Is the answer to flat feet, which only become painful with age, early treatment?

An elderly woman entered the clinic with a cane, limping and in severe pain. The pain had been gradually spreading across her foot arch, outer heel, and the achilles tendon for years, treated multiple times at various hospitals. Though the pain temporarily subsided after treatment, it returned soon afterward, making her unable to enjoy outings.

The patient lamented, "I've known I'm flat-footed since I was young. Why does this painful foot only appear as I age?" In the clinic, the physician observed her as weight was placed on it, noting how the foot arch collapsed, revealing a severely deformed arch and unstable stance. However, the most significant issue was the chronic pain that persisted even without weight on the foot, making surgery uncertain.

The physician explained, "For severely painful flat-foot, the only effective treatment is an operation that reshapes the heel bone to correct the foot shape, but it's uncertain if the patient's long-lasting pain would allow for a successful surgery." The patient sighed deeply, accepting the reality. Their main reason for seeking treatment was to avoid pain and live comfortably.

The physician, though aiming to address the root cause, felt a deep sense of helplessness and pity for the 70-year-old patient with chronic pain. The essence of adult flat-foot is 'extremely flexible feet.' The ligaments become too lax, causing instability under weight-bearing and force. As a result, various pain conditions such as achilles tendonitis, deep peroneal nerve pain, and posterior tibial tendonitis occur.

These symptoms are not separate diseases but manifestations of the structural problem in flat-foot. Although the concept of adult flat-foot as a progressive collapsing foot deformity has become clearer in recent years, the most challenging aspect in clinical practice is deciding when to perform surgery. Ideally, surgery should be done between the ages of 10 and 20, before bones become rigid and postoperative complications are minimal.

However, if this window is missed, the recovery rate after surgery is still promising at age 50. The problem lies in the fact that symptoms often appear in the 60s and 70s, when the muscles and ligaments are weak. Even for older patients with good health management, surgery can still be successful, though recovery takes longer compared to younger patients.

From the physician's perspective, the uncertainty of when the patient will fully recover makes them constantly worried. Conservative treatments, such as custom orthotics to support the inner arch and strengthening exercises for foot muscles, are the most important. While they cannot fundamentally change the foot shape, they can delay the onset of symptoms and manage them.

However, if a patient is unwilling to adopt an active lifestyle despite the lack of response to conservative treatment, surgical options should be considered. At the very least, patients should not miss the opportunity to discuss surgical possibilities.