Flat Feet: Diagnosis, Treatment, Prevention, and more

Key Takeaways

Flat feet is quite common, affecting about 30% of adults. However, you cannot ascertain whether a child has flat feet until the age of 6 to 8 when the arch should have fully developed.
Flat feet can be asymptomatic (presenting no symptoms). If, however, there are symptoms, they will include arch pain, inner ankle swelling, heel pain, and foot fatigue. For children, there may be a reluctance to engage in physical activities or clumsiness.
Flat feet can be prevented by using supportive shoes, orthotic insoles, exercise, and lifestyle management.
Flat feet can easily be managed through conservative methods. People with flat feet go on to live fully active lives, especially with the right orthotics for flat feet.
Surgical intervention only becomes necessary in extreme cases of symptom severity. This is not common so many will never require it.
Flat feet, or fallen arches is something that hundreds of millions of people experience all over the world. While most will feel little to no discomfort as a result of this condition, there are millions for whom this condition means pain and discomfort. For these folks, flat feet result in persistent foot pain, joint stress, recurring injuries, and poor posture, among other things. Whether the condition is congenital or developed later in life, it can have a massive impact on the individual's quality of life.
Thankfully, flat feet can be successfully managed in most cases with the use of orthotic insoles, supportive footwear, exercise, physical therapy, and lifestyle changes. This subject can be confusing for many so we will be breaking it down in this guide.

Let’s start from the beginning…

What are Flat Feet?

Flat feet is a condition medically known as pes planus, which describes a situation where the arches of the feet are either completely fallen or low. When completely fallen, the entire surface of the soles make contact with the floor. If only partially collapsed, then the entire sole will not make contact with the floor but enough of the arch will have fallen to reduce the support it can offer.

This condition is quite common, affecting up to 30% of adults. In children, their arches are usually undeveloped until about age 6. Some may stay undeveloped or underdeveloped, and we will discuss that in some detail in a bit.

What is the Arch and Why is it Important?

Some of the arches important functions include:

Weight Distribution – It distributes the weight of the body evenly across the foot during movement, ensuring that no part of the foot takes on more pressure than it should.
Shock Absorption – The arch shape acts as a spring-loaded shock absorber that absorbs impact shock, reducing stress on the legs, spine, and hips.
Maintaining Posture and Alignment – It keeps the legs and spine aligned, preventing overpronation or supination, which can result in imbalance or increased stress to the joints.
Movement Efficiency – It's spring-like action stores and releases energy, which helps propel the foot forward with each step. This forward thrust gives the foot an all-important propulsion that increases movement efficiency.
Protection of Blood Vessels and Nerves – The curved shape of the arch protects vital nerves, and blood vessels like the tibial nerve branches, posterior tibial artery and its branches, and several tendons, from direct contact with the floor, which can increase compression on them.
Adaptation to Different Surfaces – As you walk on an uneven or sloppy surface, the arch flexes to help you maintain balance and stability.

All of the above, therefore, means that a fallen arch cannot provide shock absorption, weight distribution, forward thrust during movement, and stability. This is what then leads to the different conditions that arise from flat feet.

Types of Flat Feet

There are two main types of flat feet – flexible flat feet, and rigid flat feet.

Flexible Flat Feet

This is the most common type of flat feet and often doesn't come with any major symptoms. In this type of flat feet, the arch is seen to be in its natural shape when the feet is not bearing any weight. However, the arch disappears (falls or collapses) when the feet is bearing weight (when you stand or walk).

People with this type of flat feet often do not require any treatment or special care except, of course, if they begin to feel discomfort or pain.

Rigid Flat Feet

With this less common type of flat feet, the arch is completely collapsed regardless of it the feet bear any weight.

Rigid flat feet is often caused by underlying factors like tarsal coalition or structural problems. They are also more likely to require some medical treatment or intervention because of the associated pain and discomfort.

Factors Contributing to Flat Feet

Gender

Both genders appear to be equally affected by flat feet. However, females appear to have a slightly higher occurrence rate because pregnancy and all that is associated with it can predispose them to flat feet.

Age

Like we noted earlier, children usually do not have a fully developed arch until about 6 or 7 years of age. Once an individual is fully matured, there’s no reason, barring some of the conditions we will be looking at shortly, why the arch shouldn’t be up and functioning perfectly.

On the flip side, as we age, the body begins to relax, including the muscles and ligaments. These include the structures that support the arch, especially the posterior tibial tendon. As these support structures weaken, the arch will begin to fall. This is referred to as acquired flat feet or more precisely, adult-acquired flatfoot deformity (AAFD).

Genetics and Heredity

Genetics can play a significant role in why a person will have flat feet. If one or both parents have flat feet, the chances of their children having the same condition is highly increased.

Here are some genetic factors that can predispose an individual to having flat feet:

Foot Structure - Foot structure, which can cause flat feet, can be inherited. It covers the way the bones and its supporting structures are formed and explains occurrences of arches that are low or completely absent from birth.
Disorders and Syndromes - The risk of flat feet is increased with certain genetic syndromes that affect joint flexibility, ligament strength, and muscle tone. Examples of such disorders and syndromes include, Down syndrome, Marfan syndrome, and Ehlers-danlos syndrome.
Muscle Function and Ligament Laxity - Muscle weakness and imbalance can be passed down from parent to offspring, and these can in turn, affect how the foot functions, including the arch. The same applies to ligament laxity, a case where the ligaments are excessively flexible. In this situation, the arch will lack adequate support to form properly.

Other Factors that Cause Flat Feet

Aside from all of the points listed above, there are environmental and lifestyle factors that predispose an individual to having flat feet. Some of these include:

Injury - If a person suffers injury or trauma that affects the support structures required by the arch, this can cause the arch to collapse. Some examples include fractures, torn tendons, and dislocations.
Excessive Weight - Obesity can cause the foot structure to weaken as it is forced to carry more weight than it should. Over time, this can result in the collapse of the arch.
Diabetes and Neurological Conditions - Any health condition that can affect circulation or the nerves can affect how to foot functions and the control of the muscles. This is why diabetes and other neurological issues, like cerebral palsy, can contribute to the development of flat feet.
Arthritis - Because arthritis, like osteoarthritis, can affect the feet joints, where they cause deformity, and inflammation, they can eventually result in the collapse of the arch.
Footwear Choice - Consistently using footwear that do not offer proper support can significantly increase the chances of a person developing flat feet. Interestingly, using footwear that offer good support can reduce the risk of a person with flexible flat feet developing symptoms that will require care.

Flat Feet Symptoms

Arch Fatigue and Pain

One of the most common symptoms is the feeling of fatigue or a dull aching pain in the area of the arch. This feeling is often more pronounced when the feet have been active for a while (standing, walking, or any other such physical activity). Since the foot is deprived of the support it requires from the arch, more strain is placed on the muscles and ligaments so they work harder, resulting in soreness and pain which can feel like cramping or a burning sensation around the arch area.

Heel Pain

As the plantar fascia, the tissue that connects the heels to the toes, gets stretched because of the fallen arch, it is put under increased strain, with the tension on it significantly heightened. This increased tension can lead to plantar fasciitis, or you can experience symptoms usually associated with plantar fasciitis.

This symptom will feel like a stabbing, sharp pain under the heel. It will often be worse after periods of rest or early in the mornings.

Note that there is crossover pain here between plantar fasciitis vs flat feet, although the two are distinct conditions.

Foot Fatigue

If you have flat feet and engage in high-impact activities, or spend a lot of time on your feet, then you are likely to experience foot fatigue. When this sets in, the feet can generally feel tired and heavy even after you've only spent a short time on any activity. This is because of the overuse of the muscles caused by inadequate or a complete lack of arch support.

Inner Ankle Swelling

For folks with adult-acquired flatfoot deformity (AAFD), the posterior tibial tendon or the inner ankle, can get inflamed, leading to tenderness and swelling. This is because of the stress on the tendons as they are overworked in their attempt to support the arch. This inflammation and swelling will often get worse with increased activity and will likely leave the area with a feeling of heaviness and puffiness.

Symptoms in Children

Children with flat feet show a lot of clumsiness, with a lot of tripping and falling. You may also find them not enthusiastic to engage in physical activity with other children because of the discomfort they feel or they may often complain about their feet being tired.

A number of factors will influence the intensity of these symptoms, and they include, the type of flat feet (flexible or rigid), presence of underlying conditions, and activity level.

Diagnosis – How to Tell If You Have Flat Feet

Proper diagnosis of any health condition is a crucial first step to effective treatment. The same is applicable here. To effectively manage or treat flat feet, you must first be able to diagnose it effectively.

There are a few ways to diagnose flat feet and we will look at three of the most effective ones.

Inspection

The first way to check for flat feet is to inspect the arch visually. While standing, there should be a slight elevation shaped like an arch on the side of the foot between the ball of the foot and the heel.

If you have flat feet, this elevation will be absent, and that entire area will be making contact with the floor. If you have low arch, then the raised part will be minimal, with most of the sole of the foot making contact with the floor.

Another thing to check is the wear pattern on your shoes. If the inside part of the soles of your shoes are more worn than the outer part, then this may be an indication that you have flat feet. This wear pattern will usually occur because of overpronation as the foot rolls inward when you walk or stand. This is a good starting point for diagnosis.

Wet Foot Test

This is a simple test that you can carry out at home to know if you have flat feet. In fact, the test can also show you whether you have flat feet (low arch), normal arch, or high arch.

To carry out this test, you will need a bowl of water, large enough to contain your foot, and a sheet of brown paper.

Step 1

Place your foot in the bowl of water as shown in the image below.

Step 2

Place your wet foot on the brown piece of paper, also as shown below.

Step 3

Check the imprint you make against the images below to confirm what type of arch you have.

Notice that the imprint of the flat feet is fuller than others. The high arch presents a different problem which is, however, not the subject of this article. With this test, you can have a pretty good idea of whether or not you have flat feet.

Professional Diagnosis of Flat Feet

Professional diagnosis is often necessary to confirm both the condition and any associated or causative factors. This is especially true for plantar fasciitis because flat feet is more easily diagnosed, thanks to the often visibly absent arch.

A professional examination to determine flat feet will usually involve the following:

Patient History Taking - This will determine if there’s a family history of flat feet.
Visual Examination - The specialist will visually inspect the arch to determine its viability. A visual examination can also show whether it is flexible or rigid flat feet. In flexible flat feet, the arch is visible but disappears with weight-bearing, while the arch is never visible in rigid flat feet.
Gait Analysis - This can show if the foot is overpronating.
Imaging - In severe cases, x-rays may be required to determine arch height, bone alignment, and also to rule out other conditions like arthritis and bone fractures.

How Flat Feet Affect the Body

Now that we’ve covered the basics, let’s take a closer look at how this condition affects the body. Since it affects the body in different ways, we will break these effects into different classifications.

Foot Mechanics and Gait

We already know that the arch plays a very important role in foot mechanics. It offers shock absorption, weight distribution, forward propelling force, and stability. In the absence of these, arising from flat feet, the following effects occur:

Loss of Shock Absorption – With each step, the entire sole of the feet hits the floor, forcing the foot to roll inward (overpronate). Aside from the increased impact shock, the inward roll of the foot, increases strain on the inner foot and ankle.
Poor Weight Distribution – In a normal stride, when the foot hits the floor, the heels first make contact and then shifts to the arch which absorbs that initial shock. In midstance, it distributes the weight evenly across the foot. However, without the arch support, the collapse of the arch forces the foot to roll inwards as already mentioned above.
Inefficient Movement – After the heel of the foot hits the floor and the shock impact is transferred to the arch in midstance where weight is also evenly distributed, in one smooth motion, the movement transitions to toe-off (ball of the foot and toes), where the spring-like action of the arch gives the foot a push or thrust. All of these describe the ideal that happens with a normal arch. With the absence of the spring-like action of the arch, there is no push-off or forward thrust so the stride is reduced, leading to inefficiency in movement.
Aligned Swing – The last stage of the movement is after the push-off from the arch. Because the arch support is missing, this last swing, in addition to being less forceful because of the absence of the push-off, is also misaligned because of the inward roll of the foot when the movement transitioned from heel strike to midstance. This overpronation starts the process of taking the entire feet out of alignment.

As a result of the above-listed points, the following effects can ensue:

The ankles roll inward and this translates to the knees, forcing them into a position where they knock together. This misalignment continues from this knock-knee position to the hip and pelvic region. The result is improper posture, increased degeneration on the knees, and hip instability.
Lack of shock absorption resulting in increased risk of tendonitis, sprain, wearing of the cartilage, patellofemoral pain, and lower back pain.
Increased inefficiency in movement because of the absence of proper push-off from the arch. This forces you to expend more energy during movement. It may also result in foot dragging or foot slapping.
Change in gait as some parts of the body’s biomechanics go into compensatory mode in an attempt to correct the issues of misalignment triggered by the inward roll of the feet and ankle.

Athletic Performance

As a direct consequence of flat feet, athletes and anyone involved in high-impact activities will experience some of the following:

Reduced ability to endure
Increased tendency to get fatigued
Increased risk of developing foot conditions like plantar fasciitis, stress fractures, and Achilles tendinitis.

While this may look like it sentences athletes or intending ones to a life of underperformance, it is not. With some interventions, like Custom Orthotics for Flat Feet, athletes can restore the missing arch support, and by so doing, get the foot’s mechanics into optimal functioning for improved performance.

Long Term Impact

If flat feet is not properly managed or treated, it can have some long-term effects which include:

Degeneration of the knee and hip joints.
Plantar fasciitis as the plantar fascia is constantly put under strain because of the increased tension brought about by the fallen arch.
Chronic and persistent musculoskeletal pain.
Postural instability arising from spinal misalignment.

Effect on Military Eligibility

As a bonus point, let’s look at how flat feet affects military eligibility with flat feet. Traditionally, individuals with flat feet were automatically disqualified from enlisting. This was generally the practice in the United States and many other countries. However, now it's only a automatic rejection if:

There is chronic pain and discomfort.
The flat feet have resulted in arthritis or posterior tibial tendon dysfunction.
The applicant cannot effectively perform physical activities because of the foot issues.
·There is extensive pronation which has had a massive impact on their posture and gait.

To ascertain the true state of an applicant’s flat feet, the military will carry out an assessment.

Flat Feet Prevention

We’ve taken some time to extensively discuss various aspects of flat feet, including its causes and effects on the body. Now, we want to look at solutions which will include prevention, management, and treatment.

Preventing Flat Feet in Children

Children have undeveloped arches until around 6 to 8 years of age. To ensure that the arches develop naturally over time:

Allow the children to play barefoot on soft surfaces like sand and grass. This will help with the development of the foot muscles.
Ensure they wear shoes that are flexible, offer good arch support, and have a firm heel counter. These can help guide the proper formation of the arch.

Preventing Flat Feet in Adults

Preventing acquired flat feet in adults will entail the following:

Wearing footwear with good support, shock absorption, and a firm heel counter. Avoid wearing flip-flops, high heels, and other unsupportive shoes for extended periods.
Using appropriate footwear for exercises and training.
Taking increases in exercise intensity gradually. Never jump straight into the deep end of an exercise. Always start gradually to allow your muscles adapt.
Efficiently managing your weight so your feet do not have to put up with more weight than they should. Doing this reduces the risk of developing flat feet in future.
Treating injuries to the foot promptly. If injuries to the foot are left unattended to, depending on the type of injury, it may increase strain on the arch, increasing the chances of it falling. While injuries like those to the posterior tibial tendon will affect the arch more, every injury should be given prompt attention just to be on the safe side.
Exercising to strengthen the foot muscles and ligaments. While this is often recommended when managing flat feet, it can also help in its prevention.

Flat Feet Treatment

Lifestyle Modification

This is an important component in the treatment or management of flat feet. First, weight management is crucial to ensure that the foot does not have to carry too much weight. Secondly, cutting down on high-impact exercises and switching to lower-impact alternatives will ensure you stay active without putting the arch under increased strain.

Orthotics

Devices like orthotic insoles are designed to provide support for the foot. Depending on the severity of the flat foot, either over-the-counter insoles or custom insoles can be used. While custom orthotics for flat feet offer better support than OTC insoles, you may get some relief with OTC insoles if yours is a mild to moderate case of flat feet.

Supportive Footwear

In addition to using orthotics, you should also consider wearing appropriate footwear. The right type of footwear should have the following criteria:

Adequate arch support
Firm heel counter
Good shock absorption and cushioning for comfort
Wide toe box to prevent squeezing

Combining supportive footwear with the right orthotic insole will yield better results.

Exercise

Some exercises for flat feet can help improve the arch by strengthening and tightening the necessary supporting structures. Some exercises known to help with this include:

Toe Yoga - In this exercise, you raise the big toe while keeping the other toes down. Next, you raise the other toes while keeping the big toe down.
Towel Scrunches - Do this exercise by using your toes to grip and pull a towel in your direction.
Arch Lifts - With your toes and heels firmly planted on the floor, try to raise your arch.
Heel Raises - Stand with your feet slightly apart and raise your heels off the floor. Hold for a few seconds and slowly lower the heels to the floor. Repeat the process a few times. You can stand near a wall, a chair, or a table for support.
Calf Stretch - While facing a wall and with both hands placed on the wall at chest level, take one foot back no more than 2 feet. Keep the back foot straight and then press the heel of the same foot down on the floor. Hold this position for about 30 seconds and repeat for the second leg. Repeat the exercise about 3 times per foot.

Physical Therapy

Physical therapy can also be helpful in managing flat feet. This is because, with target routines, it can help address the following:

Foot awareness and balance.
Issues with gait patterns.
Posture issues that worsen the condition.

Other Interventions

There are other ways to help manage symptoms of flat feet. These include:

The use of medication. NSAIDs like Ibuprofen can help with the pain and inflammation.
Elevating your feet at the end of the day to help with the swelling.
Using ice packs for flare ups and swellings.
Using compression socks to help reduce the swelling.
Taking breaks to give your feet some rest, especially if your work requires that you stay on your feet for hours on end.

All of the approaches discussed above will not treat flat feet but will help manage the symptoms, resulting in relief from pain, and discomfort. They will also help ensure that the condition does not worsen.

Flat Feet Surgery

There are cases where these conservative methods do not have the desired results. When this is the case, a more aggressive method - surgery - may be required.

To determine if treatment is indeed required, an extensive examination will be carried out to determine:

The level of structural deformity.
The extent of joint degeneration
The integrity of the tendon

A proper postural assessment and gait analysis will also be carried out.

An individual may be considered for surgical intervention if they experience the following:

If they have rigid flat feet and are experiencing a lot of pain.
They have tried every possible conservative treatment without success.
They have arthritis, severe deformity, or the tendon has ruptured.

Depending on the exact underlying issues, any or some of the following surgical procedures may be considered:

Tendon Repair or Transfer
Subtalar Arthroereisis
Osteotomy, a bone realignment surgery.
Lengthening of the Achilles tendon
Bone Fusion Precedures

Generally, most people never require surgery because their flat feet symptoms are sufficiently managed with the conservative methods discussed above. If however, surgery becomes necessary, your podiatrist or orthopedic surgeon will provide proper guidance.

Conclusion

We’ve taken some time to discuss flat feet in some detail. We’ve looked at causes, factors that can predispose a person to it, its symptoms and effects on the body, and how to prevent, manage, or treat it. This article is designed to present you with all the information you need on flat feet so you know what steps to take should you, or someone you know, be dealing with the issue.

Flat feet is easily managed, especially when it is the flexible type. Using custom orthotic insoles have been known to be very helpful. When combined with the other management methods discussed in this article, you are almost certain of getting impressive results.

Remember to see your doctor should the symptoms persist after taking the steps described in this article.