Flat feet can be categorized into different types based on cause and manifestation:

1. Flexible flatfoot: The arch of the foot is flattened only under load and returns to normal when at rest.

2. Rigid flatfoot: The arch of the foot is permanently flattened, even without load.

3. Congenital flatfoot: Occurs at birth and is often associated with deformities.

4. Acquired flatfoot: Develops over the course of life, often due to overuse, injuries, or degenerative changes.

The causes of flatfoot are varied and depend on the type of condition:

• Genetic factors:
  • Congenital weaknesses of the ligamentous apparatus or malformations in the foot area.
• Overload:
  • Frequent standing, walking, or running on hard surfaces leads to overstrain of the foot arch.
• Injuries:
  • Damage to tendons, ligaments, or bones, such as a tear of the posterior tibial tendon, can impair the stability of the foot.
• Degenerative changes:
  • Wear and tear, such as osteoarthritis, can affect the foot architecture.
• Diseases:
  • Neurological or muscular diseases such as polio or muscular dystrophy can promote the development of flatfoot.
• Overweight:
  • An increased load on the foot arch favors the misalignment.

The symptoms of flatfoot depend on the severity and progression of the condition:

- **Foot pain:** Pain often occurs in the area of the arch, heel, or ankle, especially under load.

- **Swelling:** Swelling in the area of the inner ankle can occur, especially with acquired flatfoot.

- **Gait changes:** Noticeable walking with an altered weight distribution of the foot.

- **Posture problems:** Back pain or knee problems due to the changed body statics.

- **Fatigue:** Quick fatigue of the feet when walking or standing for long periods.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

1. **Medical History:** Collection of the patient's medical history, family history, and description of symptoms.

2. **Clinical Examination:**

- Inspection of the foot while standing and walking to assess the arch of the foot.

- Functional tests, such as standing on tiptoes, to check the stability and function of the tendons.

3. **Imaging Techniques:**

- **X-ray:** Visualization of bone misalignments and joint changes.

- **MRI:** Examination of soft tissues, especially tendons and ligaments.

- **Pedobarography:** Analysis of pressure distribution in the foot.

Conservative Therapy

Most flat feet can be successfully treated without surgery:

• Orthopedic Insoles:
  • Support of the foot arch through custom-fitted insoles.
• Physiotherapy:
  • Exercises to strengthen the foot and lower leg muscles and improve mobility.
• Ergonomic Shoes:
  • Shoes with sufficient cushioning and support elements that relieve the foot architecture.
• Pain Therapy:
  • Use of NSAIDs to relieve pain and inflammation.
• Weight Reduction:
  • Reduction of body weight to decrease the load on the foot.

Surgical Therapy

In severe or therapy-resistant cases, surgical intervention may be necessary:

• Tendon Reconstruction:
  • Restoration or reinforcement of damaged tendons, such as the posterior tibial tendon.
• Osteotomy:
  • Surgical correction of bone deformities.
• Arthrodesis:
  • Fusion of individual foot joints to stabilize the foot.

To prevent flat feet, the following measures are helpful:

1. Regular foot exercises: Promoting flexibility and strengthening the foot muscles.
2. Suitable footwear: Use of well-supporting and cushioning shoes.
3. Avoidance of overloading: Limiting long periods of standing and intense stress on hard surfaces.
4. Weight control: Maintaining a healthy weight to relieve the arch of the foot.
5. Early detection: Regular examination of the foot arch, especially in children or individuals with a family history.