Information
A flat foot is a normal variant of foot shape and does not normally need any treatment. However, there are certain occasions where a flat foot can cause symptoms.
Tarsal Coalition
In the majority of patients, the foot is mobile, but in a small percentage there is failure of two of the bones to separate during growth and therefore they are joined together. In most cases this is asymptomatic and never recognised, but in some it will become painful during adolescence or later in life.
Accessory Navicular
The tendon that supports the arch of the foot (the tibialis posterior tendon) is attached onto the navicular bone. Occasionally there is an abnormal bone within the tendon or at its insertion point. This may be completely asymptomatic but, in some cases, often after a minor injury this becomes painful.
Adult Acquired Flat Foot
This is a condition which generally occurs in someone who already has a flat foot. The tendon that supports the arch of the foot (the tibialis posterior tendon) or one of the other structures fail and becomes painful. This often happens after a minor injury and the foot may become flatter than the other side.
Osteoarthritis
In some cases of arthritis in the midfoot or hindfoot the arch will collapse due to deformity in the joints. This is generally a gradual deterioration and is not always painful.
Charcot Neuroarthropathy
This is rare cause an flat foot developing in a diabetic (or patient with neuropathy). In this case either fractures occur or joints dislocate and this is as a result of the neuropathy. It should be suspected in any patient who has diabetes and develops a hot-swollen foot. The diagnosis is with an X-Ray and this is managed by the diabetic foot team.
In most instances the initial treatment will be non-operative. Insoles may take pressure off the painful structures; physiotherapy may be helpful to strengthen weak muscles and stretch tight ones. Weight loss in the obese will considerable help symptoms.
Who can refer:
GPs
Who to refer:
- Painful flat foot
- Sudden deterioration in symptoms
- Failure to improve with physiotherapy or podiatry (at least 3 months treatment)
Who not to refer:
- Diabetic Charcot – Please see Management of the Diabetic Foot – RefHelp (nhslothian.scot)
How to refer:
SCI gateway (Lauriston Buildings > Orthopaedics – Foot and Ankle)
Minimal referrals details:
- Length of time since symptoms started
- Non-operative management tried.
- Normal activity level
(SALTIN-GRIMBY PHYSICAL ACTIVITY LEVEL SCALE)
SALTIN-GRIMBY PHYSICAL ACTIVITY LEVEL SCALE Mar only one option:
1. Physically inactive (I): Being almost completely inactive, reading, watching television, watching movies, using computers or doing other sedentary activities, during leisure-time.
2. Some light physical activity (LPA): Being physically active for at least four hours/week as riding a bicycle or walking to work, walking with the family, gardening, fishing, table tennis, bowling etc.
3. Regular physical activity and training (moderate PA, MPA): Spending time on heavy gardening, running, swimming, playing tennis, badminton, calisthenics and similar activities, for at least 2 to 3 hours/week.
4. Regular hard physical training for competition sports (vigorous PA, VPA): Spending time in running, orienteering, skiing, swimming, soccer, etc. several times per week.
In most instances the initial treatment will be non-operative. Insoles may take pressure off the painful structures; physiotherapy may be helpful to strengthen weak muscles and stretch tight ones. Weight loss in the obese will considerable help symptoms.
