Flat feet is a rather common occurrence within the general population. Even in patients without pain associated with their flat feet, I always recommend an orthotic, or an arch support. Wearing an orthotic can help to protect the foot from the development of future problems related to flat feet. One of these problems is posterior tibial tendonitis. In pediatric patients a coalition (congenital fusion of cartilage or bone) may be present causing the flat foot deformity. It is typically accompanied by pain when standing for long periods of time or walking.
Some of the ways we treat is with anti-inflammatory medicines (NSAIDs) when pain is a factor, a period of casting or bracing, and activity modification. Long term treatment of this condition involves again the use of an orthotic device to help support the arch. If these modalities fail, then surgery may be indicated. The type of procedure chosen depends on the degree of deformity as well as the presence of arthritis. If there is coexistent arthritis in any of the joints involved, then fusion surgery would be indicated. In pediatric flat feet patients, if the deformity is flexible a device can be placed in the joint below the ankle joint called the subtalar joint to help elevate the arch and limit the amount of pronation. If a congenital fusion is present it is simply removed. In certain cases an adjunct procedure, such as an achilles tendon lengthening may be necessary.