Updated: Oct 7, 2019
Cause: Hereditary, trauma
Appearance: Flat appearing arch, pain under the middle of the foot, may radiate into the leg
How to Diagnose: X-ray, clinical exam (flat arch, pain along the arch), MRI (to rule in/out tendinitis)
- Treatment depends on severity of symptoms
o If mild discomfort; start with ice, anti-inflammatories(if ok to take) and OTC or custom orthotics
o If severe discomfort; Period of immobilization in brace or boot followed by custom orthotics or custom brace
o Surgery is indicated only if orthotics and bracing fail to alleviate symptoms.
§ Surgery should address root cause
· If arthritic joints – fusion should be considered
· If flexible and non arthritic- an osteotomy should be considered (breaking the bone to move it in a better position)
· If due to an “extra” bone within the tendon – a removal of extra bone should be considered
· Arthroeresis, in our opinion, should NOT be considered in tennis players.
- Shoes should have a supportive heel counter and bulky medial arch (see tennis shoe anatomy)
- Socks with a supportive arch are not first line treatment but will help with symptoms
- OTC orthotics should be changed every 4 months and custom orthotics should be changed every year in tennis players
Long-term prognosis: Tennis players with flatfoot often have trouble with pushoff, bracing/ orthotics that realign the foot under the leg can significantly improve this leading to relatively faster reaction times to the ball. Flatfoot is a chronic condition that needs constant attention with athletics. Typically orthotics and/or bracing allow for normal athletic performance. If surgery is required, return to sport can take up to 1-2 years if surgical correction is extensive.
Who to call: Podiatrist, orthopedic surgeon