Flatfoot: What It Is, Symptoms, Diagnosis, and Treatment

Individuals with flatfoot have very low arches or no arches at all. This means that one or both feet can make complete contact with the ground.

People with flatfoot have very low arches or no arches at all. This condition means that one or both feet can rest flat against the ground. Flatfoot can affect the posture of the body while standing, walking, or running. While it may be seen in children, it can also persist into adulthood.

What Is Flatfoot?

The human foot is a structure containing 33 joints that hold together 26 different bones. The flexibility created by the arches of the foot acts as a spring for the foot to make contact with the ground and helps distribute body weight between the feet and legs. However, some individuals lack this spring-like flexibility. The term "flatfoot" is used when the arch of the foot is lower than normal. Typically, the foot has an arched shape, with the middle part of the inner surface elevated above the ground. People often notice their flatfoot condition during childhood when this height is not visible. However, this condition can also develop in adulthood. If flatfoot causes pain or other problems, treatments may be necessary.

What Are the Symptoms of Flatfoot?

Many individuals with flatfoot may not experience any symptoms, including pain, but some types of flatfoot can lead to severe pain. Flat feet do not always cause symptoms. Sometimes, they can cause pain in other areas of the body, such as the heel or legs. This is because flat feet alter the alignment of the feet and legs. They also change how these parts work together while in motion. Problems associated with flatfoot include:

• Muscle pain in the foot or leg
• Pain in the arch, ankle, heel, or outside of the foot
• Pain or changes in gait while walking
• Toe drifting
• Frequent tripping or falling in children

What Causes Flatfoot?

As children grow, arches develop in the feet. These arches can be very high or very low. There are also cases where arches do not form at all. The presence of low arches or a complete absence of arches can lead to flatfoot. Some people may develop flatfoot as they age. Flatfoot can arise from improper development of the arches during childhood. Children’s feet develop at different rates. Most children develop a more visible arch by about age 10. Since wear and tear on the feet can lead to fallen arches, flatfoot can also develop with age. Some children typically experience a flexible flatfoot problem. In flexible flatfoot, the arch may be visible when the child is sitting or standing on tiptoes, but it becomes invisible when the child stands flat-footed. Most children can outgrow flexible flatfoot without experiencing serious symptoms. People without flatfoot may also develop this condition over the years due to wear and tear.

What Are the Types of Flatfoot?

Flatfoot can present in different varieties in individuals. Particularly, the age of onset and the factors causing it are determinants of these varieties. The types of flatfoot include:

• Flexible Flatfoot: Flexible flatfoot is a common flatfoot problem. This condition starts in childhood and continues into adulthood. Flexible flatfoot usually does not show symptoms other than pain and stiffness in children and may not require treatment. Children with congenital disorders such as Down syndrome or Marfan syndrome have lax ligaments that support the arch. Therefore, flexible flatfoot can develop in children with congenital defects.
• Rigid Flatfoot: In rigid flatfoot, there is no arch present. The primary cause is the tearing of the posterior tibial tendon, which provides stability and support for the arch while walking. If the posterior tibial tendon tears, stretches, or becomes inflamed due to injury or overuse, it can eventually lead to a collapsed arch causing flatfoot. This condition is characterized by pain that worsens with activity, makes simple movements difficult, and can prevent high-impact activities. Rigid flatfoot is more commonly seen in pregnant women or individuals over the age of 40. If tendon damage is detected at an early stage, non-surgical treatments such as rest, ice therapy, anti-inflammatory medications, and physical therapy can help alleviate symptoms.

How Is Flatfoot Diagnosed?

Flatfoot is often noticeable when a person feels discomfort or sees that their foot is flat; however, the underlying cause may need to be investigated by a doctor. The tests conducted for this diagnosis may include a physical examination to evaluate the structure of the foot, as well as imaging tests. Health professionals may request imaging tests to help identify the underlying cause in individuals experiencing significant foot pain. Imaging tests used include X-rays and computed tomography (CT) scans, which are ideal for diagnosing arthritis and assessing abnormalities in the angles and arrangements of the foot bones. Ultrasound can be used to produce detailed images of soft tissue damage, such as a torn tendon. Additionally, magnetic resonance imaging (MRI) can provide detailed images of bone and soft tissue damage, ideal for individuals with rheumatoid arthritis, tendonitis, or Achilles injuries. A doctor can usually diagnose flatfoot by observing the feet while the person is standing. Additionally, a shoe examination test can reveal faulty foot structures. When flatfoot occurs, more wear tends to occur on the inner part of the sole, especially in the heel area. The upper part of the shoe may also tend to tilt over the sole. A toe test is used to see whether the flatfoot is flexible or rigid.

What Is the Treatment for Flatfoot?

Many individuals with flatfoot do not have significant issues, so they may not require treatment. However, the first step in treating treatable flatfoot in children is to ensure monitoring. Since children may not notice their flatfoot condition, parents and caregivers should monitor their children for proper arch development at an early age. If any abnormalities are observed, children should be examined by a doctor. Pediatric specialists can determine the type and cause of most flatfoot deformities through both clinical examination and X-ray.

When adults experience foot pain, stiffness, or other problems, doctors may recommend non-surgical treatments. Prescribing non-steroidal anti-inflammatory drugs to relieve foot pain, along with rest and ice therapy, are among the treatments provided by doctors. Physical therapy may also be applied to stretch, strengthen, and improve flexibility and mobility in the tendons and muscles. Sometimes, specially designed arch supports shaped to fit the contours of the feet are recommended. Devices such as foot orthotics, medical foot or leg supports, and custom-made shoes are preferred equipment to ensure that untreatable flatfoot does not affect quality of life. Flatfoot may contribute to overuse injuries in some runners. If patients still have pain that limits their activities after trying non-surgical treatments, surgery may be an option. Surgery can repair bone and tendon problems that cause pain. If flatfoot causes mild pain, the following measures can be taken:

• Rest
• Avoid activities that worsen the condition
• Engage in low-impact activities such as walking, biking, or swimming instead of jumping and running
• Lose weight
• Follow the recommendations provided by the doctor