T

he most common arch problem is the flat foot. This sometimes starts in childhood or may gradually develop in adulthood.

In most cases the flat foot is related to a tight calf. The tightness of the calf forces the foot to overpronate (the inside of the foot rolls inwards) and the arch to break down and collapse.

The arch collapse leads to abnormal stress on the plantar fascia leading to heel pain, as well as to the main medial tendon (the posterior tibial tendon), leading to tendonitis and even tears of the tendon. The other common symptom in severe flat feet is pain on the outside of the foot as well as calf and Achilles symptoms.

The simplest form of treatment is the use of custom fitted orthotics. For this, it is best to see a podiatrist, who is a trained medical professional that assesses feet and gives you a prescription for the orthotic. If the orthotics do not work '€” or if the deformity is very severe '€” then surgical management may be needed.

There is a very wide range of procedures available, with varying downtimes and complexity.

The simplest procedure of all is a simple calf release. This can be done at the back of the knee or the calf, and has a very quick recovery. It is a day-surgery procedure, and the patient can walk immediately after the surgery without the need for a cast.

Recovery back to jogging can be as early as three weeks. The calf release stops the deforming force but obviously does not correct the arch itself. It is usually done in combination with some of the other procedures mentioned below. Done by itself, the patient will probably still require orthotics but by releasing the calf, it allows the orthotics to be much more effective.

The other end of the spectrum is a complete reconstruction of the arch with bone work and screws to fuse joints.

These are usually done for severe foot deformities and arthritis and require casting, and subsequently mobilization in a walking boot.

In between we have several simpler options to correct the shape of the foot.

In the younger patients with mobile (e.g., flexible) flat feet, we have the relatively simple option of a subtalar Implant.

This acts as a spacer in between the foot bones to prevent the arch from collapsing. Initially there is some difficulty in walking for about three to four weeks.

A walking boot is used for the first three weeks. The insertion is done through a day surgery procedure through a small '€œkeyhole'€ using a video X-ray machine to position the implant.

For older patients with mobile flat feet, in addition to the implants, an additional procedure that may help is a heel shift. This is to correct the alignment of the hind foot.

It can also be done by day surgery, but it involves cutting the bone and putting a screw in the bone.

The patient will need crutches for about four weeks, and following that gradual weight bearing with a walking boot.

In the older adult patient in whom there is a higher risk of needing the implant removed, the heel shift works to prevent a recurrence of the deformity.

The writer is a consultant orthopedic surgeon at Mount Elizabeth Medical Center and was previously chief of the Foot and Ankle Service at the Singapore General Hospital. For more information visit swyung.com.