Flat feet, commonly known as “flat feet”, are something we have all heard of, and many of us even have them ourselves. Some of you may have had it since you were a child, while others have had it slowly as adults. Some people may not feel anything for the rest of their lives, called asymptomatic, while others may have discomfort, called symptomatic, and a few more serious cases may be painful when walking a little, seriously affecting daily life.
What is flat feet all about?
Let’s start with the so-called normal “arch”. The earliest apes came down from the trees and first walked on all fours, and the difference between the original hands and feet (or “front hooves” and “back hooves”) was not very obvious. The feet lost the function of grasping and gripping, and were responsible for stable weight-bearing, and the feet gradually took on all the weight of the body, and the main change in the process was the formation of the arch. Comparing with the present chimpanzees and other apes, we can find that the human arch is the most well developed, with both a longitudinal arch from the toes to the heel and a transverse arch from the inside to the outside. So where are the benefits of the arch? With the arch, the first is the increase of weight-bearing capacity, the foot from the original flat piece into a flexible structure, can disperse the pressure during walking and running. For example, the famous Zhaozhou Bridge is due to its arch-shaped structure to disperse the pressure on it, so that it will not collapse for a thousand years; secondly, the space within the arch can be used to accommodate blood vessels, nerves, muscles and tendons, forming an effective protection for them, so that the foot can get sufficient blood and nutrition to withstand the needs of long-distance walking.
The foot arch is so important, how exactly is it composed?
The human body is a very complex and delicate structure that undergoes a series of changes step by step from the time it is born to its old age. To put it simply, the formation of the arch includes the bones and the ligaments connecting the bones, which are static structures, like the Roman arches; there are also muscles and tendons pulling on them for dynamic adjustment, the most important of which is the posterior tibial muscle, and many adults’ flat feet are caused by the failure of this tendon. Problems with any of these static or dynamic structures can lead to the collapse of the arch, bringing discomfort and clinical symptoms. Common causes of problems with static structures include fractures, osteonecrosis, midfoot arthritis, rheumatoid arthritis, neuroarthritis, diabetic foot, tarsal fusion, spring ligament laxity, etc. Possible causes of flat feet in dynamic structures include posterior tibial muscle dysfunction, paraspinatus, peroneal muscle spasm, and Achilles tendon contracture.
How do we know if we have flat feet?
Generally speaking, when a person is standing, under normal circumstances the medial plantar skin should have a distance of three to four centimeters from the ground, while in people with flat feet this distance will be very small, or even the plantar skin is all attached to the ground, which indicates that the medial longitudinal arch has collapsed. If you look at the heel from behind, you can find that the heel is turned outward more, and you can also see the fourth and fifth, or even the third toe (normally you should only see the fifth toe, the other toes are blocked by the lower leg). These are simple ways to distinguish flat feet, but of course the safest thing is to go to the hospital and ask the doctor to confirm, and also to find the relevant causes and countermeasures.
The left side of the hindfoot is exostosis, more toes can be seen from the back, and the hindfoot exostosis does not improve when the heel is raised, while the right foot is relatively normal; what should I do if I find I have flat feet? To tell you a simple principle, it is to see if there are any symptoms. The relevant symptoms include soreness and pain of the foot, and the parts can be the middle part of the medial side, the outer part of the heel, etc. Severe cases can also affect the muscles at the back of the calf. If you have had flat feet since you were a child, there is no discomfort in your daily life, and you can restore part of your arch when you walk, most of these cases do not require special treatment. In the case of symptomatic flat feet, whether they occurred as a child or as an adult, you should come to the hospital, where the doctor will ask questions, examine the body and conduct some auxiliary tests to find the possible causes and give professional treatment recommendations. These treatments are broadly divided into two categories: conservative and surgical. Conservative treatment includes the use of arch pads or custom-made insoles to support the arch of the foot and reduce symptoms. For patients who have failed conservative treatment or who have some serious disorders, surgery is required to remove the cause and rebuild the arch. The decision of surgical treatment needs to be made very carefully and requires full communication and exchange between the doctor and the patient, because there are many factors involved in arch collapse, and each surgical operation can only deal with one factor, some can solve the problems of static mechanics such as bones, some can solve the problems of soft tissues such as muscles and tendons, and for national people, when surgery is really needed, some patients’ conditions are already more complicated. However, one or two simple surgical procedures may not necessarily be able to both relieve clinical symptoms and reconstruct the arch of the foot, and may require multiple surgical operations combined in a multi-pronged approach, but each surgical operation has some associated surgical risks for the foot, such as delayed healing, infection, poor incision healing, hematoma, etc. Therefore, it is hoped that patients with symptomatic flatfoot syndrome will seek early consultation and early intervention to avoid aggravation and complication of the condition, and they need to fully communicate with their doctors during the treatment process to achieve scientific understanding and wise decision making.
In conclusion, the treatment of symptomatic flatfoot syndrome is a special and specialized field that requires a team of specialized physicians in conjunction with rehabilitation centers and orthopedic braces for diagnosis and treatment. Early diagnosis and treatment can provide symptomatic relief while preserving the flexibility of the foot and avoiding the development of stiff feet or arthritis.