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?

The feet, undeniably, carry the entire weight of the body when you’re standing so you can imagine the responsibility it carries. Now, nature has provided the perfect support to help the foot perform its function efficiently – the arch.

The arch is actually named after the arch shape of the inner side of the foot, between the ball of the foot and the heel. The arch shape acts as a shock absorber and a weight distributor whenever the foot is bearing weight. In effectively distributing the body weight to different parts of the feet, it also enhances stability and balance.

Finally, the same spring-like effect that acts as a shock absorber also acts as a propelling force, giving the foot a forward thrust as you walk and run. Without this thrust, you will need greater effort to move.

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, they begin to feel discomfort or pain.

Rigid Flat Feet

This is a more severe type of flat feet which, thankfully, is less common. With this type of flat feet, the arch is completely collapsed whether the feet bear any weight or not.

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 pain and discomfort is often associated with this type of flat feet.

Who Is Likely to Have Flat Feet?

Is flat feet prevalent with a particular gender, age group or individuals with certain conditions? Does genetics have anything to do with it?

Let’s answer these questions:

Prevalence Based on 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. Aside from this, there appears to be no prevalence based on gender.

Age Factor

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.

Symptoms of Flat Feet

Flat feet can trigger a range of symptoms that can be classified from mild to severe. Like we stated above, some folks with flat feet (flexible flat feet) may not exhibit any of these symptoms. However, it is important that you are aware of them so you can quickly identify them if you begin to notice any of them and know to take appropriate steps to address them.

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.

Pain in the Heels

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.

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 Examination

This is the final type of examination which will often be used to confirm the true state of the arch. A podiatrist or an orthopedist will be required to carry out this examination.

A thorough examination will involve different aspects. Some of the steps will involve:

·         A visual examination to assess the foot's shape, flexibility, and gait.

·         Imaging like CT scans, X-rays, and MRI to determine underlying factors that may not be immediately visible to the eyes.

Professional examinations like these help determine the extent of the real issues behind flat feet, especially when the symptoms are really severe. Even when you've done a personal examination, it's important to get a professional examination if the pain you're feeling is chronic or pretty severe.

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 Effect

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. Traditionally, individuals with flat feet were automatically disqualified from enlisting. This was generally the practice in the United States and many other countries.

The belief was that flat feet automatically meant reduced mobility, increased risk of injuries, and reduced ability to endure. Given how important these requirements are in the military, it was only common sense for these folks to be exempted from being enlisted.

Things have however, changed in today's military. People are no longer rejected simply because they have flat feet. A person with flat feet will only be rejected 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 that will cover the following:

·         Determination of the extent of the arch collapse.

·         Analysis of posture and gait

·         History of physical therapy, use of orthotics, and pain.

·         Ability to function to full capacity.

A person may, therefore, still make it into the military even with flat feet. They just need to meet the conditions required and be able to pass the physicals.

Prevention, Management, and Treatment of Flat Feet

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.

How to Prevent Flat Feet

This is for those who currently do not have flat feet and do not want to develop acquired flat feet. Let’s begin with preventing flat feet in Children.

Preventing Flat Feet in Children

While children will generally have their arches not fully developed until around 6 to 8 years of age, it is important to pay close attention to it. The idea is to ensure that everything is done to promote the healthy development of the arch.

This can be done in the following ways:

·         Allowing the children to play barefoot on soft surfaces like sand and grass. This will help with the development of the foot muscles.

·         Ensuring 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.

The steps above will help reduce the chances of acquired flat feet developing in people who did not previously have this condition.

Managing Flat Feet

Some folks do not have the luxury of preventing flat feet because they were born with it or have already developed it. To this set of people, only two options are open to them – management and treatment.

Let’s look at management in this section. Managing flat feet means doing everything possible to reduce the effects of the symptoms so that any associated pain and discomfort is eliminated or at least reduced significantly. It is also often referred to as “conservative treatment.”

Below are some common methods used for managing flat feet.

Orthotics

Orthotic insoles can be used to manage flat feet. They are designed to mimic the support that the arch provides, and by so doing, they:

·         Provide shock absorption

·         Correct overpronation

·         Distribute weight efficiently

·         Relieve pressure to the arch and ankle

·         Provide stability

·         Improve posture, gait, and movement efficiency

Orthotic insoles can be custom-made or over-the-counter. While over-the-counter insoles may provide some relief, for more severe cases, custom orthotic insoles are recommended.

The reason is that orthotic insoles are only as effective as they are able to effectively address the underlying issue. Since factors like foot size and shape play a critical role in this, an insole will only be effective if it is the right size and fit for the exact needs of the foot.

While over-the-counter insoles cannot guarantee this, custom-made insoles do, and so they generally get better results. If you get the right product, any other foot conditions that can be managed with insoles will also be addressed by the same insole. This means that the same custom orthotic insole for flat feet, will also address the underlying factor, be it flat feet or any other issues.

You should, however, note that insoles will not cure the problem. It will only play a supportive role, compensating for the role the arch should play and preventing pain, discomfort, and a possible worsening of the condition.

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 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.

Treating Flat Feet

Finally, we will be looking at what treatment options are available for flat feet. In general, most people with flat feet are okay with the conservative methods discussed above. While they are simply managing the condition, the result is enough to ensure they live a full and fulfilled life.

That said, 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.