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Flat Foot – Causes, Symptoms & Treatment

A flat foot is a foot deformity in which the longitudinal arch is flattened or absent. It can be congenital or acquired and may cause pain and gait problems.

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Things worth knowing about "Flat foot"

A flat foot is a foot deformity in which the longitudinal arch is flattened or absent. It can be congenital or acquired and may cause pain and gait problems.

What is a Flat Foot?

A flat foot (medical term: Pes planus), also known as fallen arches, is a common foot deformity in which the natural longitudinal arch of the foot is reduced or completely absent. As a result, a larger portion of the sole of the foot rests flat on the ground. Flat feet can affect one or both feet and occur in varying degrees of severity.

Causes

Flat feet can result from a variety of causes, broadly classified as congenital or acquired:

Congenital Flat Foot

Genetic predisposition and family history
Connective tissue disorders (e.g., Marfan syndrome)
Physiological flat foot in infants and toddlers (usually resolves by age 6)

Acquired Flat Foot

Overweight and obesity
Weakness or rupture of the posterior tibial tendon
Injuries or fractures to the foot or ankle
Rheumatoid arthritis or other inflammatory joint diseases
Prolonged standing or overuse
Poorly fitting or unsupportive footwear

Symptoms

Many people with flat feet experience no symptoms, especially in childhood. When symptoms do occur, they may include:

Pain along the inner side of the foot or ankle
Pain in the heel, knee, hip, or lower back
Fatigue or heaviness in the feet after prolonged standing or walking
Altered gait, including inward rolling of the ankles (overpronation)
Uneven or accelerated wear on the inner side of shoe soles
Swelling along the inner ankle

Diagnosis

Diagnosis of flat feet is typically performed by a physician or orthopedic specialist through a clinical examination, which may include:

Visual assessment: Evaluation of the foot while standing and walking
Footprint analysis (podoscopy): Measuring pressure distribution of the foot
X-rays: Assessment of bone alignment and arch height under weight-bearing conditions
MRI: Used when tendon or soft tissue damage is suspected
Gait analysis (podometry) for complex cases

Treatment

Treatment depends on the severity of the deformity and the extent of symptoms.

Conservative Treatment

Orthotic insoles: Custom or prefabricated arch supports to redistribute foot pressure
Physiotherapy: Strengthening exercises for the foot and calf muscles
Appropriate footwear: Supportive shoes with good arch and heel support
Weight management: Reducing excess weight to relieve pressure on the feet
Pain relief with anti-inflammatory medications if needed

Surgical Treatment

In severe cases that do not respond to conservative measures, surgery may be considered. Options include:

Tendon transfer (e.g., for posterior tibial tendon insufficiency)
Osteotomy: Cutting and realigning bones to correct deformity
Arthrodesis: Surgical fusion of joints in advanced cases
Subtalar implant: Insertion of a small device to support the arch

Prevention

While not always preventable, the following measures may reduce the risk of developing flat feet:

Walking barefoot on natural surfaces, especially during childhood
Regular foot-strengthening exercises
Wearing supportive and well-fitting footwear
Maintaining a healthy body weight

References

American Academy of Orthopaedic Surgeons (AAOS): Flatfoot (Pes Planus). orthoinfo.aaos.org (2023).
Myerson, M.S.: Adult Acquired Flatfoot Deformity. Journal of Bone and Joint Surgery, 1996.
Wirth, C.J., Zichner, L.: Orthopaedics and Orthopaedic Surgery – The Foot. Thieme Verlag, Stuttgart 2002.

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