Understanding Peroneal Spastic Flatfoot: Etiology, Clinical Features, Treatment Options, and Their Impact on Mobility and Quality of Life

Peroneal spastic flatfoot is a condition that affects the foot and ankle in a unique way creating a flatfoot deformity with a broken down or weak arch. This deformity is caused by many different types of medical problems, the most common being a talar osteochondral lesion and/or accessory talar facet impingement. These problems create inflammation or damage in the ankle joint and create significant muscle imbalances that cause the muscles on the outside of the lower leg, called the peroneal muscles, to become spastic. This creates difficulty maintaining the foot in a correct position leading to substantial changes in both the way a patient walks (gait) and the way their foot functions.

Peroneal spastic flatfoot is a serious clinical condition that affects patients of all ages. Typically, patients have pain on the outside of the foot and/or ankle that makes it very difficult for them to walk. Many have a visible flatfoot deformity, where the arch of the foot is abnormally low or absent. The foot may swell, feel sore, or be tender to the touch, especially after a long day of standing or walking. People with peroneal spastic flatfoot often have muscle cramping and spasms, frequently affecting patients while they are active, during certain positions, or even at rest. These symptoms can have a dramatic impact on a patient’s quality of life and limit them from participating in activities that most take for granted, such as walking a few blocks, climbing stairs, or even standing for a long period of time.

Peroneal spastic flatfoot, a painful condition of the foot and ankle, can severely limit individuals’ mobility and ability to perform normal activities. Often, those affected report difficulty in engaging in many day-to-day activities and some reported worsening quality of life. Being unable to participate in recreational and social events with family and friends, such as sporting events, playing with children, or walking with a friend for ice cream, can have a tremendous impact. People with pdsFTS are often unable to walk without pain and may become less active, further worsening health by causing obesity or, in extreme cases, even depression. Whether pdsFTS hinders your ability to work, exercise, go out for dinner, or just spend time with family and friends, there is no aspect of life that it does not affect.

In addition to the above symptoms, having trouble walking or completing daily activities can cause lots of stress and be frustrating to patients with peroneal spastic flatfoot. Patients may feel sad that the condition affects their daily life and keeps them from completing their usual work and activities with their family. While it is important for patients and families to know the signs and symptoms of peroneal spastic flatfoot, it is equally important for healthcare providers to have a complete understanding of the specific signs and symptoms of Peroneal spastic flatfoot as well, so that they can prescribe appropriate treatment. The treatment for peroneal spastic flatfoot is quite variable and is generally individualized. Non-surgical, “conservative” treatments are usually begun first and can help relieve symptoms of pain and difficulty walking, and aid in obtaining more foot function. One common conservative treatment for children and adults is serial casting. In this treatment, a cast is molded to the lower extremity and left on the foot and leg for several weeks, after which time, the foot and leg have grown. The cast is then removed and a new, longer cast is made, allowing the foot to continue grow in a more normal position. Serial casting allows for the gentle and gradual stretching of the tight muscles and tendons of the foot and lower leg which contribute to the painful and deformed flatfoot seen in Peroneal spastic flatfoot.

Another conservative method to treat this condition involves the use of botulinum toxin injections. These cause the overactive muscles, especially those of the peroneal muscles, to weaken temporarily. According to Uçan et al. ( 2023), patients treated with these injections had reduced muscle spasticity and subsequent pain and improved ability to perform foot functions and activities of daily living. These treatments are not permanent fixes, but can return patients to active life quite comfortably and quickly.

While there are conservative options available to manage spastic flatfoot with pain, in some cases surgical intervention is needed. If pain and functional limitations are not relieved by more conservative measures, surgery can be indicated. While different surgical procedures can be applied to treat adult spastic flatfoot, Lowy (1998) describes tendon lengthening as well as realignment of tendons and bones to correct abnormal positioning of the foot. Whitman (2010) points out that a careful choice of procedure is critical and based on a number of factors.

Outcomes following various treatment options can vary considerably. Less invasive treatments allow for operation on the body in its most natural state and generally involve the least amount of risk to the patient. While most patients who undergo conservative treatment notice a marked increase in mobility and experience a general enhancement to their quality of life, some individuals may be left with persistent difficulties that prevent participation in strenuous activities.

While surgical interventions may include significant risks and prolonged recovery periods, they often result in more durable corrections and can provide a long-term solution to managing painful foot symptoms. According to Kinoshita et al. ( 2005) patients who underwent surgical correction of peroneal spastic flatfoot experienced improvement in activity level, pain reduction, and high levels of foot function-related patient satisfaction. Treatment whether conservative or surgical, as described by Xu et al. ( 2015), can greatly affect a patient’s quality of life related to this deformity.

Importantly, Flatfoot requires a comprehensive approach to its treatment, addressing the physical deformation of the foot and its related symptoms, as well as the impact on mobility and social interaction. With the right treatment and care, healthcare providers can help people with Flatfoot to take back control of their lives.

Citations:

Blair, J., Perdios, A. and Reilly, C.W., 2007. Peroneal spastic flatfoot caused by a talar osteochondral lesion: a case report. Foot & ankle international, 28(6), pp.724-726. https://journals.sagepub.com/doi/abs/10.3113/FAI.2007.0724

Kinoshita, M., Okuda, R., Yasuda, T. and Abe, M., 2005. Serial casting for recalcitrant peroneal spastic flatfoot with sinus tarsi syndrome. Journal of Orthopaedic Science, 10(5), p.550. https://search.proquest.com/openview/3ce19761ae56186b59e1754a60894b21/1?pq-origsite=gscholar&cbl=54475

Niki, H., Aoki, H., Hirano, T., Akiyama, Y. and Fujiya, H., 2015. Peroneal spastic flatfoot in adolescents with accessory talar facet impingement: a preliminary report. Journal of Pediatric Orthopaedics B, 24(4), pp.354-361. https://journals.lww.com/jpo-b/fulltext/2015/07000/peroneal_spastic_flatfoot_in_adolescents_with.16.aspx

Hadano, Y., Kimura, T., Kubota, M. and Saito, M., 2022. Refractory peroneal spastic flat foot successfully treated with a cast in a girl. BMJ Case Reports CP, 15(3), p.e248979. https://casereports.bmj.com/content/15/3/e248979.abstract

Uçan, V., Demirel, M., Aliyev, O., Yıldız, F. and Uzer, G., 2023. Surgical management and outcomes of patients with idiopathic peroneal spastic flatfoot: a retrospective case series. Journal of the American Podiatric Medical Association, 113(1). https://japmaonline.org/view/journals/apms/aop/21-210/21-210.xml?alreadyAuthRedirecting

Lowy, L.J., 1998. Pediatric peroneal spastic flatfoot in the absence of coalition. A suggested protocol. Journal of the American Podiatric Medical Association, 88(4), pp.181-191. https://japmaonline.org/view/journals/apms/88/4/87507315-88-4-181.xml

Xu, J., Muhammad, H., Wang, X. and Ma, X., 2015. Botulinum toxin type A injection combined with cast immobilization for treating recurrent peroneal spastic flatfoot without bone coalitions: a case report and review of the literature. The Journal of Foot and Ankle Surgery, 54(4), pp.697-700. https://www.sciencedirect.com/science/article/pii/S1067251614001082

Harris, E.J., Vanore, J.V., Thomas, J.L., Kravitz, S.R., Mendelson, S.A., Mendicino, R.W., Silvani, S.H. and Gassen, S.C., 2004. Diagnosis and treatment of pediatric flatfoot. The Journal of foot and ankle surgery, 43(6), pp.341-373. https://www.jfas.org/article/S1067-2516(04)00460-0/abstract

Pedowitz, W.J. and Kovatis, P., 1995. Flatfoot in the adult. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 3(5), pp.293-302. https://journals.lww.com/jaaos/fulltext/1995/09000/flatfoot_in_the_adult.5.aspx

Whitman, R., 2010. The classic: A study of the weak foot, with reference to its causes, its diagnosis, and its cure; with an analysis of a thousand cases of so-called flat-foot. Clinical Orthopaedics and Related Research®, 468(4), pp.925-939. https://link.springer.com/article/10.1007/s11999-009-1130-1