People with flat feet have a very low arch or no arch, meaning that one or both of their feet may be flat on the ground. Arches in feet are crucial as they provide a spring to the step and help to distribute body weight across the feet and legs, ultimately determining how a person walks. The arches need to be both sturdy and flexible to adapt to stress and a variety of surfaces. Without them, feet may roll inwards when standing and walking, a condition known as overpronation, that causes feel to point outward.
Common causes of flat feet include:
Another condition that might cause flat feet is tarsal coalition, a condition that causes the bones of the foot to fuse together abnormally, resulting in stiff and flat feet. People are more likely to develop flat feet if they’re obese, diabetic, or pregnant. Flat feet can develop with age too, as daily use of the feet can cause the arches to weaken. Damage to the posterior tibial tendon can enflame (tendonitis) and cause the arch to flatten. Flat feet can also occur from developmental faults that occur during childhood, developing with age.
The most common symptom of flat feet is foot pain. This occurs when muscles and connecting ligaments are strained, including abnormal stresses on the knee and hip may result in pain in these joints, common issues if the ankles turn inward. Pain most commonly affects the arch of the foot, calf, knee, hip, lower back, and lower legs. Flat feet can also cause an uneven distribution of body weight, resulting in faster degradation of shoes, specifically on one side, that may cause future injuries.
Qualified podiatrists can diagnose fallen arches by examining the feet and observing how the patient stands and walks. The feet should be inspected from the front and back. Sometimes, patients need to stand on the tips of their toes to allow the doctor to examine the shape and function of each foot. A doctor will also look at the person's medical history. In some cases, they may order an X-ray, CT scan, or MRI scan. It’s common for people with flat feet to automatically align their limbs in a way that prevents symptoms, making them hard to identify. If flat feet are causing pain, then supportive, well-fitted shoes can help, as well as extra-wide-fitting shoes. Fitted insoles and orthotics or custom-designed arch supports may relieve pressure on the arch and reduce pain if the feet roll too far inward. However, these products only treat the symptoms and do not provide long-lasting benefits.
People with posterior tibial tendonitis might also benefit from inserting a wedge into their footwear along the inside edge of the orthotic. This should relieve some of the load that the body places on the tendon tissue. Wearing an ankle brace may also be beneficial until the inflammation reduces. Doctors may advise rest until symptoms improve by avoiding activities that aggravate the injured area. A person with arthritis or a ruptured tendon might find that a combination of an the previously mentioned treatments can reduce their symptoms.
If these do not work, surgery may be necessary.
Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, the patient’s age, and whether the foot is stiff, the appropriate procedure can be assigned. In most cases, a combination of procedures are performed.
With flexible flat feet, surgery is designed to maintain the motion of the foot and recreate the arch. This involves tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is severe, bone procedures are included to physically reconstruct the arch and realign the heel.
With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. If motion in the affected foot does not exist pre-operatively, realigning it is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.
After surgery, your leg will be in a cast or splint. It is advised to keep it elevated as much as possible for the first two weeks to reduce swelling and speed healing. It is important to not put weight on the foot for six to eight weeks. At that point, you can start easing into weight-bearing activities.