Flat Feet

What are Flat Feet?

Flat feet (pes planus) is a condition where the arches of the feet are flattened, allowing the entire foot sole to contact the ground.

• Can be flexible (arch appears with weight off foot) or rigid
• May cause foot pain, overpronation, and gait issues

Overview of the Condition

Flat feet can be congenital or acquired (e.g., posterior tibial tendon dysfunction). Many people have no symptoms; others develop pain in the feet, ankles, knees, or lower back.

Symptoms

• Pain or fatigue in arches or heels
• Overpronation (foot rolls inward)
• Ankle swelling or rolling inwards

Causes

Causes include congenital low arches, tendon dysfunction, ligament laxity, or neuromuscular issues. Certain injuries or arthritis can also lead to acquired flatfoot.

Diagnosis

Visual inspection, the 'wet footprint' test, and observation of foot alignment. X-rays or MRI may be used if pain or structural deformities are present.

Treatment Options

• Supportive shoes or custom orthotics
• Strengthening exercises for foot and ankle
• Weight management for less stress on arches
• Surgery in severe symptomatic cases

Conservative Management

Most symptomatic flat feet are managed with orthotics, supportive footwear, and physical therapy to strengthen supporting muscles and improve gait.

Rehabilitation Exercises

1. Towel curls and marble pickups to engage foot intrinsic muscles
2. Heel raises and controlled descents
3. Calf stretching to reduce Achilles tension

When is Surgery Needed?

Surgery is considered for progressive deformity or pain not relieved by orthotics or therapy. Procedures may include tendon transfers, osteotomies, or fusions.

Surgical Procedures

• Tendon reconstruction (e.g., posterior tibial tendon)
• Calcaneal osteotomy to shift weight-bearing alignment
• Arthrodesis if severe joint degeneration is present

Anatomy Overview

The foot arch is maintained by bones, ligaments, and tendons (particularly the posterior tibial tendon). Loss of arch support causes the foot to flatten.

Affected Areas

• Medial foot structures supporting the arch
• Possible strain on ankles, knees, and hips due to altered biomechanics
• Posterior tibial tendon, which may be dysfunctional

Frequently Asked Questions

QuestionAnswerDo flat feet always need treatment?Not necessarily. Many people with flat feet are asymptomatic and require no intervention.Will orthotics fix my flat feet permanently?Orthotics provide support and pain relief but do not permanently change foot structure. They help manage symptoms.

Prevention Strategies

• Wear supportive shoes, especially during sports
• Maintain healthy weight and muscle strength
• Address tendon issues early to prevent collapse

Related Conditions

• Posterior tibial tendon dysfunction
• Plantar fasciitis
• Tarsal coalition

Additional Treatments

Physical therapy focusing on gait training, foot strengthening, and proprioception can reduce discomfort and improve function.