Pain Relief for Flat Feet

Adult Acquired Flatfoot Deformity

One in four adults in the U.S. has adult acquired flatfoot deformity, otherwise known as flat feet or fallen arches, which may occur as a congenital condition or be acquired with age. The foot may be flat all the time or may lose its arch when the person stands. Patients with this condition may experience:

  • Heel or ankle pain
  • Tired feet
  • Bunions
  • Arthritis
  • Foot or ankle deformities
  • Knee or back pain

Some patients may not experience any symptoms from adult acquired flatfoot deformity. However, flatfoot tends to worsen over time, especially in patients with a tight Achilles tendon or who are obese. Athletes are also at a higher risk of developing flatfoot.

Treatment for flatfoot often begins with conservative measures such as changing shoes, wearing orthotic devices and taking anti-inflammatory medication to relieve pain. Applying ice to the foot and performing physical therapy exercises are also usually helpful for patients. In severe cases, or those that do not respond to conservative treatments, surgery may be needed to relieve symptoms and correct the problem. Surgery for flatfoot may involve removing or reshaping a bone or bone spur, or fusing one or more of the bones in the foot together.

Accessory Navicular

Some patients are born with an extra bone, known as an accessory navicular bone, located on the inside of the foot just above the arch. In many cases, this extra bone causes no problem and requires no treatment, but in some patients it may enlarge, causing pain, particularly during or after walking or athletic activity. Patients affected in this way are said to have accessory navicular bone syndrome. They present with a red, swollen protrusion in the middle of the foot that may cause them to limp. Patients with accessory navicular bone syndrome may also develop plantar fasciitis, bunions or heel spurs.

There are several treatment options for accessory navicular bone syndrome, which include:

  • Immobilization with a cast or walking boot
  • Applications of ice packs
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Injected steroids
  • Physical therapy
  • Orthotics

The Kidner procedure is the most common surgical treatment for accessory navicular bone syndrome. This procedure involves detaching the bone from the posterior tibial tendon and then removing it entirely from the foot. The tibial tendon is then reattached and the incision is closed with stitches. Patients will likely wear a light cast and use crutches after surgery. They will require some physical rehabilitation focused on stretching the affected tendon and should be able to resume normal physical activity after about 6 weeks.

Tarsal Coalition

A tarsal coalition occurs when two or more bones at the back of the foot or in the heel become improperly connected. The union of these tarsal bones can produce a pronounced form of flatfoot. Tarsal coalition typically occurs during gestation, but most children are asymptomatic. It is usually during adolescence that the affected foot begins to become painful, rigid and stiff, making common activities uncomfortable.

Treatment will generally begin with the use of customized orthotics, resting the foot, wearing a cast or boot, corticosteroid injections and a regimen of physical therapy. However, if the patient continues to experience symptoms, surgery may be necessary. The procedure chosen will depend on the severity and location of the tarsal coalition. In some cases, a resection is performed to remove the tarsal coalition and fill the area with tissue taken from another part of the patient’s body. For more extensive tarsal coalitions, a fusion may be performed to close the joint and reposition the affected bones properly.

Flat Feet in Children

Most children are born with flat feet and develop arches as their bodies grow. However, in some children, the arch never develops, leaving the child with inward-turning ankles. While this condition is not usually serious, parents should seek medical attention for flatfoot, as it may cause pain. Some children also experience flexible flatfoot, a condition in which the arch disappears while standing, and then reappears when the child sits or is on tiptoes.

Flatfoot can be diagnosed by obtaining a family history, as well as examining the feet and the child’s everyday shoes for signs of abnormal wear. This condition should be monitored on a regular basis, and most cases will gradually improve by the time the child is five years old. If the condition persists and begins to cause pain, arch supports, physical therapy or casting may be recommended to relieve pain and correct the flatfoot.

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Robert Spencer, DPM

Nitza Rodriguez, DPM

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