Flat Feet: X-Ray Measurements and Running Discomfort

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Hello, Doctor:
1.
You mentioned that many factors can affect the measurement results of flatfoot.
Is there a significant difference between standing X-rays and lateral X-rays? I had two standing lateral X-rays (at different hospitals), one showed 164 degrees and the other 155 degrees, which is nearly a 10-degree difference despite being the same type of lateral X-ray.
In another hospital, the lateral measurement was 167 degrees.
There seems to be a considerable discrepancy between all these results.
The doctor once told me that using computer-assisted measurements can lead to significant variations with slight adjustments.
If I go to a medical center for flatfoot arch angle assessment, will the results be more accurate? Additionally, when I stand for long periods, I feel slight swaying in my body and tight pain in my feet, sometimes accompanied by a tingling sensation.
Is this caused by flatfoot?
2.
Regarding frog leg deformity or calcaneal coalition, will these conditions affect running? I often feel discomfort in my feet while running, experiencing particular soreness or pain.
Could this be related to frog leg deformity or calcaneal coalition? I have consulted several doctors about this issue, but some do not seem interested in specifically diagnosing the symptoms, believing they do not impact daily life.
Therefore, I am unsure if doctors at the medical center will consider this a trivial matter.
Thank you for your response, Doctor! I apologize for bothering you, but the doctors I visit do not provide as detailed answers as you do here!

Lai, 20~29 year old female. Ask Date: 2011/10/01

Dr. Li Wenlin reply Orthopedics

Hello Lai,
1.
Theoretically, there is a certain margin of error in the standing measurements for flat feet, but the differences of 164 degrees, 155 degrees, and 167 degrees are indeed too significant.
The previous three examinations were all below 168 degrees, so the likelihood of a re-examination showing a value greater than 168 degrees is very low.
I still recommend that you go to the military service medical examination hospital (you can inquire with the military service office in your registered residence) or a medical center (which will definitely have military service examination facilities) for a check-up.
As for the margin of error, you should trust the physician, as they are not infallible!
2.
Regarding frog leg deformity or calcaneal varus, it can indeed affect running, but the impact is minimal.
Therefore, orthopedic surgeons tend to choose conservative treatment (mostly observation), as these symptoms do not significantly affect daily life.
3.
As for what issues warrant a visit to a medical center, it is because you have already consulted so many hospitals and physicians, leading to increased confusion.
In this case, the best approach is to seek an authority (medical center), such as Dr.
Jiang Qingquan from the Orthopedic Department at National Taiwan University Hospital, Dr.
Chen Tianxiong, the Deputy Director of Orthopedics at Taipei Veterans General Hospital, Dr.
Xu Hongchang from the Orthopedic Department at China Medical University, or Professor Lin Qizhen from Cheng Kung University Hospital, etc.
I believe this can help clarify your confusion.
Wishing you all the best,
Li Wenlin

Reply Date: 2011/10/01

More Info

Understanding flat feet, also known as pes planus, involves recognizing how various factors can influence the measurement of foot arch angles and the discomfort experienced during activities like running. Your concerns about the discrepancies in X-ray measurements and the associated symptoms are valid and warrant a thorough discussion.

1. X-Ray Measurements of Flat Feet: The angle of the foot arch can indeed vary significantly based on the positioning during X-ray imaging. Standing X-rays capture the foot in a weight-bearing position, which can reveal the functional alignment of the foot under load. In contrast, lateral X-rays taken while seated or in a non-weight-bearing position may not accurately reflect the foot's behavior during activities like walking or running. The differences you noted—164 degrees, 155 degrees, and 167 degrees—could stem from slight variations in foot positioning, the angle of the X-ray beam, or even the technique used by different radiology departments.
If you seek a more precise assessment, visiting a specialized medical center with advanced imaging techniques and experienced radiologists may yield more consistent results. They can ensure that the X-rays are taken under standardized conditions, which can help minimize variability in measurements.
Regarding your symptoms of body swaying, tightness, and occasional numbness in the feet, these can indeed be related to flat feet. Flat feet can lead to altered biomechanics, causing strain on the muscles and ligaments of the foot and lower extremities. This strain can manifest as discomfort, fatigue, or even numbness, especially after prolonged standing or walking.

2. Impact of Frog Legs and Calcaneal Varus: Conditions like frog legs (a term often used to describe a specific alignment of the legs) or calcaneal varus (where the heel tilts inward) can influence how forces are distributed through the foot during activities like running. If your feet are not properly aligned, it can lead to discomfort or pain, particularly in the arches, heels, or even the knees and hips.
The discomfort you experience while running—characterized by soreness or pain—could indeed be linked to these anatomical variations. When the foot's structure is compromised, it can lead to inefficient movement patterns, resulting in increased stress on certain areas of the foot and leg.
While some healthcare providers may downplay the significance of these conditions, it's essential to advocate for your health. If you feel that your symptoms are affecting your quality of life or athletic performance, seeking a second opinion or consulting with a specialist in sports medicine or podiatry may be beneficial. They can provide a more comprehensive evaluation and suggest appropriate interventions, such as custom orthotics, physical therapy, or specific exercises to strengthen the foot and improve alignment.

In summary, the discrepancies in your X-ray measurements highlight the importance of standardized imaging techniques for accurate diagnosis. Your symptoms of discomfort during standing and running may indeed be related to flat feet and other anatomical variations. Seeking specialized care can help address these issues and improve your overall foot health and comfort during activities. Don't hesitate to pursue further evaluations and treatments that can enhance your quality of life and athletic performance.

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