Growing with Flat Feet: Childhood to Adulthood

Replace ignorance with aggression for treatment of adult flat foot! Replace aggression with reassurance for treatment of paediatric flat foot!

Every adult flat foot is not due to tibialis posterior insufficiency!

Insufficiency of tibialis posterior (TP) is the most common cause of flat feet in adults!

To reach at a correct diagnosis, the examiner needs to have answers for the following questions:

Question 1: Is there a flat foot?

Answer: History, clinical examination, and radiology would help in answering this question.

Question 2: What is the cause of flat feet?

Answer: Six basic sets of causes are found for adult flat feet.

1. Adult flexible flat foot

Fig. 11.1 Clinical and standing X-ray picture of a patient with adult acquired flat foot.

Fig. 11.2 X-ray picture of calcaneonavicular coalition.

4. Posttraumatic, arthritic, or iatrogenic flat foot (Fig. 11.3)

Fig. 11.3 Clinical and X-ray picture of flat foot due to arthritis of midfoot.

5. Charcot flat foot (Fig. 11.4)

Fig. 11.4: Clinical picture and X-ray of flat foot due to midfoot Charcot.

Table 11.1 Cause-specific diagnostic features of flat foot

S. No.	Specific-cause of flat foot	Cause-specific diagnostic features
1	TP tendon dysfunction	• Tender TP • Flat arch • Forefoot deformity • Hindfoot deformity • Too many toes sign +ve • Single heel raise test +ve • Radiological signs
2	Non-PTTD flat feet	• Postural complaints • Arch pain • Heel pain • Symptomatic weight bearing • TP intact • Foot flexible • Angle changes in radiology
3	Arthritic, posttraumatic, and iatrogenic flat foot	• History of trauma or • prior surgery • RA or seronegative arthritides • Joint pain along with effusion • Radiology shows implant, arthrosis, malalignment
4	Tarsal coalition	• Adolescent age • Symptoms ± • Reduced motion of hindfoot • Peroneal spasm • Rigid flat foot • Radiology • CT Scan
5	Charcot foot	• History of swelling and deformity • Neuropathy • Radiology shows joint destruction, osteolysis, fractures, and vascular calcifications
6	Adult neuromuscular flat foot	• History of trauma, or prior surgery • Pain on ambulation • Gait abnormalities • Neuromuscular dysfunction • Radiology shows anomalies and malalignment