When standing, most people have a gap under the arch of their foot. Flat feet, or pes planus is the term used to describe collapsed arches, meaning that the entire sole of the foot rests partially or completely on the ground. A simple way to check to see if you have flat feet is to wet your feet and step onto a dry, flat surface. Step away from your footprint; if you see a complete footprint, you more than likely have flat feet. If you only see toes, the pads of your feet, and your heels, you probably do not have flat feet.
People who have flat feet usually roll their feet over to the inner side when they walk. The feet may even appear to point outward because of this movement. In most cases, the condition cannot be prevented.
There are three types of flat feet: flexible flatfoot, painful rigid flatfoot, and spasmodic flatfoot. Flexible flat feet have some arch, even if the arch only appears while the person is flexing the foot or standing on their toes. Flexible flat feet may not cause pain or require treatment. Painful rigid flatfoot, on the other hand, is abnormal and causes pain, stiffness, and the inability to flex the foot. This often indicates that there is a problem with the bones in the foot, a disease is present, or an injury has occurred. Spasmodic flatfoot involves the foot being forced outward by spasmodic contractions of the peroneal muscle.
Flat Feet Symptoms
Most people do not exhibit any symptoms of flat feet, but if the condition is due to an underlying problem, symptoms can include:
- “Rolled-in” ankle (overpronation)
- Foot pain, mainly in the arch or heel areas
- Difficulty standing on tiptoes
- Swelling that occurs on the inside of the ankle
- Pain in the calf, knee, hip, or lower leg area
- Pain in the heel, arch, ankle, or along the outside of the foot
- Shin splints (pain in shin bone)
- Both feet lie flat on the ground with no gap
- Shoes may not fit properly
- Heel may tilt away from the midline of the body more than usual
- Absence of foot arch when standing
If you are experiencing these symptoms and have flat feet, you should consider seeing your doctor or a podiatrist immediately for an examination.
Flat Feet in Infants and Children
Infants and toddlers are flat footed because their arches are not fully developed. Most infants exhibit flat feet, but this is normal since most infants still have baby fat, which hides the arch formation. Arches begin to develop when a person reaches childhood, or by the age of 3–5. As the child grows and learns to walk, the soft tissues in the foot begin to tighten and form the arch. In most cases, the child will grow out of the condition and develop an arch before reaching adolescence. It’s important to remember that the muscles, bones, tendons, and ligaments are still in development. By the time the child has reached double digits in age, he or she should have developed normal arches. Children who complain of pain and have flat feet may suffer from a condition known as tarsal coalition. Tarsal coalition occurs when two or more bones in the foot fuse together. This causes great pain while walking, and shoes with arches are not helpful and can make the condition worse.
Flat Feet in Adults
By adulthood, most people develop normal arches. However, many adults endure physiologic or structural changes that cause deformity in their foot, which typically results in a condition known as adult-acquired flatfoot deformity or AAFD. Older adults (i.e., people 60–70 years old) are said to be more prone to pronation and pes planus because they don’t participate in activities as often, gain weight with age, and have biomechanical imbalances.
The condition of flat feet in adults is known as “fallen arches.” Not all adults develop flat feet, and some people are more prone to developing the condition than others. An obese person puts extra weight on their feet while walking or standing. Over time, this can weaken the components that make up the arch and cause the arch to collapse. A woman who is pregnant may also suffer from flat feet during her pregnancy. The problem with developing flat feet as an adult is that in most cases the changes are permanent, if not bothersome. Doctors recommend using custom-made orthotics in shoes to treat the problem.
Flat feet were once considered a result of poor health, but it has been proven that athletes such as runners, who are in great condition, also suffer from flat feet. In fact, it’s very common among track runners.
Flat feet were once thought of as a bad thing. But studies show that people with higher arches are four times more likely to injure or sprain their ankles than people with flat feet. Studies conducted by the military have discredited the idea that flat feet are a reason to be excused from service.
What Causes Flat Feet?
There are many reasons why flat feet develop. Here’s a look at some of the most common causes:
- Weak arches
- Wear and tear on feet
- Tibialis posterior (ruptured tendon)
- Nervous system or muscle diseases such as cerebral palsy
- Weakness and tightness of other muscles and tendons higher up in the lower extremity
The way our arches form depends on several factors. Our feet are complex structures that comprise twenty-six bones, thirty-three joints, and more than 100 muscles, tendons, and ligaments each. Each foot forms two arches. The arch that runs from the heel to the toe is known as the longitudinal arch, while the one that runs the width is known as the transverse arch. Ligaments (fibrous tissues) give our arches their shape and hold our bones together. The plantar fascia (the long, strong band of connective tissue that runs along the sole of your foot) and muscles add secondary support. There are also foot pads that absorb impact and assist with weight-bearing functions. How these things intertwine and work together determines the formation of our arches. A structural abnormality or injury to one of these components can result in flatfoot.
Diagnosing Flat Feet
You can always give yourself the “wet test” described above to see whether you have flat feet. Most people who do not notice their flat feet or have no pain associated with them do not think to see a foot doctor. Flat feet can lead to additional problems such as stiffness or pain, however, especially if the condition appears out of nowhere. If you think you may have flat feet, you should seek medical attention to ensure there are no additional issues to worry about. Your doctor will be able to diagnose you with a number of tests. For example, he or she may have you walk around, stand still, or stand on your tiptoes while you are being examined. Your doctor may also examine your foot’s shape and functionality.
It’s important to let your foot doctor know about your medical and family history. In some cases, your doctor may order imaging tests such as x-rays or an MRI (magnetic resonance imaging) to determine a cause of your flat foot. If tarsal coalition is suspected in children, a CT scan is often ordered.
Flat Feet Treatment
If the condition is not bothering you or preventing you from being mobile, you may not need treatment (depending on your doctor’s diagnosis). Generally, treatment is reserved for those who have additional problems. Still, your doctor will probably recommend a simple treatment plan for your condition. This treatment may include:
- Rest and icing the arch
- Changing footwear
- Anti-inflammatory medication
- Using orthotics
- Over-the-counter medication such as ibuprofen
- Physical therapy
- Corticosteroid injection (usually used in cases of severe pain)
If these methods do not relieve symptoms of flat feet, your doctor may recommend surgery to reduce pain and improve the alignment of your bones. Generally one of the following procedures is used to surgically repair a flat foot or fallen arch:
- Arthrodesis: One or more of your bones in the foot or ankle are fused together.
- Osteotomy: Correcting alignment by cutting and reshaping a bone.
- Excision: Removing a bone or a bone spur.
- Synovectomy: Cleaning the sheath that covers the tendon.
- Tendon transfer: Using a piece of one tendon to lengthen or replace another.
- Arthroereisis: placing a small device in the subtalar joint to limit motion
For most people, treatment is successful, regardless of the cause, although the cause does does play a major role in determining your prognosis. Some causes do not need treatment, while others require a surgical fix.
Complications of Flat Feet
Most people do not experience any complications with this condition. In fact, the only true complication in most cases is the pain. Some people who have fusions lose some ankle motion, especially the ability to the foot inward or outward. Although most surgical procedures yield satisfactory results, some people continue to experience pain. One problem is that if flatfoot develops in adults, it is typically irreversible. Additional complications include:
- Corns and calluses
- Plantar fasciitis
- Aching legs
- Lower back pain
- Achilles tendonitis
- Knee pain
Questions to Ask Your Doctor
Here are some questions you may want to ask your doctor about flat feet:
- What are the chances I’ll be in pain for the rest of my life?
- How successful is the treatment option we plan to use?
- Can my orthotics be bought over-the-counter or do I need them custom-made?
- What can I do to reduce my risk of symptoms?
- Do you have a brochure I can take home with me?
- Should I watch for symptoms in my children too?
- How long should I wait to contact you if my symptoms do not go away?