Flat Feet: Causes & Treatment

Flat feet refer to a condition in which the foot shape changes, leaving the foot without a normal arch while standing. It is also known by alternate names such as pes planus, pes planovalgus, fallen arches, or pronation of feet.

A person with flat feet could have low arches or no arches at all. The arch (or the instep) is the inside part of the foot that is raised above the ground when the person stands while the remaining foot touches the ground. Space is present between on the inner foot, and the height of the arch varies from person to person. The arch on the inside of the feet is flattened in people with flat feet, allowing the entire sole of the foot to touch the floor when they stand.

What are the causes of the disorder?

In infants and toddlers, flat feet are normal as the foot's arch is still to develop. The foot's arch develops through childhood. However, this does not occur in some people - this could be a normal variation in foot type and many people without arches do not have problems.

The various causes of flat feet could be:

1. Wear and tear - Arches may fall over the years. Wear and tear causes weakening of the tendon that runs along the inside of the ankle to support the arch.
2. Heredity - Low or no arches is a normal condition in some people who inherit the condition from their parents, and may have feet that are quite flexible.
3. Tarsal coalition - This condition develops from an abnormality in the womb, wherein a joint may be fused together, resulting in feet that are flat and stiff.
4. Adult-acquired flat feet - Flat feet may develop in adults later in life due to:
   1. Injury - Ligament injury can cause joints to fall off alignment, causing the foot to become flat and painful.
   2. Diabetic collapse (Charcoal foot) - Diabetic people or those with a nerve problem having limited feeling in the foot can have an arch collapse.
   3. Other conditions (Inflammatory arthritis such as rheumatoid arthritis, nervous system conditions like cerebral palsy, muscular dystrophy, and spinal Bifida)

What one needs to know about symptoms or signs?

Most flat feet conditions do not cause pain. However, a doctor must evaluate children who experience pain in the foot, ankle or lower leg. In adults, achy or tired feet after long hours of standing or playing sports may signal flat feet.

Flat feet condition becomes noticeable when a person walks or stands and is characterized by rolling over of the arch or inner foot to the inner side (overpronation). To check if a person's foot overpronates, the person can stand on tiptoes or push the big toe back as far as possible. The foot is overpronating if the arch of the foot does not appear.

Which specialist should be consulted in case of signs and symptoms?

People suspecting flat feet must consult a podiatrist who is a specialist in treating foot disorders.

In this case, they might recommend a simple solution like getting insoles online or stretching exercises before suggesting surgery.

What are the screening tests and investigations done to confirm or rule out the disorder?

Flat feet are diagnosed in the following ways:

1. Physical exam - The doctor observes the feet from front and back and will ask the person to stand on their toes to view the foot mechanics. S/he may also examine the wear pattern of the person's shoes.
2. Imaging tests - The doctor will conduct tests like the x-ray, computed tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI) if the patient is experiencing intense pain in the feet.

What treatment modalities are available for the management of the disorder?

In absence of pain in the foot, no treatment is necessary. Treatment options for patients experiencing pain include:

1. Therapy - It includes
   1. Orthotic devices (arch supports) - These supports are available over the counter, or doctors may suggest custom-designed supports that are molded to the contours of the feet. These supports do not necessarily treat flat feet but are useful in reducing symptoms.
   2. Stretching exercises - Stretching exercises help patients who also have a shortened Achilles tendon.
   3. Supportive shoes - A structurally supportive shoe offers better comfort as compared to sandals or shoes with minimal support.
2. Surgery - Surgery is performed to treat an associated problem like a tendon rupture or tear or fused joints in the foot. It helps restore foot function and alleviate pain.

What are the known complications in the management of the disorder?

Complications of surgery may include:

1. Pain that does not lessen
2. Failure of fused bones to heal
3. Foot deformity
4. Infection
5. Loss of ankle movement

What precautions or steps are necessary to stay healthy and happy during the treatment?

Some remedies can help counter the pain resulting from flat feet:

1. Adequate rest - The patient must avoid activities that can aggravate the condition. Low-impact activities like swimming, walking, or biking can be done instead of more strenuous activities like running.
2. Medication - Over-the-counter pain medication can reduce pain.
3. Arch supports - Mild pain can be treated with over-the-counter arch supports.
4. Maintaining weight - Losing excess weight can reduce the stress on feet.

How can the disorder be prevented from happening or recurring?

Most cases of flat feet cannot be prevented.

Sources:

"Adult Acquired Flatfoot," Orthoinfo.aaos.org, American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/topic.cfm?topic=a00173"Flatfeet," MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/flatfeet/basics/definition/con-20023429

"Flat feet," MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/001262.htm

"Flat feet," NHS.uk, https://www.nhs.uk/conditions/flatfeet/Pages/Introduction.aspx