Suspect Flatfoot? How You Can Keep It From Getting Worse

Condition occurs 3 times more often in women than men
Suspect Flatfoot? How You Can Keep It From Getting Worse

Does it seem as though your feet have become flatter as you’ve gotten older? You may have dismissed concerns about any problems because you’re not feeling any pain.

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Or perhaps your feet seem flatter and you’re feeling foot pain in the heel or arch area, too. The pain may get worse with activity or you might have swelling along the inside of your ankle.

In either case, if the arches on the inside of your feet are flat and the entire bottom of your feet has contact with the floor when you stand up, it’s likely that you have flatfoot.

If this is a recent development and the pain is new to you, it may be time to talk to your doctor. Adult-acquired flatfoot can be arrested so that it doesn’t keep you from your time at the gym or halt that daily walk.

What causes flatfoot

Flatfoot often starts with a dysfunction of the ankle tendon called the posterior tibial tendon, says podiatric physician and surgeon Georgeanne Botek, DPM. The tendon attaches to the bones on the inside of your foot; its purpose is to maintain your foot arch and provide strength when your foot pushes off the ground as you walk.

Factors that can increase your risk of developing flat feet include high blood pressure, obesity, diabetes, previous ankle surgery or trauma, rheumatoid arthritis and exposure to steroids. Adults age 40 years and older who are sedentary and overweight also are at higher risk of developing flatfoot.

An injury such as a bone fracture or dislocation, a torn or stretched tendon, or arthritis can cause the tendon to function improperly, too. But more often, flatfoot develops gradually over time with increased age and weight, Dr. Botek says.

“When that happens, you tend to lose your arch, or become more flatfooted,” Dr. Botek says. “This problem occurs about three times more often in women than in men, especially after the age of 40.”

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Initially, you might feel pain on the inside of the ankle and/or swelling and you might begin to limp, Dr. Botek says. Without treatment, the pain on the inside of the ankle worsens. Eventually, you might begin to feel pain on the outside of the ankle, too.

Get help soon

If you suspect you’re developing a painful flatfoot, you should seek medical attention earlier rather than later, Dr. Botek says.

“It is much easier to treat early and avoid a collapsed arch than it is to repair one,” she says.

When the pain first happens and there is no significant flatfoot deformity, initial treatments include rest, anti-inflammatory medicine, foot strappings, foot inserts, and, depending on the severity, a special boot or brace.

A cast boot will stop your ankle from going up and down and allow the tendon to rest. You can take off the boot, which you will wear from four to six weeks to help resolve symptoms.

If the boot helps, your physician can prescribe shoe inserts, or foot orthotics, to take the strain off the tendon and help you maintain an arch in your everyday shoes.

If the boot is ineffective, you can have a custom-made brace made for long-time daily use. The brace will conform to your foot and ankle and it fits inside your shoe to provide continuous arch support.

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Surgical treatments

For chronic flatfoot pain that limits your activity, surgery may be the best option, Dr. Botek says.

There are a few surgical options depending on the deformity, as well as a person’s physical condition, age and lifestyle.

Surgery involves repair of the tendon by transferring a nearby tendon to help re-establish the arch and straighten out the foot. Often an osteotomy — cutting the bone and fixating with a screw— of the hindfoot is needed to realign the foot.

In severe cases, fusions of joints in the foot are performed to provide better stability and improved alignment. After surgery, you wear a cast and must avoid walking on your foot. After the surgery,  eight weeks to 12 weeks of physical therapy will help you get back on your feet and walking normally.

“Surgery can be an effective treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early,” Dr. Botek says. “That’s why it is so important to seek medical evaluation right away if you are feeling ankle pain.”

You also can take steps to avoid becoming flatfooted by lessening your risk factors, Dr. Botek says. This means keeping your blood pressure, weight and diabetes in check.

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