Flat Feet - CDA Foot and Ankle

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Flat feet is a condition in which the foot does not have a normal arch when standing.
A common and usually painless condition, flat feet may occur when the arches don’t develop during childhood. In other cases, flat feet may develop after an injury or from the simple wear-and-tear stresses of age.
Flat feet can sometimes contribute to problems in your ankles and knees because the condition can alter optimal alignment of your legs. If you aren’t experiencing any pain, no treatment is necessary.

Anatomy

The anatomy of the foot is very complex. When everything works together, the foot functions correctly. When one part becomes damaged, it can affect every other part of the foot and lead to problems. With a flat foot deformity, bones, ligaments, and muscles are all affected. A combination of malalignments results in the flatfoot appearance.

Causes

Flat feet are a common condition. In infants and toddlers, they are normal. Flat feet occur because the tissues holding the joints in the foot together (called tendons) are loose. In infants and babies, the fat in the foot is also a factor. As children grow older, these tissues tighten and form an arch, most often by the time the child is 2 or 3 years old. By adulthood, most people have normal arches. However, in some people this arch may never form.
Aging, injuries, or illness may harm the tendons and cause flat feet to develop in a person who has already formed arches. This type of flat foot may only be on one side. Rarely, painful flat feet in children may be caused by a condition in which two or more of the bones in the foot grow or fuse together. This condition is called tarsal coalition.

Symptoms

Most of the time flat feet do not cause pain or other problems.
At times, foot pain, ankle pain, or lower leg pain are present (especially in children). They should be evaluated by a health care provider.
Adults may notice some symptoms. Their feet may become achy or tired when standing for long periods of time or after playing sports.

Diagnosis

In people with flat feet, the instep of the foot comes in contact with the ground when they stand.
The health care provider will ask you to stand on your toes. If an arch forms while you are standing on your toes, the flat foot is called flexible. No treatment or further work-up is needed.
If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including:
X-ray of the foot
CT scan to look at the bones in the foot
MRI scan to look at the tendons in the foot

Treatment

Once your health care provider has examined you, no treatment is needed for flat feet that are not causing any pain or problems walking.
Your child’s feet will grow and develop the same, whether special shoes, shoe inserts, heel cups, or wedges are used.
Your child may walk barefoot, run or jump, or do any other activity without making the flat feet worse.

In older children and adults, flexible flat feet that are painless and do not cause problems with walking do not need further treatment once a health care provider has evaluated them.
If you have pain due to flexible flat feet, the following may help:

An off-the-shelf or custom-made orthotic (arch-supporting insert in the shoe)
Special shoes
Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet.
For tarsal coalition, treatment starts with rest and possibly a cast. If this does not improve the pain, surgery may be needed.
In more severe cases, surgery may be needed to:
Clean or repair the tendon
Fuse some of the joints of the foot into a corrected position
Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Self Care

If you’re experiencing minor pain from flatfeet, you might want to try:
Rest – Avoid activities that aggravate your condition. Participate in low-impact activities such as walking, biking or swimming rather than jumping and running activities.
Arch supports – A trial of over-the-counter arch supports is reasonable to consider.
Medications – Over-the-counter pain relievers may help.
Weight loss – Losing weight if you are overweight can reduce the amount of stress on your feet.

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