Orthotics for Flat Feet

What are flat feet, and should they be treated?

Flat feet (otherwise known as pes planus) are feet that lack the usual arch which serves to absorb shock as we walk or run. There are varying degrees of flat feet. Some are very flat, where the entire sole of the foot is in contact with the ground while others are just flatter than normal. Some flat feet are rigid, while others have an arch when non-weight bearing, but become flat when the person stands. Furthermore, some cases of flat feet are associated with a congenital pathology while others relate to an acquired injury which has developed over a long period.

The appropriate treatment for flat feet depends on numerous factors, such as the cause, symptoms produced and likelihood of further injury. It is quite normal for young children to have flat feet. Usually the arch develops through childhood. The arch may be slow to develop but unless the individual is in pain or is restricted from usual activities, there is often no need to treat these feet. On the other hand, some individuals are unable to stand for long periods or walk for long distances because of the pain due to flat feet. In this case, a suitably prescribed orthotic can relieve their pain quickly. The staff of Hills District Podiatry are highly trained at assessing flat feet and in most cases can relieve symptoms quickly.

As mentioned above, there are various possible causes of flat feet, and this should be determined before an orthotic is considered. The factors which may contribute to a flat foot include: tight calf muscles (gastrocnemius and or soleus), ligamentous laxity (loose or very stretchy ligaments), Tibialis Posterior Dysfunction (the failure of the main tendon used to raise the arch), and a medially deviated subtalar joint axis (a variation from the most usual axis location, around which the joint in our foot primarily responsible for raising the arch, operates).

Before action is taken it should also be determined if the flat feet are actually symptomatic (causing pain or dysfunction) or are likely to become injured in the future.

If it has been determined that treatment is required, the most appropriate treatment for that individual needs to be considered. In some cases the most appropriate course of action might be to stretch the calf muscles before any other action is taken. In many cases of symptomatic flat feet however, a customised foot orthotic will be the most effective treatment. In all customised foot orthotic prescriptions, the location of the subtalar joint axis should be carefully assessed. This is critical to producing an orthotic that is not only effective at reducing excessive tissue loads, but will also be comfortable. In our experience, the number one cause of an uncomfortable orthotic, is a failure to determine the location of the subtalar joint axis. This can result in the fitting of an orthotic that provides resistance to foot movement on the wrong side of, or directly under that axis location. In simple terms, supplying an orthotic that does not work with the foot it was designed for. After all, our feet are as individual as our faces. Just as our genetics determine our hair and eye colour, so do they determine the structure and biomechanics of our feet.

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