People who have flat feet have little or no arch. The medical term for flat feet is posterior tibial tendon dysfunction (PTTD). In this condition, changes in the tendon impair its ability to support the arch. This results in a flattening of the foot and little to no arch. In serious cases, flat foot reconstruction may be needed.
Flat feet cause problems because the arch of the foot is what normally helps distribute body weight. People with flat feet often walk on the inner side of their foot as the foot may roll (pronate). As a result, a person may wear through a pair of shoes on one side faster. While not a serious condition flat feet may require treatment if it is painful. Additionally, having flat feet can be a risk factor for other ankle, foot, or lower leg conditions.
Symptoms of Flat Feet
The most common symptom of having flat feet is ankle and arch pain. This can happen because of strained muscles and connecting ligaments. Stressors of the hip and knee may also worsen pain in these joints, notably if the ankles are inwardly turned. Pain related to flat feet may affect different parts of the body, including the:
- Arch of the foot
- Calf
- Knee
- Hip
- Lower back
- Lower legs
In the early stages of flat feet, as the arch flattens an inward rolling of the ankle occurs with pain on the inside of the foot and ankle. Later, as the condition progresses, the foot will roll outward and the pain will typically shift to the outside of the foot below the ankle. If left untreated, flat feet can increase the risk for developing ankle arthritis when the posterior tibial tendon has significantly deteriorated.
Causes of Flat Feet
Genetics that Contribute to Flat Feet
The most common cause is that it’s a hereditary foot type, in which a parent may pass the genetic trait to their children, predisposing them to issues related to flat feet.
Flexible Flat Feet
Another condition called flexible flatfoot may also be the cause. Flexible flatfoot is when a person has arches while they sit, but no visible arch when they stand. This condition is common in children and is often outgrown, but that is not always the case.
Adult Acquired Flatfoot
Arches may also fall over time due to wear and tear on the posterior tibial tendon running along the inside of the foot to the ankle, which helps support the arch. This type of flat foot is called “adult acquired flatfoot” as it is the most common type of flatfoot developed during adulthood. The condition will typically worsen, especially if it isn’t treated early. This form typically occurs in only one foot, although it’s possible to develop it in both feet.
Risk Factors for Flat Feet
Factors that may increase your likelihood of having flat feet include:
- Aging
- Diabetes
- Rheumatoid arthritis
- Obesity
- Injury of the foot or ankle
- Improper, ill-fitting shoes
Treatment Options for Flat Feet
Common treatment options to alleviate the pain associated with flat feet are:
- Arch supports/Orthotic Inserts & Supportive Shoes – Either over-the-counter or custom designed. Also, wearing shoes that
provide more support to the arch.
- Stretching Exercises – People with flat feet often have a shortened Achilles tendon. Exercises that stretch the tendon may
help reduce pain. - Immobilization – Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal. A patient
may need to completely avoid all weight-bearing for some time. - Physical therapy (PT) – PT is often utilized in individuals who are athletes, especially runners as flat feet may contribute to
overuse injuries.
When is Surgery for Flat Feet Needed?
Surgical treatment for flat feet is typically discussed after conservative measures have failed and there is pain. Surgical reconstruction is performed when the arch is collapsed, but still flexible.
An MRI (magnetic resonance image) or advanced imaging is ordered to assess the severity of the tendon damage. A surgical approach is then developed to achieve a successful outcome and rehabilitation, with the overall goal being to improve the alignment and function of the foot. Typically, a combination of procedures is performed to repair the ligaments and tendons that support the arch. Additionally, a combination of procedures is often performed to reconstruct the flat foot through correcting deformities in the bones.
Surgical Techniques for Flat Feet
- Medializing Calcaneal Osteotomy – Used when the heel bone has shifted out from underneath the leg.
- Lateral Column Lengthening – Performed when the foot is outwardly rotated.
- Medial Cuneiform Dorsal Opening Wedge Osteotomy or First Tarsal-Metatarsal Fusion – Used when the arch collapse leads
to the big toe side of the foot being raised above the ground.
- Tendon and Ligament Procedures – Used to correct a stretched and dysfunctional posterior tibial tendon
- Double or Triple Arthrodesis – In the later stages of flat feet, when the deformities are inflexible and arthritis may be present,
this procedure may be used. It involves fusion of one or more of the foot joints.
Dr. Flynn is a fellowship-trained foot and ankle surgeon with expertise in treating flat feet both conservatively and in surgical techniques for flat feet when surgery is required. Seeking treatment early for flat feet is important for the best possible outcome.
