The typical patient is a woman between 45 and 65 with a history which often extends over some years. Like many patients with an insidious, relatively uncommon problem they may be used to their complaints not being taken seriously or put down purely to obesity. The commonest complaints are:
- posteromedial ankle pain and swelling, usually clearly related to the tibialis posterior tendon
- anteromedial ankle pain, related to the deltoid ligament
- sinus tarsi pain due to lateral subtalar impingement
- medial arch aching, sometimes going into the sole
- progressive planovalgus deformity – this is the primary complaint in relatively few patients
- a few have neurological complaints in the forefoot – there is a recognised association with tarsal tunnel syndrome
It is important to enquire about:
- inflammatory joint disease, including extra-articular features, inflammatory bowel disease and psoriasis
- trauma to the foot
- whether the foot has always been flat and whether the shape has actually changed
- what treatment has been tried before, particularly orthotics
All patients are routinely asked about:
- diabetes
- neurological disease
- circulatory problems
- family history of foot problems, arthritis or neurological disease
Sometimes the patient was not conscious of having "flat feet" although the opposite foot is obviously flat. Some patients are not particularly conscious of even quite gross planovalgus deformity and complain mainly of pain.