Flat Feet : Treatment of Different Flat Feet Conditions

You may be wondering if the foot pain you are feeling will pass, or if you need to seek treatment. You can find the answers to the most common questions on your mind regarding flat feet in this detailed overview about flat foot condition.

Answers to most Common Questions Regarding Flat Feet (Fallen Arches)

According to the American Foot and Ankle Orthopedic Society, 1 in 4 Americans have flat feet, putting the figure at an estimated 60 million people in the United States.

Most people who suffer from flat foot condition are asymptomatic. They feel no pain and are able to enjoy normal foot and leg function. Some people, however, develop foot pain due to flat feet when they get older. Some even develop flat feet when they used to have normal arches.

The Nature and Origin of Flat Feet

Nature and Origin of Flat Feet

Flat foot condition is also known by other names like fallen arches and Pes Planus. Many people consider it to be a problem because they don’t look normal since there is no arch present. Usually, this condition is the result of an underlying condition although some people inherit it from their parents.

When an individual has no arch in the sole of the foot, it causes the foot to be flat while in a standing position. The sole of each foot would be partially, or completely, touching the floor.

You can watch https://www.youtube.com/watch?v=vhqsTUd7fas for more tips about checking for flat feet by measuring your arch. You can also get two simple exercises for strengthening your arches to prevent flat foot pain. Source of the picture: NHS.uk


What Causes Flat feet and Flat Foot Pain?

The foot is an amazingly specialized structure. Each foot has 26 bones that are held together by 33 joints and around 100 muscles, ligaments, and tendons. The efficiency by which they are woven and aligned dictates the formation of the foot’s arch.

While walking, pressure from gravity multiplies the body’s weight on each foot by 3 or 4 times. With the passing of time, muscle imbalance may result in an abnormality in the foot’s natural arch. The arch of the metatarsal may become flat due to excess weight or stress from pounding on surfaces.

flat feet

Normal Feet/ Flat Feet

Factors like illness, injury, or aging, can cause harm to the tendons and result in flat feet, even in persons who have formed arches. Over time, wear and tear can cause tendons along the inside of the ankle supporting the arch to weaken. It can happen to only one foot, or both. Sometimes, painful flat foot can develop in children caused by tarsal coalition, or the fusing together of bones in the foot.

Other factors that could cause flat feet include:

  • Family history
  • Weak arches
  • Health conditions such as Arthritis and Diabetes
  • Injury
  • Nervous or muscular diseases such as muscular dystrophy, cerebral palsy, or spinal bifida
  • Ruptured tendon (tibialis posterior)
  • Pregnancy

The 2 Principal Categories of Flat Feet

1. Congenital flat foot condition

Congenital flat foot condition

Pertains to those who were born with or are predisposed to the condition from birth. This category also includes asymptomatic cases, with pediatric flexible flat foot cases being the most common form. Flexible refers to cases where an arch is visible until weight is borne by the foot and the arch disappears.

In the same category can be found rare but more dramatic cases of flat feet. These include Vertical Talus, tarsal Coalitions, and Congenital Calcaneal Valgus. All these conditions are more rigid, meaning without arches, whether weight bearing or not, and exhibiting symptoms.


2. Acquired Flat Foot

Pertains to cases that develop over time. Many factors can be attributed to this type of flat feet including a child’s sleeping position, compensating for other abnormalities, ruptured ligaments or tendons in the foot, trauma, etc. Most common among these factors is tightness in the Achilles’ tendon which causes the foot to point downward, or cause plantar flexion. Even a minimal degree of plantar flexion may simulate a longer leg on one side, making the body compensate by flattening the arch to make up for the perceived additional length of the other side.

Common Symptoms Experienced Due to Flat Feet

Some flat foot cases are not severe but pain can limit movement and cause discomfort. Some of the symptoms due to flat foot condition include the following:

  • Foot fatigue
  • Aching or painful feet, particularly in the heel and arches
  • Swelling of the inside bottom of the feet
  • Difficulty with foot movement such as standing on your toes
  • Leg and back pain
  • Over-pronation (excessive inward rolling of the feet which causes shoes to wear out easily and could cause injuries


Does flat foot condition require treatment?

Flat feet treatment

Children with flat feet do not usually require treatment if there is no pain or difficulty with walking. The arches may develop as they grow older.

With older individuals, some cases of flat feet are asymptomatic. In such cases, treatment for flat feet is not required. There are some cases, however, when it can cause knee and ankle problems because the alignment of the legs is abnormal. Patients may also experience back and leg pain.

If there is foot or leg pain due to flat feet, medical treatment can help with pain management and prevention of future complications.  Your doctor can design a treatment plan based on the cause and symptoms of your flat foot condition.

Seeking Medical Advice for Diagnosis and Treatment of Different Flat Feet Conditions

Your health provider can prescribe the right treatment and medication for any of the following:

  • Painful feet despite wearing of well-fitting shoes
  • Shoes get easily worn out
  • The flatness of feet is worsening
  • Numbness, stiffness or weakness of the feet

To check on the function of your feet, the doctor will closely observe the front and back of your feet and request you to stand on your toes. He may also examine the wear pattern of your shoe.

Some imaging tests may be required for further diagnosis of the causes, symptoms and underlying conditions such as x-rays, CT scan, Ultrasound, and MRI.

What are the Common Treatments for Pain Due to Flat Feet?

There are different treatments for flat feet or fallen arches and they are based on the cause and severity of the condition. A doctor may recommend one or more treatments to address the presenting symptoms.

5 common ways to resolve problems caused by flat feet :

  1. Rest and icing to reduce pain and swelling
  2. Stretching exercises
  3. Pain relief medications including non-steroidal anti-inflammatory medicines
  4. Physical therapy
  5. The use of orthotic devices or shoe inserts, shoe modifications, casts, and braces

Patients can alleviate foot pain caused by flat feet by wearing shoes that fit well and provide good support. Orthotics (custom-made arch supports) can help reduce the pressure from the arch and foot pain for patients who over-pronate. Ankle braces, when worn, can also help reduce inflammation in patients who suffer posterior tibial tendinitis.

Lastly, proper weight management also improves symptoms considerably in obese patients. A doctor may recommend weight loss for overweight patients to reduce the excess stress on the feet.

Adult Acquired Flat Foot Condition – How does it happen?

Adult Acquired Flat Foot ConditionAdult Acquired Flat Foot, also known as Tibialis Posterior Tendon Dysfunction, is a progressive condition that exhibits increasing symptoms and stages of deformity. It is generally associated with degenerated posterior tibialis tendon, or a traumatic event and repeated micro trauma. Depending on the severity of symptoms, it can be treated with conservative management including braces and orthotics for offloading the tendon. More severe cases may require surgical treatment which will be described in detail in a subsequent subsection.

The 4 stages of Acquired Adult Flat Foot Condition

Stage 1 – The tendon becomes stretched and swollen, with instep pain during walking. A person is unable to stand on tiptoe using one leg. These cases are generally treated with orthotics and physiotherapy.

Stage 2 – There is partial tearing of the tendon, with increased swelling and pain. The foot flattens considerably. These cases, when foot function becomes limited, may be treated with tendon reconstruction.

Stage 3 –  In this stage, the heel becomes fixed. Most doctors recommend orthotic therapy and in some cases, hind foot fusion may become necessary.

Stage 4 – Ankle deformity occurs and may necessitate ankle surgery.

If you are interested in finding out exactly how and why Acquired Adult Flat Foot, or Posterior Tibialis Tendon Dysfunction progresses, watch https://www.youtube.com/watch?v=cLMgaj6QPa8. You can also find the steps you need to take to prevent more complications.

When Does Surgery Become Necessary?

Some patients with flat feet experience chronic ankle pain and difficulties with doing routine activities. Surgical reconstruction can be done in patients with a collapsed arch that is flexible. An orthopedic foot and ankle surgeon will conduct a thorough evaluation of the foot including:

  1. medical history
  2. a physical examination
  3. imaging tests (x-ray, CT scan, MRI)

Conservative and non-surgical treatments should be exhausted before before surgery is considered. Such treatments include rest, immobilization, physical therapy, medications, stretching exercises, and orthotics. Only when conventional treatments prove unsuccessful does surgery become an option.

Surgery requires rehabilitation and when done properly, patients can resume their active lifestyles. Physical activities like walking, driving, and sports are tolerable. Some activities that are too strenuous, however, such as running and jumping, may not be advisable.

Surgical Treatment Options for Serious Flat Feet Problems

For more serious pain or foot damage, surgery may be recommended which could include the following procedures:

  • Arthrodesis (fusing together the foot or ankle bones)
  • Spur excision (removal of bony growths)
  • Osteotomy (cutting the bone’s shape)
  • Synovectomy ( cleansing the tendon’s covering)
  • Tendon transfer (addition of tendon from other body parts to the foot to create a more balanced pull of tendons and develop an arch)
  • Lateral column lengthening (grafting bone to the foot to increase the arch naturally)

The primary goal of surgery to treat problems caused by flat foot condition is to improve foot alignment. This will normalize pressures during walking or standing. Some procedures can be combined to do tendon and ligament repair for better arch support. Bone cuts can be helpful in restoration of the arch. When flatfoot deformities are corrected properly, pain and walking ability can be significantly improved.





X-Ray Imaging of Flat Foot: Before and After Surgery. A Lateral column lengthening, calcaneal osteotomy, and tarsal-metatarsal fusion were performed.

Source: AOFAS

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Benefits of Early Treatment for Adult Acquired Adult Flat Foot Condition

Adult Acquired Flat Foot Condition is best treated in its early stages. The inner ankle feels tender and the patient would feel severe pain during movement, even for short distance walking. Left untreated, the shape of the foot will change, leading to a flat foot deformity.


Research shows that many patients exhibiting stage 2 Adult Acquired flat foot symptoms that were prescribed custom ankle-foot orthoses, called AFOs, were able to avoid complicated surgery and have improved foot function.

Risks for Non-Treatment of Painful Flat Feet

Risks for Non-Treatment of Painful Flat Feet

Flat feet affect an individual’s manner of walking, standing and running. The risk for pain in the hips, back, knees, and ankle becomes higher in persons with flat feet.

For individuals with existing foot problems, flat feet can worsen symptoms or contribute to these symptoms. If you have flat feet, you are also at risk for:

  • Achilles Tendinitis
  • Ankle Arthritis
  • Arthritis in the feet
  • Bunions
  • Plantar fasciitis
  • Hammertoes
  • Shin splints
  • Posterior tibial tendinitis

How to prevent Flat feet or Foot Pain due to Flat feet

Flat feet pain

Children usually inherit flat feet condition from their parents but it can be prevented in some cases. According to research, some social and cultural factors contribute to the development of flat feet.

The top 3 reasons that cause early flat feet development are:

  1. Obesity
  2. Unnecessary or improper orthopedic treatments
  3. Wearing tight-fitting shoes or rigid shoes during childhood

In adults, flat feet resulting from injury, aging, or disease are not preventable. However, the development of flat feet because of lifestyle or physical activities and habits such as shoe selection and weight gain can be avoided.

Healthy Foot Care Tips to Remember for Happier Feet

When choosing footwear, give importance to comfort. Wearing badly-fitting shoes can contribute to the condition, especially if shoes worn do not provide proper arch support or high-heels that aggravate already existing foot problems. For women wearing heels, the foot tries harder to gain balance. Further, excess weight can cause individuals to be more sedentary, thus risking tendon injury which can be painful and cause the tendon to tear.

Daily stretching of the tendon keeps it supple and flexible. It can prevent flat foot condition from developing into a fixed deformity.

Flat feet orthopedic

Benefits of Orthotics (Shoe Inserts) for Flat Foot Pain

Problems caused by flat feet make standing and walking for long periods of time painful and uncomfortable. Orthotics, also called shoe inserts, can reduce the pain by providing better arch support.

Your arch won’t magically develop in your foot with orthotics but they can stop formation of a flat foot by controlling abnormal pronation. Friction between the shoes and the foot is also reduced which will stop formation of rashes.

Custom Orthotics – Are they worth the cost?

Orthotics can range from off the shelf insoles that are built for average foot sizes with minor problems to custom built orthotics that are designed for a particular individual foot. Pre-fabricated orthotics cost less, of course, but they can do more harm than good because they do not address the specific problems of your foot.

Podiatrists can recommend custom made orthotic devices to effectively reduce pain for people with flat feet. They are made based on your individual foot structure and to suit your sports and work activities. There are many materials that can be used to give extra support to compensate for the lack of arch depression.
With the right orthotics prescribed by an experienced podiatrist, you will eliminate the pain and stay longer on your feet without getting sore feet.

Types of Custom Orthotics to Help with Flat Feet

Types of Custom Orthotics

Types of custom orthotics

Custom orthotics, also called shoe inserts, are useful for the treatment and correction of problems with flat feet.   There are two types of orthotics – functional and accommodative. Skilled technicians create the proper orthotic prescribed by your doctor using a cast of your foot for a perfect fit.

A functional orthotic is usually made of a hard material such as polymer. It can correct a variety of problems such as over pronation in flat feet. It is also used to provide more support and correct an individual’s biomechanics.

An accommodative orthotic is softer and used for cushioning the foot to eliminate foot pain.

Your podiatrist will recommend the best orthotic device for you based on a thorough assessment of your foot structure, symptoms, and biomechanics.

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