Flat Feet

Foot arches serve many important functions that help keep you standing and walking without pain and fatigue. Because they can flex gently with each step, contact and impact forces are spread out over a longer timeframe, reducing wear and tear on bones and other structures. And because they act like springs, they can “release” that stored energy when you push off, propelling your body forward more efficiently.

However, not all arches do this equally. In fact, as many as one in three people have flat feet. Some are born with them, and others develop them over time. Flat feet are not always symptomatic, but some cases can cause pain, tenderness, soreness or fatigue in the feet, and increase the risk of foot and ankle injuries and deformities.

Types of Flat Feet

Although this is an oversimplification, there are two broad categories of flatfoot conditions—congenital flatfoot an acquired flatfoot.

Congenital Flat Feet

Most kids don’t develop a full, rigid arch until around age 5 or so. However, for some the flatfoot condition persists well into adolescence, adulthood, and beyond. Connective tissues may remain too weak to support a rigid arch due to inherited genetic disorders.

Pediatric flatfoot is often “flexible.” In other words, the arch flattens completely when standing, but reappears when not bearing weight. Sometimes this self-corrects with time, and sometimes it doesn’t. If it is painful or causes difficulty with walking or wearing shoes, it should be examined and treated.

Sometimes there is a more rigid bony deformity causing the flatfoot. For example, tarsal bones in the hindfoot may be fused due to a gene mutation (tarsal coalition), which can cause a rigid flatfoot condition. Although present at birth, tarsal coalition may not become apparent until later childhood or adolescence.

Acquired Flat Feet

In other cases, arches collapse and flatten later in life, usually due to wear, tear, or injury.

The most common adult-acquired flatfoot condition is posterior tibial tendon dysfunction (PTTD). The posterior tibial tendon runs along the inside of your foot and attaches the calf muscles to the bones on the inside of the foot. It plays an extremely important role in supporting the arch; if it becomes torn or inflamed, the arch may slowly flatten and collapse.

Other causes of acquired flatfoot include traumatic injuries, diabetic foot collapse (Charcot foot), and arthritis.

How Can I Tell if I Have Flat Feet?

During an exam, your foot specialists can determine whether you have a flatfoot condition—and if so, what the root causes are.

If you want a rough idea of your arch height, you can perform the “wet test” at home. This is not a substitute for a professional exam, but can give you a general idea of your arch height. Simply wet (but not soak) the bottom of your foot and stand on a piece of construction paper or grocery bag to see the print. If about half your arch appears, you likely have a normal arch height. If most or all of the arch is visible, you likely have flat feet and should follow-up with a professional.

How Are Flat Feet Treated?

Each case of flatfoot is unique. The recommended treatment procedure will depend on factors such as the cause of your flat feet, whether or not you’re experiencing any symptoms (and how severe they are), and your lifestyle. Often, conservative treatments such as arch supports, custom orthotics, and physical therapy are effective at relieving symptoms and helping you to remain active without pain. If conservative treatments don’t work, reconstructive surgery may be necessary.