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Flatfoot

What is that?

Flat feet are acquired or congenital deformities of the foot. 

In the case of congenital deformity, individual foot bones are positioned incorrectly and touch each other in the wrong place. This causes the back of the foot to sink and the natural arch of the foot disappears. The foot lies flat on the ground like a pancake. 

In the case of acquired misalignment, there is usually an insufficiency of the tibialis posterior muscle. This muscle "pulls" the back bones of the foot upwards by attaching to their underside and originating at the back of our shinbone. If the muscle strength decreases, the back bones of the foot become misaligned and sink. 

How does this manifest itself?

The foot gets into what is known as a pronation position. This means that the foot tilts increasingly inwards, while other muscles try to correct the misalignment by pulling outwards. The misalignment can be seen when you look at the foot from behind and see the toes sticking out to the side. The heels stick inwards and the feet are tilted inwards. In this case, the change in weight distribution leads to pain on the outer ankle. The longer this condition persists, the higher the risk of arthrosis in the individual ankle joints, and the pain is then constantly present. 

Where does it come from?

In congenital flat feet, two bones in the foot are not at the right angle to each other, which causes the longitudinal arch to sink. This can be caused by poor posture in the womb, for example. Congenital genetic defects can also cause malformations or result in muscles and tendons not developing completely. 

The cause of an acquired flat foot is usually a muscular insufficiency of the tibialis posterior. Insufficiency is a weakness of the muscle. The muscle is no longer able to generate the strength it needs to give the foot the stability it needs. Such weakness is often observed in old age, as the muscles then deteriorate more and there is often a lack of sufficient movement. 

In younger patients, flat feet often develop during the growth phase of puberty and are then painful. Muscular improper loading occurs and other muscles are more stressed than the tibialis posterior. Due to the lack of loading, it breaks down over time and flat feet develop. 

Flat feet in adulthood are usually painless, but lead to an abnormal gait, which in turn can have consequences for the adjacent joints.

What happens if I don’t act here?

Painful flat feet should always be treated, as otherwise damage to the muscles, particularly the tibialis posterior, or arthrosis can occur. The first priority is to provide supportive insoles.  

How do I find out if I have something like this?

A clinical examination is important for diagnosing flat feet. This examines what type of limitation is present and how advanced it is. The type of limitation, i.e. whether the deformity is fixed and flexible, can provide clues as to whether there is a muscular maldevelopment or an underlying neurological disease. An X-ray is also often taken in order to better assess the progression of the deformity and to better adapt the therapy to the patient. 

How do you treat this?

Congenital flat feet are often treated immediately after birth. Plaster casts and other orthoses are used to allow the foot to grow into an optimal position. Surgery is also recommended, as the position of various tendons and ligaments often needs to be corrected.

If you have acquired flat feet, the first priority is to provide supportive insoles. Although they are very thin, kokochii® insoles stabilize the feet optimally. They cushion painful areas and also support the transverse arch of the foot. The advantage is that they fit in almost any shoe. Conventional supportive insoles are usually quite bulky and therefore cannot be worn in every shoe. The durability of a conventional insole is also not as high as that of kokochii®.