Joey Wahler (Host): There's an old adage, don't be caught flat footed, right? Well, some people do actually have flat feet. So, we're discussing how that's corrected. Our guest, Dr. Michael Kelly. He's a Foot and Ankle Specialist at St. Joseph Hospital Podiatry. Welcome to Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness.

Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Kelly. Thanks for being with us.

Michael Kelly, DPM: Hi, thanks for having me. I appreciate it.

Host: Same here. Great to have you aboard. So first, how common is the condition known as flat feet, at least to lay people like myself, and what exactly is this condition?

Michael Kelly, DPM: Sure. It's relatively common. It can occur in a variety of different types. In simplistic terms, a flat foot is a partial or total collapse of the arch. There are many different characteristics that are shared by different types of flat feet, which include the pointing of the toes outward, the rolling of the ankle inward, and the outward tilting of the heel.

Host: And how common, from your experience, would you say this is?

Michael Kelly, DPM: it can be fairly common. I would say it's something that's experienced in 50 percent of the population. I tend to see it a lot in my practice, because it's something that I specialize in, so a fair amount of my patients have flat feet, because that's what they're coming for me to see and treat.

Host: So what causes flat feet, and at what age would you say it typically becomes noticeable to people?

Michael Kelly, DPM: Sure, there are a number of different causes, we like to refer to it as different types of flat feet. And that's really characterized by two different terms, and that is flexible or rigid. And the term flexible refers to a normal arch when someone is non-weight bearing or sitting, with the disappearance of the arch when someone is standing. As opposed to a rigid flat foot, which is refers to the loss of arch height when someone is sitting or standing. Flexible and rigid flat feet can occur in both children and in adult, and there's a variety of different conditions that can contribute to that. A flexible flat foot is typically more common. It can begin in childhood or in adolescence and progress into the adult years. The severity can worsen as an individual ages.

And typically that's because the tendons and ligaments start to tear or rupture around the arch resulting in a further loss of that arch or collapse.

Host: And so what symptoms are most commonly associated with this?

Michael Kelly, DPM: First is pain in the arch, the heel, the ankle or sometimes the outside of the foot. People can often experience a rolled in ankle or, what we refer to as overpronation. You can have pain along the shin bone. Often kids experience general aching or fatigue in the foot or leg. People can experience tight calf muscles or Achilles tendon.

Additionally, we often see patients experience low back pain, hip pain, or knee pain. Flat feet can be apparent at birth. It's something that can show up in later years. Again, either children, adolescents, or adulthood. Children can often experience things in a different way. Adults can experience this as well, but we see an awkwardness or a change in walking, difficulty with shoes, reduced energy while they're performing physical activities, or even the voluntary withdrawal of physical activities due to pain.

Those things can often occur in adulthood, but usually it's the parent is saying, Hey, he doesn't want to get up out of bed. He doesn't want to run. He doesn't want to do sports. We go on vacation and after 10 minutes or an hour of walking, they need to sit down.

Host: Gotcha. And so if someone comes to you suspecting that they might have an issue with flat feet, how do you and yours go about diagnosing it?

Michael Kelly, DPM: Sure. First we're looking to observe how the foot looks both as an individual sits, as they stand, and as they walk. Flat feet can sometimes be related to problems that are further up in the leg, so an evaluation beyond just the foot and ankle is important. X-rays are taken to determine the severity of the deformity, and in some cases additional imaging such as an MRI or a CAT scan is needed.

Host: So, when would you say, Doc, someone should see a physician about flat feet? And do they need to do so even if they're having no symptoms but may suspect for some other reason? In other words, maybe they notice something even though they're not in any pain or discomfort.

Michael Kelly, DPM: Sure, and a lot of the children that I see are typically those that parents have noticed something, but the child isn't complaining of any pain. To answer your question, those that do not have symptoms, I do feel it is important to be evaluated. Early diagnosis and treatment from those suffering from flat feet is key to Improving long term outcomes, reduce the likelihood of more severe foot deformities from developing and lessening the need for possible surgical intervention at some point.

Host: Now you mentioned this can be found in just about any age person right down to young children, but is there one particular general age group that this seems to affect the most?

Michael Kelly, DPM: Flat feet in young children, two, three, four, five, six, seven, flat feet can be very common and almost expected in individuals in those early ages. And a lot of that is because their, their bones haven't fully developed. And the term that the child will grow out of it is something that can often be used.

But when that arch doesn't fully develop or it is more as a result of function or injury, or just general bone structure, then again, it can occur at any age. Oftentimes in adulthood, we see a condition which is referred to as posterior tibial tendon dysfunction. The posterior tibial tendon is a tendon that's on along the inside of the arch. It helps support and hold up that arch and allow us to propulse so we can walk. And when an individual has failure of that tendon, that arch will steadily start to drop and it will impact their function and almost always contributes to pain.

Host: So the good news, of course, is that there is treatment available. So tell us what those options are, if you would, please.

Michael Kelly, DPM: First is activity modifications. Are there certain sports or activities that you're doing that are heavily contributing to your pain and how can we modify that. Orthodic insoles, whether it be an over the counter, something you purchase at a doctor's office, online or in a store.

There are also custom orthotics where a plaster mold is made of someone's foot and it is customized to them. Different types of shoe modifications or gearing a patient towards specific features that are present in a shoe that will help limit the improper function of a flat foot. There are braces or ankle foot orthoses.

Again, these can be both something off the shelf, over the counter or customized. People that are in significant pain or going through some increased inflammation often require immobilization in a walking boot to allow things to calm down. Medications can be used such as non-steroidal anti inflammatories, which include those like ibuprofen and Advil, and this is to help reduce the pain and inflammation that's occurring.

Physical therapy can be prescribed to help improve not only the gait, the walking, but also the strengths of the muscles to prevent further loss of the arch and weight loss. The heavier we are. Our feet are designed to withstand a certain amount of body pressure and forces that we take on when we walk. And those that are overweight or obese are putting more stress throughout those tendons, ligaments, and joints that can lead to further pain.

Host: Interesting, I never thought about that last point you made that if someone is carrying too much weight, that's putting too much stress on the feet. How about surgery? When would surgery be necessary here and what does that involve?

Michael Kelly, DPM: Sure. First, we want to exhaust all forms of conservative non-surgical type treatment, like I just prescribed, and some of that will include a combination or if not, you know, all of those types of treatments. Um, there are many different techniques that are available to correct a flat foot deformity and some can require a combination of multiple different techniques to relieve the symptoms and improve foot function.

Host: And so in summary, Doctor, where can people go to find more information about this condition commonly known as flat feet?

Michael Kelly, DPM: FootHealthFacts.org is a great resource. It is a website that is created by the American College of Foot and Ankle Surgeons for patients to learn about a variety of different foot and ankle conditions. Nevertheless, making an appointment with an experienced Foot and Ankle Surgeon can provide in-depth knowledge to diagnosis and treatment of foot and ankle conditions to work with your healthcare providers and team to ensure that you're getting the best care possible. And we make the best decision not just for the foot, but for that individual. Many factors are taken into account when considering different treatment options, particularly surgery, and such as the extent of the deformity, age, activity level, overall health, independence, and many different social factors.

And that post surgical recovery can vary depending on the surgeries performed. So we need to take all those things into consideration.

Host: Indeed. Well, folks, we trust you're now more familiar with flat feet. Dr. Michael Kelly, great information. We appreciate it. Thanks so much again.

Michael Kelly, DPM: Thank you very much for having me.

Host: For more information, please visit stjoseph hospital.com/services/podiatry. Again, St. Joseph, that's STjosephhospital.com/services/podiatry. Meanwhile, if you found this podcast helpful, please do share it on your social media. I'm Johy Wahler, and thanks again for being part of Wellness First, a St. Joseph Hospital podcast, where we hear and learn directly from the experts on all things health and wellness.