Flatfeet

What is flatfeet?

The bones and ligaments in our feet are designed to create an arch, which provides you with flexible support when walking and standing.

Flatfeet is a condition where there is an absence of the arch of the foot. The condition can also be called pes planus or pes valgus, the meaning of which relates to the way the foot is flared outwards in someone with flatfeet.

Children under the age of 3 can appear to have flatfeet as the arch of the foot can be concealed by a fat pad. However, as they grow, the arch should become more visible. If the arch does not appear after 3 years of age, it may indicate that the child has flatfeet.

Flatfeet can vary in its presentation, either being flexible or rigid. When the condition is flexible (or postural), it means that the arch of the foot is visible when the foot does not have weight on it (i.e. the foot is lifted). In this case, when weight is applied, the foot becomes flat again. In rigid flatfeet there is no arch regardless of whether weight is applied or not.  People with rigid flatfeet may experience a lack of flexibility in the foot.

Common signs and symptoms of flatfeet

If your child has flexible flatfeet, it’s likely they won’t have any symptoms. Parents may feel concerned if they notice their child has flatfeet, but there is usually no need for any treatment. Only very severe cases of flatfeet may cause a strain later in life.

Rigid flatfeet, on the other hand, is a more serious problem and can cause pain. This type of flatfeet is present at birth and is quite obvious on visual examination. As with the name, the foot will be very rigid and in need of treatment. If it is not treated, a problem with the bones in the feet can become apparent by around age 10. This problem, called tarsal coalition, causes pain during activities.

Common Causes of flatfeet

Flatfeet in children can occur for different reasons:

  • Lax ligaments in the foot, causing the arch to collapse when weight bearing (flexible flatfeet). This is particularly common in children with Down’s Syndrome who particularly lax muscles and tendons
  • Abnormal development of the bones in the feet, seen in rigid flatfeet (this is more rare)

Adults can also develop flatfeet, due to the weakness of the muscles and tendons around the arch. Some of the adult risk factors include:

  • Obesity
  • Aging
  • Foot trauma
  • Rheumatoid arthritis
  • Diabetes

Diagnosing flatfeet

Your doctor will usually diagnose flatfeet after examining your child’s feet and checking their shoes for patterns of wear.

In unusual cases where there is a lot of pain present, your doctor may suggest one or more of the following imaging tests (scans) to rule out other problems:

  • X-rays– to detect fractures and conditions such as arthritis
  • CT scan– to look at the bones from different angles
  • Ultrasound– to look at the soft tissues and check for damage to tendons
  • MRI– to review hard and soft tissues in more detail

Treating flatfeet

In most cases, treatment of flatfeet is unnecessary, especially before the age of 3. In older children who have flatfeet, and in adults, treatment may be recommended in different forms.

Arch supports (orthotic devices)

If the arch of the foot is pronounced, arch supports may be recommended. Off-the-shelf plastic supports are available for children and are more suitable as they grow. Custom made supports are more expensive and children are likely to outgrow them quickly.  A popular arch support is the UCB, which was developed at the University of California Biomechanics Lab.

Arch supports are usually required from age 3 to age 8. The purpose of the supports is to manage the condition rather than treat it. Even after long term use, your child might still have flatfeet, but the arch supports will have at least prevented the condition from getting worse. If the condition does not worsen over time, it avoids the likelihood of any pain developing later in life.

Therapy

As some people with flatfeet may have a shortened Achilles tendon, stretching exercises and physiotherapy may be helpful.

In adults who run, a physiotherapist or a podiatrist can help to improve form and lessen the impact of exercise on flatfeet.

Surgery

Usually, surgery is not required for this condition but in case of severe rigid flatfeet, surgery has to be performed before complete bone development is reached. A metal implant can be inserted, called a subtalar implant, to form the foot arch. Reconstructive surgery is another option, by repairing the tendons and fusing the bones and joints together for correct alignment.

Recovery period

In case of surgery, several weeks of physiotherapy will be required before returning to normal activity. To facilitate recovery, it is important that you adhere to the advice given by your doctor and physiotherapist.

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