become less efficient, particularly during push-off when walking or running, leading to pain and reduced function.

Treatment for Flat foot deformity

Treatment depends on the severity of the deformity, symptoms, and underlying cause.

Assessment and Diagnosis

When a flat foot becomes painful, a detailed clinical assessment is essential. This is usually combined with imaging to understand the structure and identify the underlying cause of the deformity.

Conservative and Surgical Treatment

For early or flexible deformities, treatment may include:

  • Physiotherapy to improve strength and control of the foot and ankle
  • Footwear modification and orthotics to support the arch
  • Activity modification to reduce overload

In cases where the deformity is due to tibialis posterior tendon dysfunction, or where symptoms are persistent, surgical correction may be required. This often involves a combination of procedures to restore alignment and function of the foot.

In more advanced or arthritic cases, where joint surfaces are significantly affected, joint fusion surgery may be recommended to achieve a stable, pain-free foot.

In younger patients with flexible deformities, less invasive options may include:

  • Calf muscle lengthening if tightness is contributing to the deformity
  • Insertion of a “spacer” or implant between foot bones to restore alignment
  • Structured post-operative physiotherapy and rehabilitation

Recovery and Outcome

Recovery depends on the procedure performed but typically involves a period of rehabilitation to restore strength, mobility, and gait pattern. Physiotherapy is an essential part of the recovery process.

With appropriate treatment, most patients achieve improved foot alignment, reduced pain, and a more efficient, comfortable walking pattern.

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