Flatfoot (pes planus) is a condition that occurs when the arch or instep of the foot collapses or touches the standing surface. It is also known as fallen arches or pronation of the feet.
The human foot is made up of 26 bones, 33 joints, and over 100 muscles, tendons and ligaments. The arch of the foot is created by tightening of the muscles and various ligaments that support the bones of the arch as well as ligaments that run from the heel to the ball of the foot. The arches distribute weight evenly across the feet and up the legs, and can affect walking. A well-developed arch is balanced between rigidity (for stability) and flexibility (for adapting to surfaces).
There are two types of flatfeet. Flexible flatfoot means that the foot has some arch, even if it only appears when the person flexes the feet or stands on the toes. This is a normal condition that is generally painless and does not require treatment. Stiff, inflexible, or painful flatfoot is an abnormal condition and may indicate a bone abnormality in the foot, a disease, or an injury.
Flatfeet are a normal condition in infants and toddlers. This is partly the result of fatty deposits along the bottom of the foot that go away as the child grows. It is also because the ligaments in the foot have not fully developed. Flat-footedness in children is generally painless and does not interfere with walking or activity. In fact, as children learn to walk, the soft tissues in the foot tighten and form the arch. Most children develop arches by late childhood.
When flatfeet continue into adulthood, most cases are considered normal. Incidence of flatfeet in the general population is unknown.
Most cases of flatfeet are simply the result of normal development. When that is not the case, the condition can be caused by a number of factors, including the following:
- Physical abnormality
Flattened arches in adults may result from the stresses of aging, weight gain, and the temporary increase in elastin (protein in connective tissue) due to pregnancy.
In some cases, flatfeet are caused by a physical abnormality, such as tarsal coalition (two or more bones in the foot that have grown together) or accessory navicular (an extra bone along the side of the foot).
The effects of diseases such as diabetes and rheumatoid arthritis can lead to flatfeet. An injury (e.g., bone fracture, dislocation, sprain or tear in any of the tendons and ligaments in the foot and leg) also can cause flatfeet.
Most children and adults with flatfeet do not need to see a podiatris for diagnosis or treatment. However, it is a good idea to see a podiatrist if:
- the feet tire easily or are painful after standing;
- it is difficult to move the foot around or stand on the toes;
- the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot;
- the pain interferes with activity; or
Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the podiatrist can see how much the arch flattens during walking.
The podiatrist may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases.
If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI) may be performed.
Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels.
Flexible flatfeet with some pain can be relieved with the use of orthotics—shoe inserts that support the arch—and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons.
If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon.
If you have any concerns about your feet contact Footfit Podiatry Tauranga and we will be happy to help.