Flat Feet: Causes, Classification, and Impact

What is Flat Foot?

Flat foot, medically known as pes planus, refers to a condition where the entire sole of the foot makes complete contact with the ground while standing. This occurs due to a loss of the medial longitudinal arch, a crucial structure in the foot that provides support, absorbs weight-bearing forces, and stores energy during movement.

Causes of Flat Feet

Flat feet often develop in childhood, as the arches may not fully form. However, other contributing factors include –

• Injuries: Trauma to the foot can lead to a collapse of the arch.
• Aging: Wear and tear over time can weaken the foot’s supportive structures.
• Underlying Conditions: Obesity, tight calf muscles, or ligament laxity may increase the risk of developing flat feet.

Anatomy of the Medial Longitudinal Arch

The medial longitudinal arch consists of several bones, including the calcaneus, navicular, talus, cuneiforms, and the first three metatarsals. It is supported by –

• Soft Tissues: Plantar calcaneonavicular ligament (spring ligament), deltoid ligament, and plantar aponeurosis.
• Muscles: Posterior tibial tendon and flexor hallucis longus and brevis.

These structures work together to stabilize the arch and enable efficient foot function during walking or running.

Pathophysiology of Flat Feet

When the supporting structures of the arch are compromised, the medial longitudinal arch collapses. Factors contributing to this include:

• Excessive tension in the triceps surae (calf muscles)
• Posterior tibial tendon dysfunction
• Ligament laxity in the spring ligament or plantar fascia
• Tight Achilles tendon or calf muscle

Classification of Flat Feet

Flat feet can be classified based on two primary factors:

1. Arch Height

• The ratio of navicular height to foot length helps determine the structure of the arch. Children’s foot arches typically develop with age, with flatness reducing over time.

2. Heel Eversion Angle

• The heel’s eversion angle indicates foot posture. A resting calcaneal stance position can guide clinicians in assessing this posture. By age seven, the optimal vertical heel position is often achieved.

Types of Flat Feet

Flat feet are also categorized as rigid or flexible:

• Flexible Flat Foot: The arch is visible when the foot is not bearing weight but disappears under full weight-bearing conditions.
• Rigid Flat Foot: The arch is absent regardless of weight-bearing.

Symptoms of Flat Feet

Flat feet may be asymptomatic, but in some cases, they can alter the biomechanics of the lower body, leading to discomfort or injury.

In Children:

• Generally asymptomatic, but some may experience pain in the arch or night cramps during adolescence.

In Adults:

• Frequent ankle sprains or “rolling” of the ankle.
• Pain in the midfoot, heel, lower leg, knee, hip, or back due to strained muscles and tissues.
• Altered gait patterns in advanced cases.

Conclusion

Flat feet, while common, can range from being asymptomatic to causing significant discomfort and biomechanical issues. Understanding the causes, classification, and symptoms of pes planus can help in early diagnosis and effective management, ensuring better mobility and quality of life.

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