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Cologne Foot and Ankle Surgery Center| Flat feet (flatfoot deformity)

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... it is better to carry out a comprehensive diagnosis, than to operate prematurely!

Flat feet (flatfoot deformity)


Flat feet are caused by a pathological deformation of the ankles, whereby the arch of the foot is increasingly flattened and the entire foot surface rests on the ground, as well as an increasing change in all soft foot parts, such as tendons, ligaments, muscles, etc.
It is one of the most complex foot deformities ever, with often lasting effects on the entire body posture.
Deformity, like much in medicine, is divided into stages.
There are several international stage divisions.
Since the foot cannot properly cushion the step while walking, every step hurts.
Causes for the formation of a sink or flat foot are diverse and, despite the most advanced research, often still unclear.
Injuries and rheumatic and neuromuscular diseases can also cause it.


The pain usually develops within the instep, at the level where the laces are tied and/or on the inside of the ankle joint where the main tendon that supports the arch of the foot passes.
Disease related pain can occur in the ankle joint region, calf muscles, hips, or back due to improper alignment of the feet, legs, and hips.
In most cases, the pain is due to increased traction on the posterior tibial tendon, the main tendon, which supports the instep and aligns the foot under the leg. Problems with this tendon usually occur in stages and begin with inflammation of the tendon itself.
Over time, the tendon becomes fatigued and overstretched, "frayed" or torn.
Scarred tissue, which is much weaker than the normal tendon and easily injured, replaces the healthy tissue.
Once this happens, increased pressure is applied to the joints, small muscles and ligaments that support the foot bones, and other muscles are pulled in to support the instep. This causes swelling, pain and sooner or later osteoarthritis in the foot and ankle joints.
Left untreated, the tendon may rupture and the foot may tilt increasingly under the leg, resulting in an improperly positioned, stiff and sore foot and ankle joint.
The Achilles tendon and calf muscles often lose their length and flexibility and become immobile over time, which puts further pressure on the instep.

Conservative treatment

When flat feet cause little pain, the simplest solution is to prescribe position-correcting orthopedic insoles.
However, as these are purely passive assistive devices, the foot support apparatus tends to weaken in the long run.
In young people, therefore, depending on the individual situation, it is even better to do without insoles and perform foot-muscle strengthening physical therapy.
In some cases, this is combined with insoles, at least temporarily.

Surgical treatment

The goal is to restore the normal position and function of the foot.
Depending on the expression, a variety of methods are available.
A child’s skewed flat foot (pes planovalgus) can usually be fixed with minimally invasive surgery by immobilizing the lower ankle joint (arthrodesis) and inserting a small titanium implant, which can remain lifelong.

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