The flat foot is produced by the loss of the plantar arch. The bones that form the back of the foot (hindfoot) are: talus, calcaneus and scaphoid; flatfoot occurs when there is a deformity of these bones or an alteration in the joints that bind these bones together. In the maintenance of the plantar vault bones, ligaments that hold the bones together and certain tendons thanks to the tension they generate.
It is due to the alteration of any of the components involved in the maintenance of the vault:
Alterations of the bones and defects of the articulations: That they can be congenital deformities (that is to say that they appear from the birth), fractures, necrosis or infections of the bones.
Alterations of the ligaments: Children’s laxity since children have a greater flexibility of their tissues naturally than until 3 years of age can cause a flat foot. Some diseases (rheumatic and collagen diseases) can damage the ligaments, reducing the tension they are able to withstand.
Muscle disorders: neurological and muscular diseases
In most cases the flat foot does not produce special symptoms in young people, since in young people the foot is flexible and is able to adapt to the demands without causing pain. The pain arises when the foot is rigid and therefore is not able to adapt to the needs of walking. The latter usually occurs when the origin of the flat foot is a neurological or muscular disease that fixes the deformity, when there is a fusion of the bones from birth and when over time there is osteoarthritis due to the bad articulation of one bone with another . In cases of rigid flat foot the pain becomes more intense when walking. The altered distribution of the loads can facilitate the appearance of tendinitis, especially that of the tibialis posterior tendon.
The treatment will depend on the pain, in the cases of flexible and not painful footing as it happens in the majority of people, it will not require any type of treatment. The only exception to this rule are the important congenital deformities that are known to evolve safely to a painful foot: such as vertical flat talus or abnormal bone fusions, but these are relatively rare.
As a general rule, with few exceptions, only flat feet that produce painful symptoms should be treated. In principle you can use templates of discharge, if these are not enough to allow a normal and painless gait, it will require a surgical intervention that consists basically of the restoration of foot shape with or without fusion (arthrodesis) of the altered joints . Generally in the deformities developed with intractable pain that have produced osteoarthritis of the joints of the foot, these should be fused (arthrodesis) to avoid pain although in many cases a perfect shape is not achieved with a normal plantar vault.
One last consideration about the use of templates, is that its purpose is not to restore a normal foot shape, but to avoid pain. In many occasions the specialist prescribes them to children with flat feet rather than to avoid an evolution on flat foot of the adult (since this is shown to be useless for this purpose) to avoid the anxiety of some parents who think that nothing is being done to treat your child’s deformity. In all cases it is advisable to avoid obesity and the use of comfortable footwear.