Flat Feet

Flat feet, also known as flatfoot, are characterized by the absence of a noticeable arch in one or both feet. When standing, the inner soles of the feet are flattened and make direct contact with the ground. All newborns are born with flat feet; typically, arches begin to develop around age 6. About two out of every ten individuals continue to have flat feet into adulthood. In some adults, the foot ligaments and tendons may degenerate, leading to a condition known as fallen arches.

In general, flat feet do not present any problems. Nevertheless, the condition can become a health issue if it persists from childhood or has recently developed in adulthood.

Types of flat feet

• Flexible: This is the most common type of flat feet. When not standing, you can notice the arches in the feet. When standing or putting weight on the feet, the arches disappear. This condition may persist from childhood or adolescence and worsen over time due to stretched, torn, or swollen tendons and ligaments.
• Rigid: This type of flat feet develops during adolescence. While sitting or standing you cannot see the arches in your feet. Flexing the feet or moving from side to side can be difficult and painful.
• Acquired flat feet in adults: This condition can result from torn leg tendons, leading to sudden fallen or collapsed arches. This condition can be painful.  
• Vertical talus or rocker-bottom foot: This is a congenital condition because the talus bone of the ankle is not in the correct position.

Symptoms

Some people may not experience any symptoms at all; others may have common symptoms, including pain on the inside of the foot due to tendinitis, cramps in the leg, pain in the foot or leg muscles, arch, heel, or outside of the foot from collapsed arch causing friction, pain when walking or changing the way you walk.

Causes

Flatfoot can run in your family. However, some people may have health conditions that increase the risk of flat feet, such as Down syndrome, cerebral palsy, diabetes, hypertension, obesity, rheumatoid arthritis, pregnancy, or broken bones in the foot.

Diagnosis

• Physical examination

  Your doctor will examine your feet and observe the wear pattern on your shoes to assess the mechanics of your feet and your gait. If you experience pain, inform the doctor. You may need to consult a podiatrist or orthopedic surgeon.

• Imaging tests

  • X-rays can generate images of the foot bones and joints, assess foot alignment, and detect arthritis.
  • CT scan can provide more details than an X-ray. Doctors order the scan if you have a rigid flat foot to locate where the bones are connected or if you have flat feet associated with degenerative joints.
  • Ultrasound can produce images of soft tissues in your foot to determine if you have a tendon injury.
• MRI can provide images of bone, soft tissues, and torn ligaments.

Treatment

Usually, treatment is not necessary, especially if flat feet do not cause any symptoms or pain. If you have pain, your doctor may suggest therapies.

• Therapies can relieve pain but cannot help straighten the feet.
  • Arch supports (orthotic devices) customized for individual foot contours. It can relieve symptoms but cannot cure flat feet.  
  • Stretching exercises can help stretch the shortened Achilles tendon.
  • Physical therapy is good for strengthening the muscles and tendons in the feet and improving gait.
• Surgery may be necessary when nonsurgical treatment cannot improve the symptoms or pain, or patients have persistent pain that restricts their daily activities. It can be a minimally invasive or open surgical procedure.

Lifestyle modification and home remedies

To relieve symptoms and minor pain, you can do as follows:

• Avoid high-impact activities such as running or jumping that can worsen your condition. Try swimming, walking, or biking instead.  
• Use arch supports.  
• Take pain relievers such as ibuprofen or naproxen sodium.
• Lose weight to lower the strain on your feet. 

Preparation

Wear your everyday shoes on the day of the doctor’s appointment so your doctor can determine the wear pattern and whether the shoes are right for you.

Prepare answers for questions that your doctor may ask. For example:

• When did the symptoms start?
• Do you have dull, sharp, or burning pain? Does it affect your daily activities?
• What improves or worsens your symptoms?
• What kind of shoes do you regularly wear?
• Do you have any other health conditions?
• Have you ever had foot or ankle injuries?
• Does anyone in your family have flatfoot? 

FAQ

• Does flatfoot cause any pain?
  The prevalence in adults is around 30%, but flatfeet are usually pain-free and do not need any treatment.
• How can the doctor diagnose flatfoot?
  Physical examination can detect flatfoot. The foot has a minimal arch, or the entire sole meets the ground.
• Is it normal for children to have flat feet?
  Newborns are born with flat and flexible feet. When they are 3, their feet start to form an arch. At around 7, complete arches will develop like in adults.
• What age is the most suitable for flatfoot surgery?
  Correction of flatfoot at a younger age is more effective because the foot bones are highly flexible. Patients 16 years old and above may need more extensive treatment due to more rigid footbones.
• Will flatfoot surgery affect my height?
  Flatfeet surgery can help you stand up straighter and appear taller, but your height does not significantly change. 

Doctor’s note

All newborns are born with flat feet. By age 6, their feet will form an arch in the midfoot. Therefore, children older than six, with no foot arches, will be diagnosed with flat feet. In some cases, flat feet can develop in adolescents or adults due to weak ligaments. If you experience symptoms, you should see a doctor promptly. Wearing arch supports can help relieve pain and inflammation. In cases of flat feet with severe pain, surgery may be necessary to remedy the problem, but this is rare.