Flatfoot Treatment

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Dr. Stern has diagnosed, treated, and educated patients about flatfoot in Vancouver for over 30 years. The following is a brief overview of flatfoot, its symptoms, prevention, and common ways this condition is treated.

What Is Flatfoot?

Flatfoot refers to a range of conditions where the person’s feet have partial or total collapse of the arch. The medical term for flatfoot is pes planus or pes planovalgus, depending on the type of condition. Unlike a typical foot structure where only the heel and ball of the foot touch the ground, flat feet touch the ground with the entirety of the foot.

All babies are born with flat feet, and arch development takes up to six to fully complete. Most children will develop their arches by age 7, but around 20% will have flat feet as adults.

In most cases, having a flatfoot won’t cause any noticeable symptoms or harm. However, some people with flat feet may develop other complications, such as bunions, painful flat feet, and tight Achilles tendons. If the foot structure begins to cause quality-of-life concerns, then addressing the underlying cause — flatfoot — may help resolve the problem.

Types of Flat Feet

While all types of pes planus deformity have a lack of arch in common, various types of flatfoot present different symptoms and require individualized treatments.

Flexible Flatfoot

The most common type of flatfoot deformity, flexible flatfoot, is characterized by the appearance of an arch in a relaxed foot that disappears when you put weight on the foot. Flexible flatfoot affects both feet and starts in childhood.

The condition tends to worsen as the individual ages. Children and teenagers may not have any negative symptoms associated with the condition, but as it worsens, patients may suffer from torn or stretched ligaments and tendons, which causes pain and inflammation.

Rigid Flatfoot

Individuals with rigid flatfoot have no arches, regardless of whether they put weight on the foot or not. The condition often develops during the teen years and may affect one or both feet.

As with flexible flatfoot, the condition worsens with age. Common symptoms include an inability to move the foot from side to side or flex the affected foot up and down. Feet may often feel painful and tight, and rigid flatfoot may affect a person’s ability to participate in high-impact activities.

Adult-Acquired Flatfoot

In adult-acquired flatfoot, the person starts with a normally developed arch that collapses or drops. The fallen arch causes many other deformities in the foot, such as an outward turning of the toes that affects the person’s gait.

Most fallen arches are due to posterior tibial tendon dysfunction (PTTD). This tendon runs from the back of the calf to the interior foot bones, where it connects the foot to the leg. It supports the foot arch, and inflammation or tearing may result in a complete arch collapse.

Adult-acquired flatfoot may have other causes, such as arthritis or Charcot foot, that can cause a similar condition to PTTD, but treatments of these causes will vary.

Vertical Talus

The talus bone connects the foot to the leg and transfers weight across the ankle bone. Vertical talus is a congenital condition where the talus forms in the wrong position, causing the rest of the bones in the foot to misalign.

Instead of having an arch, infants with vertical talus have feet that curve out, leading to the condition’s common name: rocker bottom feet.

Vertical talus is a congenital disability, but children can still live a pain-free normal life with the correct treatment.

Causes of Flatfoot

Flatfoot is normal in infants and toddlers since it takes up to six years for normal arch development. In some instances, the arches fail to develop due to genetics or hereditary factors.

In general, people with flexible flatfoot don’t experience pain or any other adverse symptoms due to their condition. People with rigid flatfoot may suffer from joint pain and other complications, which is why doctors evaluate these on a case-by-case basis.

Adult-acquired flatfoot can have a wide range of causes, including:

• Genetics – some families are prone to developing flat feet later in life

• Broken bones, ligaments, or tendons

• Diabetes

• Pregnancy and obesity – the increased pressure on the posterior tibial tendon can result in inflammation and tearing, which leads to flatfoot

• Rheumatoid arthritis

• Cerebral palsy

• Aging

Symptoms and Complications Stemming from Flat Feet

Most cases of pes planus are asymptomatic or don’t cause any pain or other issues. However, some people with flat feet suffer from symptoms including:

• Leg cramps

• Muscle pain and fatigue in the foot and leg

• Foot pain in the arch, ankle, heel, or outside of the foot

• Pain stemming from gait changes

• Toe drift where the front part of the foot points outwards

• Difficulty moving the foot from side to side or up and down

• Outward tilt at the heel

Flat feet may also increase the risk of additional complications such as:

• Bone spurs

• Bunions

• Corns and calluses at the bottom of the foot

• Shin splints

• Arthritis

• Lower back pain

Flatfoot Diagnosis

Dr. Stern will use a variety of techniques to determine the severity and type of flatfoot that a patient has.

The examination will often start with questions about the type of pain you feel, if anything makes the pain worse, and how the pain affects your life. Dr. Stern will also conduct a physical and visual examination to see how your arches behave under various conditions, such as standing, sitting, and walking.

If necessary, a podiatrist may order some imaging tests to look at your foot’s bone and soft tissue structure. These tests may include:

• X-rays: X-rays produce a clear image of the bones and joints in your feet, can provide information on your foot structure, and can also detect arthritis and other joint conditions.

• CT scans: CT scans provide better image quality than X-rays because they take images from multiple angles. They offer higher resolutions and can offer more insight into your foot structure than an X-ray.

• Ultrasounds: These are useful in imaging soft tissues like ligaments, tendons, and muscles. They’re a common tool in diagnosing posterior tibial tendon dysfunction that causes fallen arches in adults.

• MRIs: MRIs provide a comprehensive overview of hard and soft tissues that allow podiatrists to diagnose the cause of flat feet in children and adults.

Flatfoot Treatment and Management

In general, flat feet don’t present any health concerns and don’t require treatment or management. However, if your flat feet cause you pain or affect your ability to walk or conduct daily activities, you may need to consider therapies or surgery.

Common therapies for painful flat feet include:

• Orthotic devices that provide the necessary arch support for your feet. In some cases, over-the-counter products may be sufficient, or your doctor will suggest custom-made orthotics tailored to your feet. While arch supports won’t cure flatfoot, they offer the necessary pressure relief that will keep pain low and reduce other symptoms and complications associated with flat feet.

• Supportive shoes will provide more support than sandals but less than orthotic devices. They’re usually sufficient for people with minor pain from flat feet who don’t want the added expense of orthotics or arch supports.

• Physical therapy can help alleviate shortened Achilles tendons and other injuries commonly associated with flat feet. While the therapy will not cure flatfoot, it can help reduce the strain on the rest of the foot, which will lessen pain.

While surgical treatment for flatfoot is rare, they can treat associated issues that caused an arch collapse in the first place. If you’ve suffered a tendon tear that caused a fallen arch, surgery can restore function to the tendon and potentially minimize your flat foot at the same time.

Management

Some people who have flat feet will suffer occasional pain that’s not enough to warrant more extensive treatment. Lifestyle and home remedies can address minor pain, though it’s a good idea to speak with a doctor if the pain persists or worsens.

The best advice for minor foot pain is to rest the foot. High-impact activities such as running, court games, and jumping can put additional pressure on the foot, resulting in inflammation and pain. Avoiding these activities is a good first step to stopping the pain. If you don’t want to give up exercise completely, consider low-impact sports like swimming or cycling that don’t put too much pressure on the foot itself.

Over-the-counter NSAIDs can help relieve pain and inflammation associated with flat feet. They won’t cure the condition, but when combined with rest, they’ll help you get you back on your feet sooner.

For overweight or obese individuals, losing weight can help reduce the pressure on the foot, which can reduce the chance of developing adult-acquired flatfoot and overall foot and joint pain.

Flat feet are generally harmless and asymptomatic. However, flat feet may cause pain and other adverse symptoms and can also lead to other conditions that are more difficult to address and manage.

Dr. Stern Will Help You Get Back on Your Feet

Dr. Joseph Stern is a foot and ankle specialist with over 30 years of experience and offers a broad range of advanced orthopedic and non-surgical treatment options for flatfeet.

Working out of their Vancouver office, our doctor and his team offer the highest level of care to address painful flat feet and help you return to your daily activities.

Schedule an appointment today if you’re ready to better understand your treatment options.