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Flat Feet (Pes Planus)


Arch height is a major characteristic of a wide range of foot shape variants. Low arch height results in flat feet, or pes planus.

 

Flat feet usually is not abnormal in itself, but it can predispose an individual to many musculoskeletal conditions and injuries. Therefore, it is used by non-specialists as an umbrella term to describe any foot problem which features a low arch.

 

This is why just using a generic arch support often does not resolve an individual’s foot pain, even if he/she has flat feet. “Flat feet” is not a medical diagnosis by itself.

 

As lower limb specialists, podiatrists would conduct a full biomechanical examination in order to make a comprehensive diagnosis of a patient’s present and future foot conditions. Addressing the low arch height is only a part of the treatment.

Flat Foot

Flat foot is a very common condition in Singapore. This is due to the genetical demographics of the region where this type of foot may be hereditary, acquired or due to ligamentous laxity. The artificial surfaces we walk upon every day exposes our foot to more at risk of wear and tear or degeneration.

 

The foot is the foundation of the whole body, when the foot is out of alignment (fallen arches), it will lead to compensation or stress towards other joints in the body. This is often the cause of many soft tissue pathology and the two most common ones are Achilles tendinosis (tendon overuse injury) or Plantar fasciitis (inflammation of the ligament).

 

Other than heel pain, flat foot is also associated with many musculoskeletal conditions such as bunions, metatarsalgia, lower limb fatigue, knee pain, lower back pain, ankle arthritis and many more.

 

Flat foot should not be neglected, it is recommended to consult with a podiatrist for professional advice before the condition leads to other biomechanical problems.

Flat feet a lot of the time aren’t painful but patients have concerns about the way their feet look, developing bunions or aware that flat feet runs in the family. Sometimes flat feet can occur from childhood or is acquired throughout life. A lot of cases in Singapore with flat feet is from:

 

  1. Childhood (congenital) or family history where the arches do not develop and feet can look deformed. Children often present with flexible flat foot where the arches appear with standing on tip toes or visible when seated but collapse when standing. Flat foot individuals may also have hypermobility syndrome. This syndrome is very common in the demographics of Singapore. Hypermobility syndrome relates to the laxity of muscles, especially in the feet where they can move easily beyond their normal range of motion and unable to support an arch of the foot. This laxity can cause problems elsewhere in the lower limb also, not just in the arches with unstable knee and hips. 
  2. Acquired flat foot can be caused by Tibialis posterior dysfunction, arthritis, injury or with Diabetes. Depending on the cause of flat foot, individuals may experience a few symptoms such as:
  • Pain on the inside of the foot and ankle near the navicular bone.
  • Pain after activity or with high intensity sports
  • Pain on the outside of the ankle at the fibula bone. This is due to the valgus position of the heel
  • Pain along the arch of the foot

 

Flat foot can be treated by customised foot orthoses and appropriate footwear. Please seek your Podiatrist’s advise if you feel yourself or a family member has flat foot.

 

High Arch Foot (Pes Cavus)

Higher arches are common in overseas countries but with Singapore’s urban jungle filled with slippers and hard floors, higher arches are becoming less common.

 

If patients present with higher arches, we assess to rule out neurological conditions first. Secondly, we assess the pain and problems that the patient is experiencing. Thirdly, we assess the foot to determine if it is flexible enough to tolerate biomechanical correction.

 

Most shoes are not made to be biomechanically friendly to high-arched feet. Often, we have to add custom orthotics to fill the gap between the shoe and the foot, to redistribute pressure and load on the foot bones, and to reduce strain to the soft tissues stabilizing the foot and ankle.

 

Pes cavus conditions are often more complex and requires specialist consultation to determine what is needed.

Scanning machines

At East Coast Podiatry Centre, we utilise one of the most advanced CAD/CAM technology that provides extreme accuracy up to +/- 0.4mm. To ensure the 3D image of the foot is captured perfectly, patient will undergo 3 different types of 3D scans. The scan relies heavily on the clinician’s skill and it requires a series of training to capture the foot at maximum precision.

 

  1. Full Weight Bearing 3D Scans
  2. Partial Weight Bearing 3D Scans
  3. Non-Weight Bearing 3D Scans

 

All the scans will be combined with the information taken from the musculoskeletal/biomechanical assessment done by the podiatrist. This to assist with the prescription and manufacturing of the specialized foot orthotics that is designed specifically for the patient and the foot condition.

 

 

Foot Orthotics

Customised foot orthosis is a prescription only medical device to achieve therapeutic purpose for specific foot pathology. The podiatrist will decide on the materials, densities and designs of the orthotics depending on the presenting foot condition and also the footwear. With the advancement of technology, specific custom foot orthosis can also be fitted into pumps and court shoes, and even soccer boots.

 

For diabetic patient, total contact orthotics has to be tailored with the aims to offload high pressure and provide cushioning during gait. This is to prevent foot ulceration that is often develop in areas of high pressure.

 

 

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Author: Podiatrist Louis LOY