The flatfoot with inward rotation can be divided into different categories:

1. Physiological flatfoot with inward rotation:
   • Often occurs in children and corrects itself with age.
2. Pathological flatfoot with inward rotation:
   • Persists or develops in adulthood, often accompanied by pain and limitations.
3. Acquired flatfoot with inward rotation:
   • Develops due to external influences such as overweight, injuries, or other conditions.

The causes of a flatfoot can be varied:

• Genetic predisposition:
  • A familial accumulation of the deformity indicates a genetic component.
• Muscle weakness and ligament weakness:
  • Lack of exercise, infrequent barefoot walking, or unsuitable footwear can weaken the muscles and lower the arch of the foot.
• Overweight:
  • The increased body weight puts stress on the arch of the foot and promotes its flattening.
• Injuries and diseases:
  • Damage to the tibialis posterior tendon, rheumatic diseases, or bone injuries can affect the foot's statics.
• Misloading:
  • Frequent standing or working on hard surfaces favors the deformity.

The symptoms depend on the severity of the misalignment and include:

• Pain:
  • Discomfort usually occurs in the area of the inner edge of the foot, the inner ankle, or the plantar fascia. It can also radiate into the lower leg.
• Rapid fatigue:
  • Affected individuals complain of tired feet after short walking distances or prolonged standing.
• Tension:
  • Altered foot statics can cause muscle tension or cramps in the lower leg.
• Deformity:
  • Visible flattening of the foot arch and inward tilting heel.
• Irregular shoe wear:
  • Excessive wear on the inside of the shoes is a typical sign.

The diagnosis is based on a thorough examination of the foot:

• Clinical examination:
  • Assessment of foot position, mobility, muscle strength, and pain points.
• Footprint analysis:
  • To determine the condition of the arch and pressure distribution.
• Imaging techniques:
  • X-ray: Assessment of bone position and exclusion of other causes.
  • MRI or ultrasound: Examination of soft tissues, especially the tibialis posterior tendon.

Conservative Therapy

Most cases can be treated without surgery:

• Orthopedic Insoles:
  • Custom-made insoles support the arch of the foot and correct the misalignment.
• Physiotherapy:
  • Exercises to strengthen the foot and lower leg muscles and improve mobility.
• Shoe Fitting:
  • Special footwear with good arch support can alleviate discomfort.
• Medication Treatment:
  • NSAIDs to reduce pain and inflammation in acute cases.

Surgical Therapy

Surgery may be necessary for therapy-resistant or severe misalignments:

• Arthroereisis:
  • Minimally invasive correction of heel position using implants.
• Tendon Reconstruction:
  • Repair or reinforcement of damaged tendons, especially the tibialis posterior tendon.
• Osteotomies:
  • Correction of bone position through surgical procedures.

To prevent a flatfoot, the following measures are recommended:

1. Regular barefoot walking: Promotes the natural strengthening of the foot muscles.
2. Targeted exercises: Strengthening of the foot muscles and improvement of foot statics through physiotherapy or special training programs.
3. Suitable footwear: Wearing shoes with good cushioning and arch support.
4. Weight control: Avoiding overweight to relieve the arch of the foot.
5. Early treatment: Consult a doctor promptly at the first signs of a misalignment.