Appointment
Appointment
  • 773-775-0300Call today!
  • 6560 W Higgins Ave.Chicago, Illinois
Appointment

The Stages of Flat Feet

Classification systems are in use everyday in the medical field. Everything from kidney, and heart disease, to the stages of cancer, right down to the pathology or problems found in the feet. The staging systems enable clinicians to organize their thoughts when evaluating conditions, communicate with other physicians, and discuss prognostics (or future course of the disease) based on the level of disease. Having flatfeet and a condition called posterior tibial tendon dysfunction (PTTD) go hand-in-hand. There are four stages to PTTD. One textbook states that the stages of PTTD should be viewed as a “syndrome in which there is a spectrum of clinical presentations.”1 In a recent post, I mentioned the last stage of flatfeet, “flattest of the flat,” in which I described the last and final stage. The PTTD, or flatfoot can be viewed as a progressive dsisorder, in which a patient progresses from one stage the next over time.

The Visible Spectrum

The Flatfoot Spectrum (stages 1-4)
The location of the pain, function of the posterior tibialis tendon, and amount of deformity will typically distinguish one category from another. Using the diagram below will help in understanding the different terms that are used to describe this condition.

Stage I
Pain and swelling are the hallmarks of this stage. The pain is generally located along the course of the posterior tibial tendon, as seen in the image to the left, and at the end of the tibia bone, called the medial malleolus. Function of the posterior tibial tendon is preserved at this stage, and major deformity, i.e. hind foot valgus, and too-many toes sign, are absent. Part of the examination at this in every stage is to ask the patient to perform a single toe raise, meaning that with one foot off the ground, the patient goes up on there could be toes on the other leg. This maneuver usually only causes pain with repetition.

Foot Joints

Stage 2
At this stage, the tendon starts to stretch out and degenerate. There is obvious deformity present as well. As noted in the image above, there is hind foot valgus, and the forefoot may have started to abduct or turn outward. Further deformity at this stage includes collapse of the medial or inner arch of the foot, or collapse of the talonavicular joint. Although there is deformity present, the deformity remains “flexible.”

Stage 3
By the time a patient reaches stage 3, the deformity becomes rigid. The deformity of the forefoot is demonstrated in the image to the right and is called “forefoot varus.” When the patient is standing flat, the arch is collapse. In this stage, the deformity at the hindfoot (heel) and forefoot can no longer be reduced. There is tightening of the posterior muscle group, (the calf muscles). Usually, by this stage there is no longer pain on the inside of the foot or ankle, and it is all moved to the outside of the foot. Most patients will describe this as outside of the ankle pain, at the fibula or just below it. Pain at rest is common as the arthritic process sets in.

Locations

Locations

The forces involved in this deformity will overtime create an arthritic condition. In the case of flatfoot, the wear and tear on the foot and its structures progresses towards arthritis and changes in which the tendons and ligaments don’t support the bones and the bones rub away the cartilage at the joints leading to arthritis. Stage four or endstage flatfoot is an arthritic foot condition. The pain described in stage 3 is more due to ankle arthritis than it is to the structures encroaching on one another.

Images:
1. http://www.tissuegroup.chem.vt.edu/chem-ed/light/em-spec.html
2. www.geminipt.com
3. Mann’s Surgery of the Foot and Ankle, Chapter 25, figure 25-4

References:
1. Mann’s Surgery of the Foot and Ankle

Stage 4

  • Share this post

Previous Article Plantar warts - CO2 Laser and Surgical Excision
Next Article A few thoughts on injections

Comments

  1. Wow, superb blog layout! How long have you been blogging for?

    you made blogging look easy. The overall look of your
    web site is magnificent, as well as the content!

  2. Hi there I am so happy I found your blog, I really found you by
    accident, while I was researching on Aol for something else,
    Nonetheless I am here now and would just like to say cheers for a
    tremendous post and a all round enjoyable blog (I also llve the
    theme/design), I don’t have time to browse it all at the
    minhte but I have bookmarked it and also included your RSS feeds, so
    when I have time I will be back to read a lot more, Please do keep up the superb work.

  3. I think other web-site proprietors should take this web site as an model, very clean and magnificent user friendly style and design, as well as the content. You’re an expert in this topic!

  4. I am usually to running a blog and i actually recognize your content. The article has really peaks my interest. I am going to bookmark your site and keep checking for new information.

  5. It’s hard to come by experienced people for
    this subject, but you sound like you know what you’re talking about!
    Thanks

  6. An outstanding share! I’ve just forwarded this onto a coworker
    who has been conducting a little homework on this. And he in fact ordered
    me dinner simply because I found it for him… lol. So let me reword this….

    Thank YOU for the meal!! But yeah, thanx for spending the time to talk about this issue here on your web site.

  7. I love your blog.. very nice colors & theme.
    Did you design this website yourself or did you hire someone to do it for
    you? Plz respond as I’m looking to construct my own blog
    and would like to know where u got this from. thanks a lot

  8. Hello there, I found your site by the use of Google
    at the same time as looking for a comparable topic, your web site came
    up, it seems great. I have bookmarked it in my google bookmarks.

    Hi there, simply changed into aware of your blog thru Google, and found that it’s truly informative.
    I’m gonna be careful for brussels. I will be grateful for those who proceed this in future.
    Lots of folks can be benefited from your writing. Cheers!

  9. I blog often and I really appreciate your information. This article
    has truly peaked my interest. I will take a note of your site and keep checking for
    new details about once per week. I subscribed to your Feed too.

  10. I am curious to find out what blog platform you have been using?

    I’m experiencing some minor security problems with my latest website
    and I’d like to find something more risk-free. Do
    you have any solutions?

  11. When someone writes an paragraph he/she maintains the plan of a
    user in his/her mind that how a user can be aware of it.
    Thus that’s why this piece of writing is great.
    Thanks!

  12. If you wish for to increase your knowledge only keep visiting this web site and be
    updated with the latest gossip posted here.

  13. Hey there would you mind letting me know which web host you’re utilizing?
    I’ve loaded your blog in 3 different browsers and I must
    say this blog loads a lot faster then most. Can you recommend a
    good internet hosting provider at a honest price? Thanks a lot, I appreciate it!

  14. You could certainly see your skills within the work you write.
    The world hopes for more passionate writers like
    you who are not afraid to mention how they believe.
    Always go after your heart.

  15. Wonderful goods from you, man. I’ve understand your stuff previous to and you’re just
    extremely magnificent. I actually like what you have acquired here, really like what you’re saying and the way in which you say
    it. You make it enjoyable and you still care
    for to keep it sensible. I cant wait to read much more
    from you. This is really a great web site.

  16. You really make it seem so easy with your presentation but
    I find this matter to be really something
    which I think I would never understand. It seems too complex and extremely broad for me.
    I’m looking forward for your next post, I’ll try
    to get the hang of it!

Leave a Comment