Define Flat Feet

Flat feet, also known as pes planus, fallen arch, low arch, or flat foot, describes a condition where the arch of the foot is fallen, undeveloped, or underdeveloped. With the arch fallen or absent, the entire sole of the foot is flattened and makes contact with the floor. Many solutions like custom orthotics, icing, and orthopedic shoes are first line options for pain relief.  

Key Takeaways

• Flat feet means the absence or inadequacy of the arch, which causes the entire sole of the foot to make contact with the floor when the foot is load-bearing.

• Flat feet can be present from birth or it can be acquired later in life as a result of aging, injury, or a medical condition.

• It can be caused by genetic factors, lifestyle choices, medical conditions, and injury.

• The three main types of flat feet are flexible, rigid, and adult-acquired flat feet.

• Flexible flat feet is the most common type and it is often asymptomatic, while rigid flat feet, which is rare, can be severe.

• Flat feet will often not require any treatment or intervention unless symptoms begin to develop.

• The use of orthotic insoles is usually sufficient to treat or manage most cases of flat feet.

Why is the arch Important?

The arch of the foot is a shape or structure formed by a combination of the bones, ligaments, tendons, and muscles. These different parts of the foot create a raised area in the sole of the foot between the heel and the forefoot. This raised area is shaped like an arch, hence the name.

As shown in the image above, the arch is divided into three parts:

1. The Transverse Arch

2. The Medial Arch

3. The Lateral Arch

The arch plays some critical roles, which include:

• Shock Absorption - Acting like a spring, the arch absorbs shock during movement and spreads it evenly across the foot, protecting the kinetic chain from injury.

• Weight Distribution - Similar to its shock absorption role, it helps distribute body weight evenly across the foot so that no part of the foot is exposed to more stress than the other.

• Balance and Stability - The arch helps the foot maintain stability by preventing overpronation (the excessive inward rolling of the foot), which can lead to imbalance or even injury as the ankle rolls inward.

• Adaptability - The arch helps the foot maintain balance when walking on an uneven surface. Its spring-like nature provides the flexibility required to quickly adjust to any unevenness on the floor.

• Propulsion - Just before the swing phase of the gait cycle, the arch pushes off with its stored-up energy, giving the foot a propelling force that increases its movement efficiency.

With the arch undeveloped, underdeveloped, or fallen, the foot loses the above functions, which then forces the plantar fascia and other foot structures to try to compensate. This can then lead to pain, discomfort, and other foot conditions like plantar fasciitis.

What Causes Flat Feet?

Flat feet can be caused by a number of factors, including the following:

Congenital Factors

These are factors that a person was born with. Examples include:

• Genetic Factors - A person born to a parent or parents with flat feet is likely to have flat feet. This can be because of an inherited trait for flexible or loose ligaments that makes it difficult for the arch structure to be maintained.

• Development Issues - Every child is born with flat feet because the arch does not fully develop until about age 6. In some cases, the arch may not fully develop when it should, resulting in flat feet.

• Congenital Health Conditions - Children born with conditions like Ehlers-Danlos syndrome, Down syndrome, or Marfan syndrome have a high chance of having flat feet as a result of abnormalities in the development of foot structures.

Acquired Factors

In some cases, the factors leading to flat feet are acquired. This means that the arch was developed and then fell as a result of these acquired factors. Some of these factors include:

• Injuries - Injuries that weaken the structures that support the arch can lead to a collapse of the arch. Examples of such injuries include fractures, tendon damage, or ligament tear.

• PTTD (Posterior Tibial Tendon Dysfunction) - Any dysfunction, injury, overuse, or degeneration of this tendon can lead to a collapse of the arch because it supports the arch.

• Obesity - Excess weight increases the load that the arches have to carry. This increased stress can lead to an eventual collapse of the arches.

• Aging - The natural process of aging often results in ligaments, tendons, and muscles losing their strength and elasticity. This can lead to the gradual collapse of the arch.

• Medical Conditions - Any medical condition that causes damage to the tendons and ligaments can lead to the collapse of the arches. Examples of such medical conditions include diabetes, rheumatoid arthritis, and neuropathy.

Other Contributing Factors

Aside from the factors discussed above, there are other factors that can contribute to flat feet. Some of these other contributing factors include:

• Pregnancy - During pregnancy, hormonal changes increase the level of relaxin in the body, leading to a loosening of ligaments. This, in addition to increased body weight, can contribute to the collapse of the arch. This should usually be temporary, but can become permanent in some cases.

• Repetitive Stress or Overuse - Individuals who engage in high-impact activities, like running, jumping, and those who spend extended periods on their feet, put a lot of pressure on the arch. This can lead to the collapse of the arch, especially when they do not use supportive footwear.

• Tarsal Coalition - This is a rare condition in which some bones in the foot are fused. While this is usually a congenital condition, its effect is often felt from the adolescent years as the bones become more ossified.

• Unsupportive Footwear - Consistently putting on footwear that don’t offer proper support can weaken the structures of the foot, leading to a collapse of the arch.

Types of Flat Feet

There are different types of flat feet, with the major types being flexible flat feet, rigid flat feet, and adult-acquired flat feet.

Flexible Flat Feet

This type of flat feet is the most common. It is described as flexible because the arch is visible when the foot is not bearing any load. However, once the foot is bearing load (you are standing), the arch collapses and is no longer visible.

While this type of flat feet is prevalent among toddlers with still-developing arches, it can persist into adulthood. It is often asymptomatic, requiring little to no intervention. In some cases, it can result in overpronation, which can cause further discomfort or even lead to other foot conditions.

Rigid Flat Feet

This is a less common type of flat feet, and unlike the flexible type, the arch is not visible (absent) whether the foot is bearing load or not. This type of flat feet is often associated with stiffness, pain, and difficulty walking.

Rigid flat feet will often require medical intervention because it is often caused by conditions like arthritis or even congenital conditions like tarsal coalition.

Adult-Acquired Flat Feet

This type of flat feet describes a condition where a previously present arch collapses over time for reasons which we already discussed above under "what causes flat feet."

Conclusion

Flat feet is a condition that is quite common, especially flexible flat feet. Like we already stated above, in most cases, it is asymptomatic, requiring no treatment or intervention. Even in cases where some intervention is required to correct overpronation, the use of orthotic insoles is often sufficient.

However, in rare cases, especially with some cases of rigid flat feet, medical intervention, which may include surgery, may be required. This is, however, quite rare and not something to be worried about.

To manage or prevent symptoms of flat feet, getting good-quality orthotics is crucial. Thankfully, there are top-quality manufacturers like Stride Soles, that offer products designed to deliver good support and comfort for people with flat feet.