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Many patients have a low arch when standing, but this doesn't necessarily mean that treatment is required. However, many patients will develop pain in association with a flatfoot where the mid and rearfoot (hindfoot) joints become collapsed and misaligned. There are several causes with names such as collapsing pes valgo planus (CPVP), tibialis posterior dysfunction and hyperpronation. Rarely children are born with hindfoot bones misaligned (e.g. vertical talus) and bones that are joined together, which should be separate (tarsal coalitions). These tend to cause a very inflexible or rigid flatfoot. The majority of presenting flatfoot conditions seen in our clinics are "adult acquired flatfoot" deformities.

What is hyperpronation?

Pronation is a normal motion of the foot. Specifically, it is the complex motion between the ankle bone, which rotates inwards, and causes the foot arch to lower. This is a very important function of the foot to aid walking, especially on uneven ground.

Hyperpronation is a very common deformity where there is too much pronation occurring in the foot. This increased abnormal motion closes down the "sinus tarsi" under the ankle bone, causing the foot arch to collapse and the knee to rotate inwards. This can lead to many symptoms in the foot, ankle, knee, hip and lower back.

Symptoms

May present in a variety of ways, ranging from arch pain, swelling and pain under the ankle bone and joint aches. Pain can also be caused higher up, for example in the knee hip or lower back due to the general poor posture of the foot which rotates the leg inwards.

Can this cause real damage?

Certainly; one condition in particular seen regularly in our clinics is "Tibialis Posterior Dysfunction Syndrome". In simple terms this is when one of the important muscle/tendon groups around the inside of the ankle and foot becomes stretched, torn or even completely ruptured. Important supporting ligaments which maintain the strength of the arch can also become stretched and damage and over time it is likely that wear and tear joint (osteo) arthritis will develop.

What are my treatment options?

Depending on the severity and length of your symptoms, we may organize some tests such as x-rays, ultrasound or MRI scans to look at the alignment of the foot and any potential; damage to the soft-tissue and joints. This will inform on the treatment choices, which could include insoles (orthoses), ankle bracing; physiotherapy or reconstructive surgery.

What type of Flatfoot Surgery is available?

Flatfoot Surgery has changed enormously over the last 30 years and some recent developments such as the Hyprocure sinus tarsi stent are giving exciting results. If you have significant tendon damage then this will need to be repaired. The malposition of the foot can also be corrected by a variety of bone and joint procedures. Generally these are major flatfoot surgery corrections with a protracted recovery, but results are usually very rewarding for the patient.

The Hyprocure implant procedure

Is a conservative surgical procedure where a device is inserted into the pre-exisitng space (sinus tarsi) between the ankle (talus) bone and the heel (calcaneus) bone. This idea has been around since the early 1900s and is the simplest method for correcting hyperpronation and abnormal motion but allowing normal motion to occur.

Advantages of the Hyprocure procedure for Flatfoot Correction

• Best anatomically developed implant for the sinus tarsi
• Far less trauma than other flatfoot correction procedures
• Minimally invasive with only one small incision (around 2cm)
• No cast required
• Will not wear out
• Easily removed (fully reversible) if not tolerated
• Does not set off airport metal detectors
• Back in regular shoes within a week
• No limitations to activity once the implant site has healed

NB Additional flatfoot surgery procedures may be required which will increase the recovery time.

For more information on flatfoot surgery please download the P12 and or Hyprocure Info documents from Information Leaflets.