The foot is the lowermost point of the human leg. The foot’s overall shape, along with the body’s natural system of balance-keeping, make each person capable of not only walking, but also running, climbing, and countless other activities.
‘Flat feet’ (also referred to as flatfoot, pes plants, pronated foot, and fallen arches) is a deformity with various degrees of physical impact. This condition in one or both feet can be passed down as a heredity trait or may simply develop over time. Flat feet are characterized by no arch; the entire sole of your foot touches, or nearly touches, the ground when standing.
Flexible flatfoot is a common form of flatfoot that usually presents itself in children and worsens with age due to wear and tear. Flexible flatfoot typically occurs in both feet and is characterized by feet that flatten (meaning the arch gives way) when the foot is supporting the body but regains its arch when the foot is relaxed.
Other certain types of flat feet include rigid, adult-acquired (or fallen arch), and vertical talus, as described below:
- Rigid – A patient with rigid flat feet has no arches when he or she is standing or sitting. This condition commonly develops during the teenage years and worsens through age. In addition, your feet may also feel painful. Therefore, it can be difficult to flex the feet up or down or move them side-to-side.
- Vertical talus – Some babies carry a birth defect (also known as congenital disability) called ‘vertical talus’ that prevents arches from forming. The bottom of the foot may resemble the bottom of a rocking chair, which is known for its nickname “rocker-bottom foot”.
- Adult-acquired (fallen arch) – With an adult-acquired flat foot, the foot’s arch unexpectedly drops or collapses. The fallen arch causes the foot to turn outwards and can be extremely painful. Although, this condition may only affect one foot. The most common cause is inflammation or a tear in the leg tendon that supports the arch.
Causes & Symptoms
Flat feet are usually associated with excessive pronation of the foot. As opposed to normal pronation, overpronation occurs when the arch descends downward and inward as the foot strikes the ground. Because of their tendency to overpronate, flat feet are less able to absorb shock, placing persistent stress on the feet, ankles, and knees.
Overpronation causes the excessive rotation of the tibia, increasing the risk of shin splints. Furthermore, the inward tilt of the foot places further strain on the tendons and ligaments of the lower extremities.
In addition, flat feet in newborn and toddlers is normal because the arches have not yet developed. While most children will develop arches by the age of 3, some may, unfortunately, experience delays or have structural deformities that interfere with the normal alignment of the foot bones. Flat feet may come and go as a child develops.
During growth spurts, changes in the tightness of the calf muscles may cause temporary flat-footedness. A similar example is genu valgum (also known as knock-knees), which typically occurs between the ages of 2-5, and usually corrects itself during adolescence.
In some cases, children’s flat-rootedness will not correct itself. While there may be no outward explanation for this, obesity can often contribute by placing additional stress on a current-developing foot. Flat feet in children may only become apparent between adolescence and the early teen years when abnormalities in gait and pronation become much more apparent.
Many patients with flat feet do not experience pain or other problems. However, certain types of flatfoot can be painful. Some of these symptoms associated with flat feet include:
- Muscle pain in the foot (or in severe cases, in the leg).
- Pain in the arch, ankle, heel, or outside of the foot.
- Pain when walking or sudden changes in how you walk.
- Leg cramps.
Who Gets Flat Feet?
Certain common risk factors linked to flat feet are:
- Weak arches – Weakened aches, meaning that the arch is visible when a patient sits but his / her foot flattens onto the ground when he / she stands.
- Injuries – Injuries located on the foot or ankle.
- Genetic – as flat feet can pass from parents to children in the genes.
- Tarsal coalition – Patients who suffer from flat feet may be at risk of developing another condition known as ‘tarsal coalition’. This condition causes the bones of the foot to fuse together unusually, resulting in stiff and flat feet.
- Age – Children and infants may often appear to have flat feet. In fact, the arch is typically present but still forming. In time, the arch should develop normally. However, if a child has flat feet as a result of incorrect bone development, or another condition, such as spina bifida, a doctor will need to treat the underlying cause.
- Obesity / diabetes – Most patients are prone to develop flat feet if they have obesity or diabetes.
- Pregnancy – Flat feet during pregnancy is caused when the arch of the foot flattens out upon weight bearing. This causes the feet to roll inward when walking, thus causing stress on the plantar fascia band of tissue that runs from the heel to the forefront leading to significant pain.
How Does it Affect You? How Serious is it?
In most cases, simple measures can resolve your flat feet pain, such as custom orthotics you can wear to compensate for your fallen arches. However, if this condition is left untreated, your flat feet can lead to other serious health problems, such as:
The ligament that runs from the back of your heel and across the length of the bottom of your foot, called the plantar fascia, is susceptible to inflammation, a condition known as plantar fasciitis. Characterized by heel pain that seems to worsen in the morning as you take your first steps of the day, plantar fasciitis commonly begins with flat feet.
Flat feet cause your Achilles tendon, which connects your calf to your heel, to work extra hard every time you walk or run. That additional stress can cause micro-tears and inflammation of the tendon, which is called Achilles tendonitis.
When your arch is flat, you lose significant stability, and your joints tend to take the brunt of the abuse. Overworked joints are highly susceptible to arthritis, as the protective cartilage wears away and allows your bones to rub against one another.
Recommended Treatment & Rehabilitation
A diagnosis for flat feet starts with a foot specialist known as a podiatrist. This may involve a visual exam as well as imaging tests to rule out other conditions associated with flat feet. The podiatrist can normally diagnose flat feet by looking at your feet while standing among some of the visual tests used, such as the following:
Wet footprint inspection
This is performed by wetting the feet and standing on a smooth surface. The thicker the print between the heel and ball of the foot, the flatter the foot. By contrast, a high-arch foot would leave only a narrow print of the outer foot.
Tiptoe testing is used to see if you have flexible or rigid flat feet. If a visible arch forms when you stand on your toes, you have flexible flat feet. If not, a healthcare provider would most likely recommend further treatment for a rigid flatfoot.
Shoe inspection tests can provide evidence of faulty foot mechanics. If you have flat feet, there will be more wear on the inside of your sole, especially in the heel area. The upper side of the shoe will also tend to lean inward over the sole.
Many toes test
Also known as the “too many toes” test, this specific exam is performed as the healthcare provider stands behind you and counts the number of toes peeking out to the sides. While only the pinky toe would be seen in people with normal pronation, three or four may be seen in those who overpronate.
Alongside the tests mentioned above, your healthcare provider may order imaging tests to help pinpoint the underlying cause – therefore, the following imaging tests include:
- Ultrasound – can be ordered to help produce detailed images of soft tissue damage, such as a ruptured tendon.
- Magnetic Resonance Imaging (MRI) – can provide detailed images of bone and soft tissue damage, ideal for people with rheumatoid arthritis, tendonitis, or an Achilles heel injury.
- X-ray / Computed Tomography (CT) – these two scans are ideal for diagnosing arthritis and evaluating irregularities in the angle and / or alignment of the foot bones.
During the midst of physiotherapy for flat feet, a physiotherapist will begin by reviewing your issues to determine any underlying health problems. He or she will be able to design a treatment program in order to keep your feet strong while alleviating ankle, knee, and back pain.
Some commonly suggested physiotherapy routes include, better footwear with substantial arch support (such as custom-made orthotic shoe inserts), insoles to relieve foot pressure, daily stretching exercises for both feet and the legs, ice therapy to reduce inflammation, and wearing supportive ankle braces.
Below are the following exercises you can perform to help correct fallen arches and pain:
Stand with your feet directly underneath your hips. Making sure to keep your toes in contact with the floor, roll your weight to the outer edges of your feet as you lift your arches up as far as you can. Afterward, release your feet back down as you work the muscles that help to lift and supinate your arches. Repeat this method with 2-3 sets of 10-15 repetitions a day.
While standing, lift your heels as high as you can. Hold the upper position for 5 seconds, then lower back down to the floor. Repeat this exercise with 2-3 sets of 10 repetitions a day.
Stair arch raises
Stand on a stepper with your left foot one step higher than your right foot. Next, use your left foot for balance as you lower your right foot down so your heel hands are lower than the step. Slowly lift your right heel as high as you can, focusing on strengthening your arch. Rotate your arch inward as your knee and calf rotate slightly to the side, causing your arch to become higher. Slowly lower back down to the starting position, while you repeat this exercise 2-3 sets of 10 repetitions on both sides, each day.
While standing, press your right big toe into the floor and lift up your other four toes. Then, press your four toes into the floor and lift up your big toe. Perform each way 10-15 times, holding each lift for 5 seconds a day.
Alternative & Homeopathic Treatment
There are various homeopathic treatments that can help alleviate the symptoms linked to flat feet. Some of these include:
- Custom-made orthotic shoe inserts – You can order orthotic supportive inserts or gel pads that are custom-made to shape your foot and your individual movement. Certain types include comfort shoes, insole shoes, and stability shoes.
- Therapeutic massage – such as rolling a ball under your foot may help improve arch flexibility while alleviating arches and pains.
- Rest – Avoid activities that aggravate your condition. Participate in low-impact activities (such as walking, biking, or swimming) rather than jumping and running activities.
- Medications – Over-the-counter pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation.
- Ice application – Applying ice for 20 minutes (for example, a bucket filled with ice) can help reduce inflammation and pain linked to flat feet.