Flatfoot (Fallen Arch)

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:

- 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.

Shoe Recommendations:

- 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