(ii) Flatfoot deformity: an overview

Flatfoot deformity is a common complaint with various etiologies. It causes confusion as to when and how to treat it. Unnecessary treatment is a problem, especially in asymptomatic flexible paediatric flatfoot. The human foot is a sophisticated biomechanical structure. Interference with this complicated system of joints, ligaments, tendons and muscles has to be based on a sound knowledge of anatomical structures and their interactions. It is therefore important for every doctor dealing with this condition to be able to differentiate between cases needing treatment and cases that simply need reassurance. Historically, flatfoot deformities have been over treated with the aim to correct deformity, in the process not only failing to achieve the desired correction but also creating symptoms in previously symptom free individuals. A lot has been learned about flatfoot deformity and a more sensible approach based on symptoms and expected disability has been adopted.The adult acquired flatfoot is a complex condition, commonly caused by posterior tibial tendon deficiency (PTTD). Management of these patients is based on a thorough assessment of the underlying pathology.In this article we give an overview of the condition, with emphasis placed on assessment and management of the more common causes.