Intended for healthcare professionals

Practice 10-Minute Consultation

Adult flatfoot

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m295 (Published 24 February 2020) Cite this as: BMJ 2020;368:m295
  1. Chris Yuk Kwan Tang, resident specialist1,
  2. Ka Ho Ng, consultant1,
  3. Joyce Lai, resident2
  1. 1Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
  2. 2Department of Family Medicine and Primary Care, Queen Mary Hospital, Hong Kong
  1. Correspondence to CYK Tang medic.chris.tang{at}gmail.com

What you need to know

  • Flatfoot is a deformity associated with the collapse of the medial longitudinal foot arch, valgus deformity of the heel, and abduction of the forefoot

  • Patients with symptomatic flatfoot usually present with pain in the medial sided foot arch and ankle

  • Offer instructions for home exercise programmes and a referral for foot orthosis for flexible flatfoot. Patients with a rigid flatfoot need referral to an orthopaedic team

A 45 year old woman who is overweight presents with pain in the medial ankle radiating to the medial foot arch area. She reports a noticeable flattened foot arch.

Flatfoot is a deformity associated with collapse of the medial longitudinal foot arch, valgus deformity of the heel, and abduction of the forefoot. It is commonly encountered in primary care settings. The prevalence of flatfoot is estimated between 3% and 25% in the general population based on studies in healthy volunteers.12 In 1989, Johnson and Strom3 created a three stage classification system for adult acquired flatfoot deformity. This was further modified by Myerson4 with the addition of a fourth stage in 1997 (table 1). Causes of flatfoot include posterior tibial tendon dysfunction, trauma, inflammatory arthritis, Charcot arthropathy, and congenital causes such as tarsal coalition.5 The most common cause in adults is posterior tibial tendon dysfunction.6 It is associated with obesity, diabetes mellitus, hypertension, trauma, and corticosteroid injections.7 The symptomatic flatfoot presents with medial arch pain and can affect gait.8 Untreated symptomatic flatfoot in the long term can become a rigid deformity, which will further affect the patient’s quality of life. Despite this, there are few publications or guidance for management of adult flatfoot in primary care. This article aims to give a systematic approach to manage a patient presenting with symptomatic flatfoot.

View this table:
Table 1

Myerson modification of Johnson and …

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