Flat feet: overview and treatment options

Patient

Q: I'm 17 years old, and I have had flat feet all of my life. Within the last year or so, my knees have started turning in. It's really noticeable and causes some trouble when I walk. About a month ago, my insurance suddenly changed, and they decided to cover the cost of foot arches. However, after making me some custom foot arches, the doctor told me that the only way to permanently fix my feet was with surgery (I was told that I have a bone in my foot that needs to be moved). Since then, I have tried some other things to improve my feet. I started running barefoot. In the morning, I do some ballet foot exercises to strengthen the arch. And I've been wearing my arches every day.My question is this: is it possible to correct my feet with running barefoot, arch exercises, and wearing my arches everyday? Or is this something that can only be fixed with surgery?

Doctor

A:    The most important aspect of treatment is determining the exact type or underlying cause of flat feet that you have thorough clinical examination and special imaging studies (x-rays, CT, and/or MRI). Conservative treatment is effective in the majority of flat foot cases, and consists of treatments such as orthotics, shoe recommendations, anti-inflammatory measures and special strengthening exercises. Surgery is rarely required, and is reserved only for the most severe types of flat foot that do not respond to conservative therapy. Acquired flat foot, develops over time, rather than at birth and is likely to cause pain and other symptoms including the development of arthritis in the feet. Many different factors can contribute to the development of flat feet. These include a child's sitting or sleeping positions, compensation for other abnormalities further up the leg, or more severe factors such as rupture of ligaments or tendons in the foot. A common cause for flat feet is that the foot is compensating for a tight Achilles tendon. If the Achilles tendon is tight, then it causes the foot flatten. The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction. I strongly recommend you to get an appointment with an Orthopedic Surgeon and have a comprehensive evaluation, physical exam and imaging tests to assess the functional repercussion of your “flat feet” and from there decide if you are or not candidate for surgical treatment. You mentioned that your knees have started to “turning in” so it would be important to rule out a possible problem with the Tibial bone also.

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