In my office, a flat foot is never a diagnosis but a symptom of a problem.
There are many causes of flat feet. The causes can be due to a tight calf muscle, loose ligaments, angular deformities of joints, low muscle tone, neurologic or congenital. This is why a very in depth history is important. In my office you might be surprised when I ask questions such as:
1. When did this problem start?
2. Was your child carried full term?
3. How long was labor?
4. Was it a regular or c-section delivery?
5. Was there any complications during birth?
6. When did your baby start crawling?
7. When did your baby start walking?
I will then discuss issues such a speech, coordination and socialization. All of these questions and their answers help me understand the underlying cause of the flatfoot. Next a thorough musculoskelatal exam is performed. Things such as range of motion, strength, abnormalities of the foot, and gait observation is performed. A neurologic exam is then completed. Weight bearing x-rays might be taken and measurements on the x-rays performed to see where the breakdown in the foot is located. Congenital problems are usually revealed at this time.
Treatments vary greatly for flat foot.
Treatment depends on the cause of the problem, whether there is pain, age of the child, activity level, weight, and many other issues. Treatments vary from physical therapy, custom made foot orthotics, braces, stretching, strengthening, and in very serious cases surgical intervention
This foot shows why flat foot is not the main problem. When your child is standing, look at them from behind. If you see what looks like the above picture, there might be a problem This is a right foot and notice how it collapses to the left where the black arrows are located. The bulge is not just a “fallen arch” but a bone coming out of place. This bone is called the talus. If you now look at the blue and green arrows you will notice the the heel at the green arrow is lifting off of the ground and then rolling on to the blue arrow. Next if you look at the longer red arrow you will notice how the foot looks indented. That is because the bones are pushing toward the black arrows. This particular area is the calcaneal-cuboid joint. Lastly, the small red arrow shows the front part of the foot near the pinky toe lifting up. Each of these arrows represents abnormal forces going through the foot giving the simple appearance of a flat foot.
Now, lets take a look at what an x-ray of the above foot would look like. On the x-ray shown you will see a bone labeled ” TALUS”. It is highlighted in two different shades of blue. The light blue shows the bone forming a joint with the NAVICULAR. The dark blue outline of the talus is the part of the bone coming out of the joint. This corresponds to the bulge on the left hand side of the above pictures where the black arrows are located. This is called a subluxation and is not a “simple flatfoot”. You see the TALUS should be going in the direction of the long green arrow but instead it is going in the direction of the short red arrow.
Lets take a look on the right hand side of the x-ray. Notice the CUBOID bone is going in the direction of the short red arrow instead of the long green arrow. The cuboid forms a joint with the CALCANEOUS (heel bone). When the cuboid goes out of alignment with the calcaneous you get the indentation in the foot that can be seen in the above photograph corresponding to the larger open red arrow.
In summary a flat foot is just a symptom, not a diagnosis. Are the joints coming out of place? Are the ligaments too soft to hold the joints in place? Is there any muscle imbalance causing these abnormalities. If you are unsure about the structure of your child’s foot, please don’t hesitate to make an appointment.