The human foot is a complex structure that distributes weight evenly when standing across the heel, the ball of the foot (area under your big toe) and the outside edge of the little toe.
This “tripod” effect is made possible by an intricate arch system in the middle of the foot, but for almost 1 in 3 people, their arch has fallen or flattened leading to a common condition known as flat feet (pes planus) or “fallen arches”.
“About 30 percent of people have a flat foot,” West Penn Hospital Orthopedist Dr. Victor Prisk told CBS News. “For every person who has a flat foot, one in 10 probably have some symptoms from it."
Flat feet have been around since the dawn of humanity with historical cases of “flat feet” ranging from King Tut to Abraham Lincoln to Elton John to Usain Bolt, who didn’t let his flat feet prevent him from becoming the world’s fastest man!
Leonardo de Vinci in the 15th century even made anatomical drawings of the condition in which the entire sole of the foot touches the ground when standing.
Flat feet can affect one or both feet and may develop during childhood or later in life.
Let's take a closer look at the types of flat feet, causes, symptoms, and treatment options for the disorder.
Types of Flat Feet
Understanding the different types of flat feet is crucial for proper diagnosis and treatment. There are two primary types of flat feet:
- Flexible Flat Feet: This is the most common type of flat feet. In individuals with flexible flat feet, an arch is visible when sitting or standing on tiptoes, but it disappears when weight is placed on the foot. This type of flat foot is often considered a normal variation of foot structure and may not require treatment unless it causes symptoms.
- Rigid Flat Feet: This is a more severe condition where the arch is always flat, even when not bearing weight. Rigid flat feet are often the result of underlying structural abnormalities or medical conditions and are more likely to cause pain and functional limitations.
It's also important to note that flat feet can also be categorized based on when they develop:
- Congenital Flat Feet: Present from birth or early childhood.
- Adult-Acquired Flatfoot: Develops later in life, often due to injury or degenerative conditions.
“Pediatric flatfoot is a childhood condition that, if left untreated, can result in permanent deformity in adulthood. Flatfoot deformity makes mobility and exercise painful, increasing the risk of reduced cardiovascular health and obesity,” says the American College of Foot and Ankle Surgeons (ACFAS).
Causes of Flat Feet
Flat feet can result from various factors, and understanding these causes can help in prevention and management of the condition. Some of the primary causes include:
- Genetics: Flat feet can run in families, suggesting a hereditary component to the condition.
- Developmental Issues: In some cases, the arch doesn't develop properly during childhood, leading to flat feet.
- Injuries or Trauma: Damage to the tendons or ligaments that support the arch can result in flat feet.
- Weakening of the Posterior Tibial Tendon: This tendon plays a crucial role in supporting the arch. When it becomes inflamed or torn, it can lead to adult-acquired flatfoot.
- Medical Conditions: Certain conditions like arthritis, diabetes, and obesity can contribute to the development of flat feet.
- Pregnancy: The hormonal changes and increased body weight during pregnancy can cause the arches to flatten.
- Aging: As we age, the tendons and ligaments in our feet can weaken, potentially leading to flat feet.
“Arches can collapse abruptly after an injury. Or the collapse can happen over years of wear and tear,” explains the Mayo Clinic. “Over time, the tendon that runs along the inside of the ankle and helps support the arch can get weakened or tear. As the severity increases, arthritis may develop in the foot.”
Symptoms of Flat Feet
While some people with flat feet may not experience any discomfort, others may encounter a range of symptoms that can significantly impact their quality of life. Common symptoms include:
- Pain: This can occur in the feet, ankles, knees, hips, or lower back. The pain may be mild to severe and often worsens with activity.
- Difficulty Standing or Walking: People with flat feet may find it challenging to stand for long periods or walk long distances without discomfort.
- Inward Tilting of the Ankles: Also known as overpronation, this can lead to alignment issues in the legs and contribute to knee and hip pain.
- Swelling: Some individuals may experience swelling along the inside of the ankle.
- Fatigue: Tired or achy feet after standing or playing sports are common complaints among those with flat feet.
- Difficulty with Certain Activities: Flat feet can make it harder to perform activities that require quick changes in direction, such as dancing or some sports.
It's important to note that the severity of symptoms can vary greatly from person to person.
"You can have problems with ankle arthritis that can result from the foot being flat. You can have knee problems. You can end up having stress fractures," said Dr. Prisk.
Some individuals with flat feet may be completely asymptomatic, while others may experience significant pain and limitations in their daily activities.
Diagnosis of Flat Feet
Proper diagnosis of flat feet is crucial for developing an effective treatment plan.
A podiatrist or orthopedic specialist can diagnose flat feet through a combination of methods:
- Physical Examination: The doctor will observe your feet while you're standing and walking. They may ask you to stand on your toes to see if an arch forms.
- Footprint Analysis: Wet footprints on a flat surface can reveal the extent of contact between the sole and the ground.
- Imaging Tests: X-rays can show the alignment of the bones in your feet. In some cases, MRI, CT scans or ultrasounds may be necessary to evaluate soft tissue structures or more complex cases.
- Gait Analysis: The doctor may observe how you walk to assess your biomechanics and identify any abnormalities in your gait.
- Medical History: Your doctor will ask about your symptoms, medical history, and any injuries or conditions that might contribute to flat feet.
“A doctor can diagnose flat feet by observing your feet and pinpointing the area of your pain. They may ask you to stand on your toes and test the strength of your ankles. The wear pattern on the bottoms of your shoes may also reveal information,” explains New York-Presbyterian Hospital.
These diagnostic methods help the healthcare provider determine the type and severity of flat feet, which is essential for developing an appropriate treatment plan.
Treatment Options for Flat Feet
Treatment for flat feet depends on the severity of the condition and associated symptoms.
In many cases, especially with flexible flat feet, treatment may not be necessary if there are no symptoms. However, for those experiencing pain or other issues, several treatment options are available:
Conservative Treatments
- Orthotic Devices and Arch Supports: Custom-made or over-the-counter orthotics can help distribute pressure more evenly across the foot and provide arch support.
- Supportive, Well-Fitting Shoes: Shoes with good arch support and a wide toe box can help alleviate symptoms.
- Physical Therapy and Exercises: Specific exercises can strengthen the muscles that support the arch and improve flexibility.
- Weight Management: Maintaining a healthy weight can reduce stress on the feet.
- Activity Modifications: Temporarily reducing high-impact activities may help alleviate symptoms.
Medical Interventions
- Pain Relief Medications: Over-the-counter pain relievers like ibuprofen can help manage pain and inflammation.
- Corticosteroid Injections: In some cases, these injections may be used to reduce inflammation and pain.
Surgical Options (for severe cases)
- Tendon Repairs: Surgery to repair damaged tendons, particularly the posterior tibial tendon.
- Bone Realignment Procedures: Osteotomy or calcaneal osteotomy to correct severe misalignments.
- Joint Fusion: In cases of rigid flat feet or severe arthritis, fusing certain joints can provide stability and pain relief.
It's important to note that surgery is typically considered only after conservative treatments have failed to provide relief.
Living with Flat Feet
While flat feet can cause discomfort, many people lead active lives with proper management (and even win Gold Medals!).
Here are some tips for living with flat feet:
- Wear Appropriate Footwear: Choose shoes with good arch support and avoid high heels or shoes with minimal support.
- Use Custom Orthotics: If over-the-counter inserts aren't sufficient, custom orthotics can provide personalized support.
- Maintain Healthy Weight: Excess weight puts additional stress on your feet, so maintaining a healthy weight can help reduce symptoms.
- Engage in Low-Impact Exercises: Activities like swimming or cycling can help you stay active without putting excessive stress on your feet.
- Stretching and Strengthening Exercises: Regular exercises to strengthen the muscles in your feet and ankles can help support the arch and reduce pain.
- Manage Related Conditions: If you have conditions like diabetes or arthritis that can affect your feet, proper management of these conditions is crucial.
- Regular Check-ups: Schedule regular appointments with a podiatrist to monitor your condition and adjust your treatment plan as needed.
When to Seek Professional Help
While many cases of flat feet can be managed with conservative measures, there are times when professional help is necessary. Consult a podiatrist or orthopedic specialist if you experience:
- Persistent foot pain doesn't improve with rest or over-the-counter treatments.
- Difficulty walking or standing for extended periods.
- Worsening of flat feet symptoms over time.
- Development of other foot problems, such as bunions or hammertoes.
- Sudden change in the appearance of your feet.
- Symptoms that interfere with your daily activities or quality of life.
Early intervention can often prevent more serious complications and help you maintain an active, pain-free lifestyle.
If you're concerned about flat feet or experiencing foot pain, don't hesitate to contact Sweeney Foot & Ankle Specialists today for a comprehensive evaluation.
