FLATFOOT WITH HINDFOOT VALGUS
Flatfoot with hindfoot valgus – when the heel tips outwards
In this deformity the heel tips outwards and the long arch of the foot sinks. The foot rolls too far over its inner edge – it overpronates. Seen from behind, the heel no longer sits straight under the lower leg but at an angle, and more toes appear beside the Achilles tendon than there should be.
What matters is whether the deformity still moves. If the arch rises again when the patient stands on tiptoe, the foot is flexible – and then a great deal can be done. If it stays flat, the deformity has stiffened, and the treatment is a different one.
How it develops
In children a soft arch is normal at first: almost every toddler has flat feet, and the arch builds itself up by around the age of ten. If it does not, we speak of flatfoot in childhood. In adults the foot was usually fine once and sinks later – most often because the posterior tibial tendon, which holds the arch from the inside, gives way.
- A family tendency – parents and children are strikingly often affected alike
- Very lax ligaments in general
- Excess weight pressing permanently on a soft arch
- A shortened calf muscle that pulls the heel upwards
- The posterior tibial tendon giving way in adulthood
- Bony causes such as a tarsal coalition – a bridge between two tarsal bones
Symptoms
This deformity does not hurt for a long time. Complaints usually arise not from the deformity itself but from what it demands of the tendons and ligaments.
Pain along the inner edge
A pulling sensation below the inner ankle bone, where the posterior tibial tendon runs – at first only after long periods of standing or walking.
Tiring quickly
The feet tire fast. Children ask to be carried on walks; adults avoid longer distances without consciously deciding to.
Pressure and shoe trouble
The shoe wears down on the inside. A tight feeling develops below the outer ankle bone, where the heel bone now butts against it.
When not to wait
In children a painless, mobile flatfoot often needs no treatment at all. It is different when the foot hurts, when only one side is affected, when the deformity increases within a short time, or when the foot no longer rises on tiptoe.
In adults, a foot that sinks over the years and hurts on the inside is a reason to look early. The longer the tendon is overstretched, the sooner a mobile deformity becomes a stiff one – and a small operation becomes a large one.
Treatment options
Conservative treatment always comes first: insoles that support the arch and lift the heel upright, together with stretching the calf and strengthening the muscles of the foot. In children, time is part of the treatment – much of it grows out.
If pain remains and the foot still moves, a small operation comes into question: subtalar arthroereisis. An implant is placed in the sinus tarsi, the channel between the talus and the heel bone. It is not anchored in bone; it works as a stop that limits the tipping without abolishing the movement.
Therapy options
Support and strengthen first – surgery follows when that is not enough and the foot still moves
Insoles
A support under the navicular and a wedge under the heel lift the hindfoot upright and take load off the tendon at the inner ankle.
Physiotherapy
Stretching the shortened calf, strengthening the small muscles of the foot and the posterior tibial muscle. In children, much of it through play, balancing and going barefoot.
Orthosis
With a pronounced deformity or an irritated tendon, a below-knee orthosis takes the foot out of loading altogether for a time.
Subtalar arthroereisis
An implant in the sinus tarsi limits the tipping of the talus against the heel bone. The operation is small, and the implant can be removed again.
Frequently asked questions
My child has flat feet – does that need treating?
Do insoles really help?
How long does the implant stay in the foot?
How safe is the operation?
Can I do sport afterwards?
And if the foot is already stiff?
Our foot specialists
Specialists in foot deformities in children, adolescents and adults
