• Definition: The term flatfoot when used to describe foot pathology does not describe the height of the arch of a foot. The term is used synonymously with the words pronation or pes planus. It is intended to describe a genetically inherited instability of the rearfoot. The rearfoot has two bones, the heel bone (calcaneus) and the bone above it and below the ankle (talus). The rearfoot composes the foundation of the foot. During walking if it functions normally, it stabilizes all the bones in the foot and allows them to function normally.
  • The cause of pronation or flatfoot in Aiden’s foot is severe tightness in the muscles of the back of the calf. These muscles pull the heel bone out of place and cause the foot to break apart or pronate. This is the same as collapsing the arch. The tightness in the muscles of the back of the calf is called (Equinus) and must be addressed or control of the foot will be impossible. Consultation with a pediatric orthopedis and or physical therapist to reduce the (Equinus) is mandatory.
  • Consequences: If these bones fail to function normally, the foot collapses. Bones in the forefoot move out of place. Toes drift out of place and can become hammered. Metatarsals will bear weight unevenly and may cause callus and pain. Bunions can develop, and tendons and ligaments can become injured or strained. Heel pain can develop and the leg can be twisted during walking causing upper leg joint injury.
  • Treatment: Flatfoot is not cured but controlled. Orthotics are used to control and stabilize the rearfoot (calcaneus and talus). Orthotic casting involves placing the bones of the foot in a proper stabile alignment, and capturing this corrected shape in a cast. This cast is then sent to the lab. There a positive of the cast is made and then a proper orthotic is made over an exact replica of the corrected foot according to my prescription. Orthotics take up some room in shoes and that they will not fit in all shoes. The patient may need to purchase larger or different style shoes to accommodate orthotics. In some cases an implant can be surgically placed between the talus and the calcaneus to aid in stabilization. Placement of this implant (sinus tarsi implant) is a surgical procedure and carries several risks and possible complications associated with its use.
  • Recommendations: Flatfoot instability will continuously function to adversely deform the foot throughout a person’s life. Control of this condition is mandatory for foot health maintenance. It is mandatory when considering surgical correction of foot deformities such as bunions, hammertoes, metatarsals etc. Failure to adequately and consistently control flatfoot deformity will ensure eventual failure of most foot surgical procedures.
  • If not covered by insurance the cost of orthotics is $500.00 for a pair.

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