The shape of the foot varies remarkably amongst individuals and a different shape does not automatically lead to problems. Flat feet can become problematic and various pathologies can lead to it. Most commonly the degeneration of a tendon running along the inside of the ankle and hindfoot called tibialis posterior tendon is responsible for the development of the flat foot deformity. A tarsal coalition, arthritis of hindfoot joints, trauma and congenital deformities might also be responsible for the development of a flat foot deformity. As the deformity progresses the inability to push off with the foot can be compromised needing treatment. An asymptomatic flat foot on the other hand normally does not need any special attention except for good footwear.
In case a flat foot becomes painful, a thorough clinical examination with good imaging will reveal the reason for the deformity. In case of the “typical” flat foot deformity caused by the degeneration of the tibialis posterior tendon, a combination of soft tissue and bony procedures will achieve a normal alignment of the foot with good muscle function. Recovery will take time and physiotherapy is very helpful to regain good function of the foot again. When joints are very arthritic fusing some of the joints will be the better choice but this will eventually also achieve a similar result. In younger patients, less invasive surgery can help. This entails releasing an often very tight calf muscle, inserting a “spacer” between two bones and having intensive physiotherapy afterwards. At the end, surgery will achieve a good alignment and pain-free gait again.