![]() Surgery should only be considered if conservative care has failed, except when the deformity arises from an acute injury such as a fracture or tendon rupture. Therefore, it needs to be fairly stiff and to be held firmly to the foot with laces that are securely fastened. If the shoe is to provide support it needs to reduce unwanted motion.They do not cure the poor alignment, but if used they can provide support, although they are generally only effective in laced training shoes. These devices help hold the foot in a neutral position when walking.An individual programme of exercises would be needed, although the major muscle groups are the core, thigh and buttocks.Physiotherapy to strengthen muscles and improve coordination An improvement in flexibility can normally be achieved by standing on an adjustable slant board for 2-3 minutes twice a day, indefinitely. Having tight calf muscles has been shown to increase the likelihood of the foot collapsing (arch height reducing and the heel bone rolling in).Stretching exercises for the calf and hamstring muscles ![]() The diagnosis will be given to you during your outpatient appointments along with the treatment options and the likely outcomes. The causes as outlined above are varied and investigations are often required in the form of X-rays and scans to confirm the severity and underlying causes. The diagnosis is made by a clinical examination of the foot and the patient’s gait. The pathological flat foot can be divided into flexible and rigid, and whether it is an adult or child. Abnormal joining of two bones (coalition) resulting in a rigid flat foot.Diseases that affect muscle and nerve function.Tendon injuries, typically Tibialis posterior.If the patient does not respond to conservative treatment, then surgery might be considered. In the majority of cases the symptoms respond to stretching exercises, orthoses (shoe inserts) and supportive footwear. These patients are considered to have a pathological flat foot. Treatment is required in severe cases or where the degree of mal-alignment is such that the patient experiences pain or fatigue, or is likely to do so. However, a foot that rolls in excessively with most of the weight passing over the inside border is a cause for concern, as shown in the left foot pictured below. A flat or low arched foot is not considered abnormal, the height of the arch does not have any bearing on how well a foot can function. ![]()
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