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Overpronation of the Subtalar Joint Causing Flat Feet

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
When the subtalar joint in your foot is misaligned, it has a knock on effect to the rest of the joints in the foot, knee and hips. One such problem is a slowly progressive problem that causes excessive strain on the posterior tibial tendon, the main tendon holding up the arch of your foot. Another common issue is knee pain (find out more here) and bunions.
Over time this important tendon becomes dysfunctional, resulting in the development of chronic tears and damage to the tendon. The consequence of this is chronic pain and a significant limitation of activities, such as avoiding walking or standing or limping due to the foot pain. Early treatment consists of wearing a custom foot orthotic inside your regular enclosed shoes, sports shoes or school shoes to realign the subtalar joint.
How Your Arches Fall
The ‘acquired’ flatfoot is a progressive, sometimes painful condition resulting from gradual stretch of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. It was not present at birth, but developed over time. It can be worse in one foot compared to the other.
In the acquired flatfoot, pain occurs because the soft supporting tissues (tendons and ligaments) of the joint have been torn. It worsens because once the vital ligaments and posterior tibial tendon stretch, nothing else can hold the bones in place and the foot’s arch drops.
A person with flat feet has greater load placed on the foot arch’s posterior tibial tendon, the main tendon unit supporting up the arch of the foot. The tendon can stretch over time due to hormonal changes (especially during pregnancy), due to other medical treatments such as chemotherapy, an increase in body weight, amongst a range of factors. It is not a sudden event in most cases, but is a slow, gradual stretching followed by inflammation and degeneration of the tendon.

Once this posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down. The foot rolls in at the ankle in a movement called over-pronation. The arch appears collapsed, and the heel bone is tilted to the inside. This can progress until the foot literally dislocates outward from under the ankle joint in the most extreme cases.
Diagnosis
The most accurate diagnosis is made by a skilled Podiatrist utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable, as part of an overall assessment called a lower limb biomechanics assessment.
Treating Flat Feet
Acquired flatfeet are best treated early – hence we advise all children aged 4/5 years old to have a foot screening to pick up any issues early. There is no recommended home treatment other than the general avoidance of prolonged weight bearing in non-supportive footwear such as flip flops or ballet pumps, until the patient can be seen and treated by a Podiatrist.
Treatment with custom made orthotics worn inside regular enclosed footwear is critical to maintain stability of the foot and ankle and to allow the muscles and tendons to tighten and tone, regaining correct foot posture and function.
For assessment and treatment of flat feet, contact the expert team at Dubai Podiatry Centre, headed by Chief Podiatrist Michelle Champlin, on +971 4 3435390.


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