Flexible Flatfoot Deformities: Overview

Flexible Flatfoot Deformities: Overview

This video will provide an overview of flexible flatfoot deformities. While this condition commonly occurs with children, this overview will focus on the condition in adults. It is important to recognize that flatfoot deformities occur on a spectrum. They can progress with time and cause pain and loss of function.

Other names to describe the condition may be used, such as progressive collapsing foot deformity or posterior tibial tendon dysfunction. Flexible flatfoot deformities are an earlier stage of the spectrum. Flat feet can be described as loss of the medial or inside arch of the foot while standing. A health care provider will perform various exams to determine if the foot can be placed into a normal position. If so, the deformity will be defined as flexible. This is important to distinguish from a deformity that is rigid, or will not move, as the treatment options may be different.

Flatfoot deformities are common. Studies have shown the condition present in approximately a quarter of the population. Flatfoot deformity is more common in women over 40 and those with diabetes and obesity. Patients with loss of sensation in the feet and arthritis are also at higher risk for this to develop. Additionally, those with soft tissue laxity or looseness are at higher risk for this condition.

While some people can be born with flat feet, it can also occur over time and is most commonly the result of repetitive microtears to the posterior tibial tendon. This tendon arises from a muscle in the calf and passes by the medial or inside ankle, where it finally attaches to the arch of the foot. This tendon helps support the arch, and when damaged, over time, support will be lost. While this tendon is most likely to contribute to this problem, there are other soft tissue structures that can lead to the progressive changes seen.

In the first stage of flatfoot deformity, patients may present with pain and swelling on the inside of the foot and ankle. In this stage, the posterior tibial tendon is swollen and inflamed and is the most common source of pain. Visible deformity of the foot may not be present.

In the second stage of the flatfoot deformity, deformity will be visible. Patients may notice that their heel seems to be collapsing towards the inside of their ankle, and the front of the foot may be deviating outwards. Symptoms of pain at this stage are likely to remain isolated to the inside of the ankle.

A thorough history of the patient's medical conditions will be completed to determine if they are at risk for this condition. A health care provider will examine a patient standing and sitting. A flexible flatfoot will have an arch present while sitting, but upon standing, the arch will disappear. When testing for this condition, a provider will assess if a patient is able to raise their heel while standing on 1 leg, which helps determine the condition of the involved soft tissues.

A provider will look closely at the foot to see if collapse of the heel and turning outward of the front of the foot is present. X-rays will be ordered to assess the alignment of the bones in the feet to accurately stage the condition. A CT scan may be ordered ahead of any surgery to look closely at the bones. MRI or ultrasound may also be ordered to assess for inflammation around the soft tissues.

Following a careful history, examination, and review of imaging, a health care provider will determine the best treatment options for the patient.