I’ve tried to avoid this topic for a while now. (shh! Don’t tell) There are just so many ways to write about this broad topic (flatfoot) for which I will continue to write in the future, no doubt. Children have flatfeet, athletes have flatfeet, and you probably know someone with flatfeet. For some it is painful, for others, it is not. Some have “flexible” flatfeet, some have “rigid” flatfeet.
Where do you start?
I’m not going to start with talking about children or how if you have flat foot, you may not be qualified to serve in the nations Armed Forces. I will start with the worst of the worst: The end-stage flatfoot for which ankle/foot braces and major reconstructive surgery are the only options, with prevalence for the latter. This is the worst of the worst. These are the cases where the words reconstruction and salvage procedures are a propos!
How do you get to the “end-stage” of any condition? There is a progression of the disease process. In the case of orthopedic conditions, there is a lack of aggressive enough treatment or conservative measures that leads to the end stage, or, the parts just wear out over time. In the case of flatfoot, the wear and tear on the foot and its structures progresses towards arthritis and changes in which the tendons and ligaments don’t support the bones and the bones rub away the cartilage at the joints leading to arthritis. Endstage flatfoot is an arthritic foot condition.
What is arthritis?
From the greek, arth meaning joint and –itis meaning inflammation. Arthritis is inflammation of the joint. Endstage or rigid flatfoot disorder is a wear and tear joint inflammation caused by the loss of cartilage–the hard, slick, smooth coating on the ends of bones wears away. With the lack of cartilage comes a lack of motion and an increased amount of pain. The lack of motion means this is a “rigid” flatfoot.
Which Joints are effected?
Depending on the specific mechanics of each case, different joints can be affected in varying degrees, but the image here illustrates where the arthritis sets in.
Goals of Treatment
Conservative treatment includes bracing the foot, locking up the remaining motion to prevent further inflammation and pain. At this point, the goal of surgical management is to restore the foot to be able to propulse while walking, stable while standing, and with overall less pain. There is no guarantee of eliminating pain, only a hope for a significant reduction in pain levels.
Surgery for the rigid flat foot requires fusion or arthrodesis. It entails shaving off the remaining cartilage and using screws, plates, rods, or some combination thereof, to lock the foot into an adequate position. But didn’t the pain come from lack of motion? Very astute question. Yes, the pain came from a lack of motion, but there is still some motion in the joints. This motion allows for rubbing, inflammation, and therefore pain. Fusion or arthrodesis procedures do more to reduce the motion.