Flat Feet

Flatfoot, or pes planus, is a condition where the arch of the foot is lowered or absent. In this condition, the inner sole nearly or completely touches the ground when standing. 

While all infants are born with flat feet, most develop arches during childhood. If the arch never forms or collapses later in life, it results in flatfoot.

There are two main types:

• Flexible flatfoot: An arch is visible when not standing, but flattens when weight is applied.
• Rigid flatfoot: The arch is always flat, and the foot remains stiff.

Flatfoot can be congenital (present at birth) or acquired. Common congenital causes include genetic traits, tarsal coalition, and connective tissue disorders like Ehlers-Danlos syndrome. 

In adults, flatfoot often develops due to posterior tibial tendon dysfunction (PTTD), along with other factors like injury, obesity, arthritis, or diabetes.

Flatfoot affects 30% of the population. While many people have no symptoms, some may experience foot pain, instability, or limited mobility. Risk factors for painful or symptomatic flatfoot include age, female gender, obesity, high-impact activity, hypertension, and diabetes.

Flat feet often don’t cause problems, especially in children or adults who’ve had the condition for years without symptoms. Many cases of fallen arches are flexible and go unnoticed. 

However, when symptoms occur, they can affect multiple areas of the foot and may also involve the knees, hips, or back.

• Arch or midfoot pain: One of the most reported signs is aching or sharp pain along the inner arch or near the posterior tibial tendon, which runs behind the inner ankle. This is a common reason people seek arch pain treatment.
• Heel or ankle pain: When the heel shifts outward due to foot misalignment, it can irritate tissues under the ankle bone. Flatfoot may also contribute to heel pain, Achilles tightness, or inflammation (plantar fasciitis).
• Foot fatigue: Many patients feel tiredness in their feet after walking or standing for long periods. Running or standing on tiptoes can become difficult. Some experience calf pain or shin splints due to overpronation.
• Deformities or uneven shoe wear: Over time, flatfoot can lead to visible changes like heel valgus (outward tilt of the heel), bunions, hammertoes, or a “too many toes” sign where the forefoot shifts outward.
• Pain in the knees, hips, or lower back: Flatfoot can alter lower limb alignment, causing stress that travels up to other joints.

When to Seek Medical Care

Red flags include:

• Severe or increasing pain, especially at rest
• Worsening foot shape (progressive arch collapse or stiff, rigid foot)
• Numbness, tingling, or foot coldness—these may indicate tarsal tunnel syndrome
• Signs of nerve or blood flow problems

Children should also be evaluated for flat feet at an early age. Early assessment helps identify whether it may lead to problems later.

Unrelenting flat foot pain or symptoms involving nerves or joint degeneration should be evaluated by a specialist. Prompt care can help slow progression and guide the right treatment approach.

If flat feet cause occasional, mild aches and pains, conservative care is usually recommended.

Conservative Treatment Options

• Over-the-counter (OTC) pain relievers

Medications such as NSAIDs or acetaminophen can help manage discomfort related to flat foot pain.

• Physical therapy exercises

Targeted exercises can stretch and strengthen the feet, which may help improve support and reduce symptoms. 

• Custom orthotics or walking supports

Custom orthotics and supportive footwear can provide added structure and reduce strain on the arch.

When Is Further Treatment Needed?

Flat feet that cause frequent or significant pain or lead to other complications may require additional treatment. Depending on the underlying cause, some individuals may need surgery to correct the structural issue contributing to their symptoms.

Flatfoot can result from inherited traits, developmental delays, or changes that happen later in life.

• Genetic or congenital: Some people are born with loose ligaments or foot structures that prevent arch formation. Conditions like tarsal coalition, vertical talus, cerebral palsy, Ehlers-Danlos, or Down syndrome can also cause flat arches.
• Ligamentous laxity: Loose ligaments (often genetic or seen in pregnancy) can cause the arch to collapse.
• Posterior tibial tendon dysfunction (PTTD): The most common acquired cause. This tendon weakens or tears, usually in middle-aged women, leading to arch collapse.
• Trauma: Fractures or severe sprains can damage foot structures and flatten the arch.
• Obesity and high-impact activity: Extra weight and overuse strain the foot’s support system.
• Neuropathy/Charcot: Nerve damage, especially in diabetes, can cause fractures and foot collapse.
• Arthritis: Joint inflammation or wear in the midfoot can destroy arch support.
• Footwear/occupation: Flat shoes and long hours standing may contribute, though many people have flat feet without a clear cause.

Risk factors include age over 40, female gender, obesity, hypertension, diabetes, and family history.

Struggling with fallen arches or ongoing flat foot pain? Get expert evaluation and care at Central Florida Foot and Ankle Center, LLC. Our experienced podiatrists are available in Winter Haven, Lakeland, and Davenport, FL, with same-day appointments. 

Call today to schedule your visit.