Flat Foot
CAUSES
Flat foot is most commonly a genetic condition passed on from generation to generation. The ankle bone (talus) rests atop the heel bone (calcaneus) and moves back and forth when putting weight on and taking weight off your foot with every step. Flat feet happen when the ankle bone falls off the shelf and unlocks the middle arch of the foot causing the arch to collapse. This condition is called talo-tarsal dislocation. This condition will ultimately lead to a weaking of the posterior tibial tendon causing the foot to further collapse because the posterior tibial tendon was meant to help hold the arch upwards and also plantar flex and invert the foot. Other causes can include trauma induced flat foot deformity from damage caused to the bones or muscles altering their function.
DIAGNOSIS
Diagnosis is made using x-rays to check the structure of the foot and the alignment of the bones as well as possible fusions. Also a physical exam is done to check for the flexibility of the arch by lifting the big toe while weight bearing and standing on your toes to see if the heel bone is movable. Occassionally an MRI is performed to check for possible fusions that most commonly form between the ages of 8-12 and cause a rigid flatfoot. We also check for conditions such as posterior tibial tendonitis that may lead to a flat foot deformity. Most commonly associated with an enlargement of the navicular bone located on the inside of the arch in the middle of the foot.
TREATMENT
Most commonly hard rigid orthotics are recommended to help support the arch but unfortunately research shows that only about 3% of the dislocation is addressed. This means that eventually those expensive inserts you purchased will be worthless in a month or a year(s) depending on the severity of the deformity.
Once conservative treatment has failed other physicians will recommend a fusion of the subtalar joint (which is the ankle bone fused to the heel bone) and possible additional fusions to control the flattening of the foot. This requires a non weight bearing status for 6-8 weeks with 3-6 months of physical therapy and 4-6 months off work if you have a job that requires you to stand. This is per foot. Also this procedure is fraught with complications and cannot be reversed if the correction was inadequate.
HYPROCURE
At mofas we recommend the hyprocure procedure on patients as young as 8 and as old as 80 which can be performed through a one centimeter incsion on an outpatient basis and allows you to bear full weight the same day. After 2 weeks you are placed back into your shoe and the other foot can then have the same surgery performed if needed. You will be able to return to work in 4-6 weeks if you have a stand-up job.
It has been my experience that 98% of patients do well with the stbailization procedure and the other 2% actually require fusions because their condition is so severe.
When considering your options remember this, you can always remove the implant and then fuse the joints if needed, but you can’t remove the fusion once it is performed.
