Categories: Orthopaedics

Flat Feet – Types, Causes and Treatment

The human feet contain numerous muscles, tendons, bones, and soft tissues that enable us to stand upright and aid in various activities, such as balancing, walking, jumping, and running. Human feet vary in shape, size, and curvature of the foot arch. The foot arch can be:

  • High arch: Foot with high curvature known as cavus foot. In this type of foot, there will be no impression of the curve, but just only the toes and the heels are visible. It puts extra pressure on the ball and the heel, which leads to less shock absorption and increases the risk of strained bones and musculoskeletal joints.
  • Neutral or normal arch: It is the most common and most desirable foot shape. The foot is half-filled in the middle forming the natural structure. But with aging or an increase in weight, the normal arch can be flattened.
  • Flat arch: In this type, the whole foot touches the floor, leaving no space. A flat or fallen arch generally begins in childhood when the tendons that help pull the curvature upward do not tighten. It is usually not painful, but it changes the way of walking and can lead to problems in the ankles or legs.

Flat feet and their type

Flat feet or fallen arches or pes planus, is a condition in which whole foot contacts the floor without leaving any space. Flat feet are typical in infants and recede between 2 to 3 years of age as the supporting ligaments and tendons of the feet and legs tighten. But in some cases, these ligaments and tendons fail to taut, leading to flat feet.

Flat feet do not possess any difficulty in daily routine, but you can have pain while doing extensive physical activities.

The following are types of flat feet:

  • Flexible flatfoot: In this type, the foot has a normal arch at rest condition, but it disappears once the foot comes in contact with the surface (while sitting, standing, or walking). It usually affects both feet simultaneously.
  • Rigid or True flatfoot: If a person has no arch on foot while sitting or standing also, they have True or rigid flatfoot. It is present since birth, but if it develops in adults, it is called Adult acquired flatfoot or posterior tibial tendon dysfunction. Adult acquired flatfoot can develop in one or both feet.

Symptoms of flatfoot

Sometimes flatfoot condition remains asymptomatic. But some patients may feel the following symptoms:

  • Foot fatigue eve in the resting phase
  • Pain and discomfort in the inside area of the arch, heel, or ankle
  • Difficulty in performing strenuous work
  • Pain in the shin area
  • With time it can lead to inward rolling of the foot and ankle and outward tilting of the heel.
  • Sometimes pain in the knee, hip, or lower back area

Causes of flatfoot

The prime cause of flatfoot is hereditary. Other causes are:

  • Trauma
  • An extra navicular bone (os tibiale externum) in the posterior tibial tendon area that weakens the tendon support of the arch
  • Tarsal coalitions
  • Some congenital conditions (Marfan syndrome or Ehlers-Danlos syndrome) have ligament laxity, which causes flatfoot condition.
  • Charcot arthropathy
  • Obesity
  • Neuropathy
  • Diabetes
  • With the advancement of age
  • In pregnancy, an increase in elastin hormone causes flatfoot
  • Osteoporosis

Treatment for flatfoot

Treatment for flatfoot depends on the type and severity of symptoms. Early treatment is advisable in rigid flatfoot. Treatment includes:

  • Medications: your healthcare provider may prescribe medicines to reduce pain, swelling, and inflammation.
  • Foot support: The doctor recommends foot support to halt the unnecessary pressure on the feet, ankles, and joints. A shoe insert, custom functioning orthotics or bracing can provide foot support efficiently.

The doctor may recommend special shoes or heel cups for children until their feet do not develop.

  • Lifestyle modification: Controlling obesity and diabetes can reduce pain from flatfoot conditions. A balanced diet and exercise regimen reduces extra weight and decreases the pressure on the feet.

You can also avoid standing or walking for long, as they worsen the pain and discomfort in your feet.

  • Physiotherapy: Many strengthening, raising, and lengthening arch exercises can help rectify fallen arches and reduce pain. Exercises include:
  • Heel stretches
  • Ball (tennis or golf) rolls
  • Calf raises exercise
  • Arch lifts
  • Toe raises
  • Surgery: A doctor recommends surgery in severe cases of flatfoot and when other treatments fail. The surgeon creates an arch in your sole, repairs tendons, lengthens the short Achilles tendon, and repairs the fused joints to relieve you from flatfoot symptoms.

A flat foot condition is not a life-threatening situation. Modification in your lifestyle and some daily exercises may improve its symptoms. Consult your doctor if you are experiencing pain while walking or standing for a few minutes.

Dr. V. A. Senthil Kumar | HOD & Senior Consultant – OrthopaedicsSpine Surgery and Arthroscopy | Dharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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