Flat feet are a common condition—but they can lead to serious problems of the ankle and foot by changing the alignment of your legs.
Both children and adults can suffer from flat feet.
The good news is that flat feet can be treated before trouble begins, if they are diagnosed in time.
Tune into SMG Radio to hear Summit Medical Group foot and ankle expert Dr. Tony DiStefano discuss how to recognize flat feet and the first steps to take to correct them.
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Do You Suffer from Flat Feet?
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Learn more about Tony DiStefano
Tony DiStefano, DPM
Tony DiStefano is a doctor of podiatric medicine at Summit Medical Group. He specializes in reconstructive foot and ankle surgery and treatment for sports-related injuries.Learn more about Tony DiStefano
Transcription:
Do You Suffer from Flat Feet?
Melanie Cole (Host): Flat feet are a common condition but they can lead to serious problems of the ankle and foot by changing the alignment of your legs. Both children and adults can suffer from flat feet but the good news is that they can be treated before trouble begins if they’re diagnosed in time. My guest today is Dr. Tony Distefano. He’s the doctor of podiatric medicine at Summit Medical Group. Welcome to the show, Dr. Distefano. So, tell us what are flat feet and how do they get flat?
Dr. Tony Distefano (Guest): Good morning. Thank you for having me. Flat feet is a common condition, a progressive change where there’s a flattening of the arch. It usually starts at young ages and then progressively gets worse. A lot of times it’s asymptomatic. Parents recognize it, they notice the changes but it doesn’t hurt. Parents bring them in stating they seem some changes, what’s happening? We take some x-rays and x-rays show collapse of the arches. They have discomfort in the ankle, the subtalar joint, the legs, a lot of it is compensation. We try to slow it down with devices called “orthotics” so that they don’t progressively get worse. As time goes on, if it goes untreated it leads to severe changes that eventually will need the surgical intervention.
Melanie: Is this a genetic thing, Dr. Distefano? Is there a hereditary component to flat feet?
Dr. Distefano: There’s definitely a hereditary component. It’s something that’s usually picked up at a young age. There is a genetic component and there’s an acquired component which certain shoes and certain activities tend to progress but there’s definitely a genetic component.
Melanie: So, if there’s an acquired component and you say certain shoes, would women be more likely to get fallen arches if they wear high heels or that sort of thing?
Dr. Distefano: Yes, there’s definitely an acquired component and shoes do play a role. The shoes that we tend to point to in terms of causing a collapse of the arches – flat shoes, the flip flops, the sandals, the shoes that have absolutely no arch. What happens in that type of a shoe, the foot tends to collapse more and as that – we call that hypropernation which is the collapse of the arch – if we don’t find a way to slow it down and it keeps getting worse, the arch keeps collapsing and the shoe doesn’t help. What happens is, in patients who are wearing flat shoes, it tends to keep collapsing further and further and then you’ll see the changes that start to occur where you look at the foot and ankle and there’s like a misalignment of the foot and ankle in relationship to the leg.
Melanie: If you start to feel that pain on the top of your foot or you’re starting to notice back pain or any of these kinds of symptoms, then do you recommend somebody get right into a podiatric doctor or can they try ice or some of the over the counter orthotics? Speak about the treatments involved.
Dr. Distefano: Initially, when we do see patients coming in, we talk about sometimes using an over the counter insole and that that can, a lot of times, alleviate the symptoms. We have put patients into their shoes and a lot of times it gives some adequate support. The problem with today’s society is, we’re very active. We’re doing a lot of walking, a lot of standing and sometimes the over the counter insoles are not successful enough and that’s when we’ll talk about the more custom mold or orthotics where we take an impression of the foot and from that impression, we make an orthotic that’s geared towards holding up that arch. What happens is that you put them into your shoes, they’re transferable in different shoes and what they are trying to do is hold that arch up and prevent that hyperpronation which causes the arch to collapse and which leads to all the compensation pain that patients will come in – ankle pain, leg pain, knee pain, hip pain simply because the foot is collapsing and it’s compensating all the way up. What the custom mold or orthotic will do is put that foot and ankle back into alignment underneath the leg so that it slows down the progressive nature of the deformity.
Melanie: So many people, Dr. Distefano, think “Oh, it’s my back and my hip,” and the simple problem of what could become a complicated issue is really when they look at their feet. If they want to look at their own feet, what do you tell them to look for if they’re pronating or if they’re looking to see if they have flat feet?
Dr. Distefano: Look at their shoe gear where you’ll notice the changes as the foot keeps collapsing. You have a lot of medial column tear on the shoe so the foot tends to wear out more on the medial side as a result of that. If you look at the back of the heel, you’ll start to see a tilt on the shoe. If you look at the back of the shoe and all of a sudden you see this tilting going on and physically the best way to do it is have the patient walking. A lot of parents will look at their kids and say, “Look. This doesn’t look good. There’s something awkward in the gait.” Mom and dad’s pick up on it and they’ll bring them in and we do a gait analysis in the office. We will see them stand, walk and what gives it all away is the x-ray findings. What the x-ray findings will show that change that starts to occur at the subtalar joints where all of a sudden that arch is no longer there and there’s bony changes that start to occur and, all of a sudden, that collapse gets further and further. As that arch collapse gets further and further, the symptoms tend to get worse, meaning more arch pain, more ankle pain, more leg pain, knee pain, hip pain that radiates up. So, they key is to be very aggressive in early intervention so we slow down the changes because, as time goes on and as a deformity gets worse, eventually the orthotics will no longer be successful and then we are discussing surgical options at that point.
Melanie: That was going to be my next question is, like glasses and you have to change your prescription over the years, do orthotics change as the years go on and is it something that you’re going to pretty much have to wear the rest of your life?
Dr. Distefano: Correct. That’s something that you’re going to be in the rest of your life. They have a shelf life. The average patient, a custom mold or orthotic can last anywhere between two to three years. My sports athletes will change them on a yearly basis but they’re doing more high impact activities. I tell all my patients that you’ll know when you’re due for a new pair because you get used to a certain amount of support and all of a sudden that support starts to collapse. The material that the orthotic is made out of starts to compress and then a lot of my patients will hand me their orthotic and say, “Dr. Distefano, I no longer feel the same. I feel like that arch is no longer there.” That’s when we will look at them, have them stand without the orthotic, see what it’s doing to the arch and, if need be, make them a new pair of orthotics. But, changing them regularly and they’ll most likely be with them the rest of their life to slow it down. Unfortunately, flat feet are progressive.
Melanie: Now, the shoe industry is really getting more and more technology in that the shoes, running shoes and sports shoes are getting more and more support in the middle for those fallen arches. Do you think there’s a possibility for some people that they could over correct if they’re diagnosing themselves and they see that they’ve got a fallen arch and they put in one of these over the counter orthotics and they get one of these shoes that are corrective shoes that they could over correct and sort of change the problem?
Dr. Distefano: Yes. Shoes have come a long way and the shoe industry has recognized that keeping those arches up is important and a lot of times the shoes have come a long way and there’s other shoes out there that have gone the opposite way and become worse. So, yes, there is a possibility if you’re trying an over the counter and putting into a shoe that’s already correcting, you’re over correcting. We tell patients to use your symptoms as a guide. So, if you have pain and discomfort that’s not being alleviated with your shoes, that’s not being alleviated with your over the counter insoles, having a doctor of podiatric medicine take a look at it to evaluate it to see if they are providing adequate support. If not, going the custom molded orthotic route.
Melanie: When does it go down to surgery? And, in the last few minutes, give your best advice about fallen arches, flat feet, home treatment, when it might require surgery and why they should come see you at Summit Medical Group.
Dr. Distefano: Surgical intervention is always the last resort. We tend to exhaust all these conservative measures and a lot of times, if the patient is having a lot of pain, we will put them a custom mold or orthotic and a majority of our patients get better with orthotics. Then, there’s a certain percentage, I would say 10-20%, which are not being alleviated enough with the orthotics. At that point, we will consider a cortisone injection, immobilization and the goal of that treatment is just to calm the swollen foot which is inflamed because as the arches collapse, a lot of the ligaments, a lot of the tendon structures start to change structurally and that leads to a lot of the visual changes that you’re seeing on the foot where, as time goes on, they’re almost walking directly on their ankle. That is years of abuse, years of not treating it, not slowing it down. Unfortunately, with time, if it is untreated, surgery becomes an option. There are different treatments, surgical options to treat it, depending on the age of the patient, depending on the structural changes that we’re seeing on the x-rays. Unfortunately, if it goes unchecked, it leads to arthritis in the ankle joint, the subtalar joint and then leads to other joint destructive changes that change the surgical procedure. So, the surgery is based on the patient – the age of the patient, the structural changes that we’re seeing on the x-rays and seeing what best alleviates this patients symptoms. Treating orthotics, treating flat feet on a regular basis is very important. A lot of my patients will come in with asymptomatic flat feet and the parents will say, “Well it doesn’t hurt, can we ignore it?” You may be that lucky patient that will never hurt but the majority of patients, if it goes unchecked, it does eventually become symptomatic and as patients get older, they get heavier, they do more high impact activities in inappropriate shoes, the symptoms eventually come. At that point, you are chasing the problem. You always want to be pro-active and that’s what the orthotics allow us to do.
Melanie: Thank you so much doctor. It’s really, really great information. You’re listening to SMG Radio and for more information you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Flat Feet?
Melanie Cole (Host): Flat feet are a common condition but they can lead to serious problems of the ankle and foot by changing the alignment of your legs. Both children and adults can suffer from flat feet but the good news is that they can be treated before trouble begins if they’re diagnosed in time. My guest today is Dr. Tony Distefano. He’s the doctor of podiatric medicine at Summit Medical Group. Welcome to the show, Dr. Distefano. So, tell us what are flat feet and how do they get flat?
Dr. Tony Distefano (Guest): Good morning. Thank you for having me. Flat feet is a common condition, a progressive change where there’s a flattening of the arch. It usually starts at young ages and then progressively gets worse. A lot of times it’s asymptomatic. Parents recognize it, they notice the changes but it doesn’t hurt. Parents bring them in stating they seem some changes, what’s happening? We take some x-rays and x-rays show collapse of the arches. They have discomfort in the ankle, the subtalar joint, the legs, a lot of it is compensation. We try to slow it down with devices called “orthotics” so that they don’t progressively get worse. As time goes on, if it goes untreated it leads to severe changes that eventually will need the surgical intervention.
Melanie: Is this a genetic thing, Dr. Distefano? Is there a hereditary component to flat feet?
Dr. Distefano: There’s definitely a hereditary component. It’s something that’s usually picked up at a young age. There is a genetic component and there’s an acquired component which certain shoes and certain activities tend to progress but there’s definitely a genetic component.
Melanie: So, if there’s an acquired component and you say certain shoes, would women be more likely to get fallen arches if they wear high heels or that sort of thing?
Dr. Distefano: Yes, there’s definitely an acquired component and shoes do play a role. The shoes that we tend to point to in terms of causing a collapse of the arches – flat shoes, the flip flops, the sandals, the shoes that have absolutely no arch. What happens in that type of a shoe, the foot tends to collapse more and as that – we call that hypropernation which is the collapse of the arch – if we don’t find a way to slow it down and it keeps getting worse, the arch keeps collapsing and the shoe doesn’t help. What happens is, in patients who are wearing flat shoes, it tends to keep collapsing further and further and then you’ll see the changes that start to occur where you look at the foot and ankle and there’s like a misalignment of the foot and ankle in relationship to the leg.
Melanie: If you start to feel that pain on the top of your foot or you’re starting to notice back pain or any of these kinds of symptoms, then do you recommend somebody get right into a podiatric doctor or can they try ice or some of the over the counter orthotics? Speak about the treatments involved.
Dr. Distefano: Initially, when we do see patients coming in, we talk about sometimes using an over the counter insole and that that can, a lot of times, alleviate the symptoms. We have put patients into their shoes and a lot of times it gives some adequate support. The problem with today’s society is, we’re very active. We’re doing a lot of walking, a lot of standing and sometimes the over the counter insoles are not successful enough and that’s when we’ll talk about the more custom mold or orthotics where we take an impression of the foot and from that impression, we make an orthotic that’s geared towards holding up that arch. What happens is that you put them into your shoes, they’re transferable in different shoes and what they are trying to do is hold that arch up and prevent that hyperpronation which causes the arch to collapse and which leads to all the compensation pain that patients will come in – ankle pain, leg pain, knee pain, hip pain simply because the foot is collapsing and it’s compensating all the way up. What the custom mold or orthotic will do is put that foot and ankle back into alignment underneath the leg so that it slows down the progressive nature of the deformity.
Melanie: So many people, Dr. Distefano, think “Oh, it’s my back and my hip,” and the simple problem of what could become a complicated issue is really when they look at their feet. If they want to look at their own feet, what do you tell them to look for if they’re pronating or if they’re looking to see if they have flat feet?
Dr. Distefano: Look at their shoe gear where you’ll notice the changes as the foot keeps collapsing. You have a lot of medial column tear on the shoe so the foot tends to wear out more on the medial side as a result of that. If you look at the back of the heel, you’ll start to see a tilt on the shoe. If you look at the back of the shoe and all of a sudden you see this tilting going on and physically the best way to do it is have the patient walking. A lot of parents will look at their kids and say, “Look. This doesn’t look good. There’s something awkward in the gait.” Mom and dad’s pick up on it and they’ll bring them in and we do a gait analysis in the office. We will see them stand, walk and what gives it all away is the x-ray findings. What the x-ray findings will show that change that starts to occur at the subtalar joints where all of a sudden that arch is no longer there and there’s bony changes that start to occur and, all of a sudden, that collapse gets further and further. As that arch collapse gets further and further, the symptoms tend to get worse, meaning more arch pain, more ankle pain, more leg pain, knee pain, hip pain that radiates up. So, they key is to be very aggressive in early intervention so we slow down the changes because, as time goes on and as a deformity gets worse, eventually the orthotics will no longer be successful and then we are discussing surgical options at that point.
Melanie: That was going to be my next question is, like glasses and you have to change your prescription over the years, do orthotics change as the years go on and is it something that you’re going to pretty much have to wear the rest of your life?
Dr. Distefano: Correct. That’s something that you’re going to be in the rest of your life. They have a shelf life. The average patient, a custom mold or orthotic can last anywhere between two to three years. My sports athletes will change them on a yearly basis but they’re doing more high impact activities. I tell all my patients that you’ll know when you’re due for a new pair because you get used to a certain amount of support and all of a sudden that support starts to collapse. The material that the orthotic is made out of starts to compress and then a lot of my patients will hand me their orthotic and say, “Dr. Distefano, I no longer feel the same. I feel like that arch is no longer there.” That’s when we will look at them, have them stand without the orthotic, see what it’s doing to the arch and, if need be, make them a new pair of orthotics. But, changing them regularly and they’ll most likely be with them the rest of their life to slow it down. Unfortunately, flat feet are progressive.
Melanie: Now, the shoe industry is really getting more and more technology in that the shoes, running shoes and sports shoes are getting more and more support in the middle for those fallen arches. Do you think there’s a possibility for some people that they could over correct if they’re diagnosing themselves and they see that they’ve got a fallen arch and they put in one of these over the counter orthotics and they get one of these shoes that are corrective shoes that they could over correct and sort of change the problem?
Dr. Distefano: Yes. Shoes have come a long way and the shoe industry has recognized that keeping those arches up is important and a lot of times the shoes have come a long way and there’s other shoes out there that have gone the opposite way and become worse. So, yes, there is a possibility if you’re trying an over the counter and putting into a shoe that’s already correcting, you’re over correcting. We tell patients to use your symptoms as a guide. So, if you have pain and discomfort that’s not being alleviated with your shoes, that’s not being alleviated with your over the counter insoles, having a doctor of podiatric medicine take a look at it to evaluate it to see if they are providing adequate support. If not, going the custom molded orthotic route.
Melanie: When does it go down to surgery? And, in the last few minutes, give your best advice about fallen arches, flat feet, home treatment, when it might require surgery and why they should come see you at Summit Medical Group.
Dr. Distefano: Surgical intervention is always the last resort. We tend to exhaust all these conservative measures and a lot of times, if the patient is having a lot of pain, we will put them a custom mold or orthotic and a majority of our patients get better with orthotics. Then, there’s a certain percentage, I would say 10-20%, which are not being alleviated enough with the orthotics. At that point, we will consider a cortisone injection, immobilization and the goal of that treatment is just to calm the swollen foot which is inflamed because as the arches collapse, a lot of the ligaments, a lot of the tendon structures start to change structurally and that leads to a lot of the visual changes that you’re seeing on the foot where, as time goes on, they’re almost walking directly on their ankle. That is years of abuse, years of not treating it, not slowing it down. Unfortunately, with time, if it is untreated, surgery becomes an option. There are different treatments, surgical options to treat it, depending on the age of the patient, depending on the structural changes that we’re seeing on the x-rays. Unfortunately, if it goes unchecked, it leads to arthritis in the ankle joint, the subtalar joint and then leads to other joint destructive changes that change the surgical procedure. So, the surgery is based on the patient – the age of the patient, the structural changes that we’re seeing on the x-rays and seeing what best alleviates this patients symptoms. Treating orthotics, treating flat feet on a regular basis is very important. A lot of my patients will come in with asymptomatic flat feet and the parents will say, “Well it doesn’t hurt, can we ignore it?” You may be that lucky patient that will never hurt but the majority of patients, if it goes unchecked, it does eventually become symptomatic and as patients get older, they get heavier, they do more high impact activities in inappropriate shoes, the symptoms eventually come. At that point, you are chasing the problem. You always want to be pro-active and that’s what the orthotics allow us to do.
Melanie: Thank you so much doctor. It’s really, really great information. You’re listening to SMG Radio and for more information you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.