Part 1-Pain Many of our patients are concerned that they have flat feet. When asked if they are painful, they respond "no", yet they remain concerned that their feet are flat and subsequently they are not normal. I am not prepared to tell them they don't have a normal foot based on not having an arch; however what I can tell them is that it is not normal to have a painful foot. With or without an arch, your feet are not supposed to hurt. Are flat feet a concern to us? They are if they hurt. And that is the topic of this article, not flatfeet in general, but flatfeet that hurt. Referred to as calcaneovalgus, pes planus or kidner foot type, the painful flatfoot will present to us with a variety of symptoms. Children will often complain of leg pain which is commonly referred to as growing pains, and is written off as a "rite of passage" that many children must endure through adolescence. Why is it only the legs hurt when they grow? Why not any other part of the body? The answer is that legs don't hurt when they grow. What is hurting the child's legs is the abnormal twisting of the child's flatfoot when they stand and play. The flattening of the child's arch when they place weight on the foot, twists the ankles inward which pulls the tibia (leg bone) inward and forces the knees to come together (knock-kneed). The muscles of the thigh and leg counter this pull by exerting a twist of their own in an outward direction. The feet and legs turn inwards and the muscles pull outwards every day, all day until the child wakes up one night crying in pain and rubbing their legs. And just like their parents' parents had, they will comfort the child, apply a warm compress, attribute the pain to fast growth of the legs, and get ready to it again the next night. Other children won't have complaints about their legs, but instead will have a painful boney prominence on the inside of their foot. Their only complaint will be that their feet hurt when they wear shoes that have an arch in them. The arch of the shoe will rub against the boney projection causing it to become red and swollen. These children will commonly want to be barefoot, will readily complain about the comfort of their shoes and avoid any shoe which has an arch. This prominence is an outgrowth of one of the foot bones that is jutting from the side of the foot making it susceptible to injury. As we get older, the complaints change from ones of night pain to instead pain during the day while we are at work. Adults with painful flatfeet tend to frequently look for places to sit down and rest or if they are forced to stand will shift their weight repeatedly from one foot to another. They will have one maybe two pairs of shoes that they can tolerate on their feet for several hours and find it very difficult to replace these because it takes so long to "break in "a new pair. Some adults, either spontaneously or after a fall or trauma, develop one foot which is flatter than another and hurts along the inner arch area extending into the heel and up to the ankle bone. The area maybe frequently swollen and is tender to the touch. When standing, the foot appears to be turned out like a ducks' foot and it becomes progressively more difficult for the person to stand on their toes without any pain. These patients have injured or torn a critical tendon which is responsible for holding up the arch of the foot. As the injury or tear progresses with time you can watch the arch of the foot drop to the floor and the foot becomes bulbous, warm and painful where there once was an arch. Weeks lead to months which turn to years of having painful flatfeet where the adult patient will come to accept that their feet hurt and they can't remember a time when they didn't. They just accept that it's normal for their feet to always hurt. Perspective is lost that nothing else on their body hurts with the regularity and frequency of their flatfeet and they never make the connection that maybe something is wrong that can be treated. They accept that it is normal for their flatfeet to hurt. It's not normal for any foot to hurt whether it has an arch or not. Children and adults can both be affected by this and treatment is readily available. Part 2 of A Look at Flatfeet from Your Warwick Podiatrist is coming soon.
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