Flat Feet (Fallen Arches)

• Congenital Vertical Talus:  In this condition, there is no arch because the foot bones are not aligned properly.  In some cases, there is a reverse curve (rocker-bottom foot) in place of the normal arch.  Congenital vertical talus is a rare condition present at birth.  It often is associated with a genetic disorder such as Down syndrome or other congenital disorders.  The cause is unknown in up to half of cases.
• Tarsal Coalition (Peroneal Spastic Flat Foot):  In this rare, inherited condition that often affects several generations of the same family, two or more of the foot bones are fused together, interfering with the flexibility of the foot and eliminating the normal arch.
• Lateral Subtalar Dislocation:  Sometimes called an acquired flat foot, it occurs in someone who originally had a normal foot arch.  In a lateral subtalar dislocation, there is a dislocation of the talus bone, located within the arch of the foot.  The dislocated talus bone slips out of place, drops downward and sideways and collapses the arch.  It usually occurs suddenly because of a high-impact injury related to a fall from a height, a motor vehicle accident or participation in sports, and it may be associated with fractures or other injuries.

• Congenital Vertical Talus:  The foot of a newborn with congenital vertical talus typically has a convex "rocker-bottom" shape, like the bottom rails of a rocking chair.  This is sometimes combined with an actual fold in the middle of the foot.  The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be.  If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body.
• Tarsal Coalition:  Many people have no symptoms, and the condition is discovered only by chance when an xray of the foot is obtained for some other problem.  When symptoms occur, there is usually foot pain that begins at the outside rear of the foot, then spreads upward to the outer ankle and to the outside portion of the lower leg.  Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground.  In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
• Lateral Subtalar Dislocation:  Because this often is caused by a traumatic, high-impact injury, the foot may be significantly swollen and deformed.  There also may be an open wound with bruising and bleeding.

• Congenital Vertical Talus:  At first, some doctors try a procedure called serial casting.  The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually.  This generally has a low success rate.  Most people ultimately need surgery to correct the problem.
• Tarsal Coalition:  Treatment depends on your age, extent of bone fusion and severity of symptoms.  For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast.  For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot.
• Lateral Subtalar Dislocation:  The goal is to move the dislocated bone back into place as soon as possible.  If there is no open wound, the doctor may push the bone back into proper alignment without making an incision.  Anesthesia is usually given before this treatment.  Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently.  About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.