Arches and aches

Flatfoot or "fallen arches" is a medical condition that affects the arches of the human feet, causing them to fall flat. It occurs in about 20 per cent of the world's population. "Flatfoot, or pes planus, as it is medically called, refers to the loss of the normal arch in either or both feet. In infants it is common for the baby fat between the foot bones to cause the foot arches to fall flat," says Dr Amith Kumar Krishna, an orthopaedic surgeon with Lifeline Healthcare Group, Dubai. "At first, all babies' feet look flat, because the arch hasn't formed yet. Arches should form by the time your child is 3 years of age and develop by the time he or she is 7 or 10 years old." Wear and tear In a lot of cases flatfoot develops due to ill-treatment of the feet. Muscles wear out due to ageing, sports injuries, standing or walking for prolonged periods of time on high heels or in shoes without proper support. Dr Christina Kabbash, an orthopaedic surgeon at Foot & Ankle Surgery, says weight and age are big factors. "There are multiple causes of flatfoot, including trauma or injury, inflammatory arthritis and chronic wear and tear, often augmented by an increase in weight and age. The main injury occurs to a tendon on the inside of the ankle called the ‘posterior tibial' tendon that supports the arch. As this tendon tears or weakens, the arch collapses, the heel tilts and the foot turns out." One of the signs of flat feet in children is when they begin to complain of pain in their calf muscles or feet. If parents notice their child walking oddly, on the outer edges of the feet, or limping during long walks with pain around the area of the foot, they should get it checked. "In severe cases of childhood flatfoot, a ‘knock knee' deformity may develop," says Krishna. If the child complains of foot, heel or ankle pain, you should visit the specialist who will take foot X-rays in a standing position to check joints and feet bones." "Pain on the inside of the ankle or the arch or a decreased ability to walk or run due to aching feet is often the first sign of a flatfoot developing," says Dr Caterina Obrador Riera, a podiatrist at the Dubai Bone and Joint Centre. It is not just the feet that hurt. Flatfoot affects other parts of the body too. Dr Riera says: "Flat feet can affect the knees, hips and back. The arch collapsing inwards places stress on the knee, which may rotate the hip and cause back pain. Avoid high heels and flat shoes with no support, such as ballet flats and flip-flops." Experts recommend that children run or walk barefoot on rugged terrain such as sand or rocks. Dr Krishna says: "Patients between the ages of 3 and 9, with no family history, will probably have arches form later. If the child has flatfoot symptoms, an arch support can be placed inside the shoe to correct it." Dr Kabbash says: "In case of severe collapse, additional arch support with an orthotic insert may be required. Many shoe brands today are building arch support into the shoes. Surgical correction is required when patients continue to have pain in spite of corrective shoe wear or physical therapy, and it will correct abnormal stress on the knees, hips and back."