Foot Conditions A-Z

Flat Feet

Flat feet (pes planus) is a fairly common condition in which the foot does not have a normal arch, and so the entire foot touches the floor when you’re standing. According to the 2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 8 percent of U.S. adults ages 21 and older (about 18 million people) have flat feet. Another 4 percent, or about 8 million U.S. adults, have fallen arches.  

Flat feet and fallen arches are similar and closely related to overpronation, which is an excessive inward rolling of the foot during walking and/or running. Flat feet are normal in infants and toddlers because their arches have not yet developed. In most people, the arches develop throughout childhood, but some people never develop arches.

Flat feet can also occur as normal arches “fall” over time. Years of walking, running and standing can weaken the posterior tibial tendon, which runs along the inside of the ankle from just above the joint to the arch. This tendon is the main support for the arch; overloading the tendon can cause inflammation (tendinitis) and tearing. Once the tendon is damaged, the arch loses support and can flatten, resulting in “fallen arches.”

The main way to determine if a person truly has flat feet (as opposed to simply being an overpronator) is to observe the arches in both seated (non weight-bearing) and standing (weight-bearing) positions. In the person with flat feet, no arch will be observable in either the seated or the standing position. In a person who overpronates, the arch will be at least slightly visible in the seated or non weight-bearing position, even though it may not be observable while he or she is standing.

Causes

Foot shape and arch type have a strong hereditary component, but a number of conditions and events can cause or contribute to flat feet:

  • A posterior tibial tendon tear can cause the arches to fall.
  • Obesity and pregnancy put excessive stress on the arches and tendons and cause the arch to flatten.
  • Systemic conditions such as rheumatoid arthritis and diabetes can also lead to fallen arches and flat feet.
  • A flattening of the arch often occurs as a result of the aging process.

Prevention and Treatment

There is little in the way of preventive remedies for those who inherit the condition. If there are no complications or pain from flat feet, simply protecting them with well designed footwear is helpful. If pain is present or complications arise, orthotics or arch supports may be effective.

To minimize pain or complications, wear properly designed shoes or boots that have toe boxes that are sufficiently wide and high to allow the toes to spread, reducing pressure in the forefoot. Solid heel counters in the rear of the shoe or boot help protect the heel, posterior tibial, and Achilles tendon areas and provide support for the entire foot. Well designed outer soles help prevent the inward “rolling” that is characteristic of flat feet and overpronation. Avoid high heels, which can stress the forefoot.

To ensure that feet are optimally protected, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach,  padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.  Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot.

Flat feet may contribute to or worsen other foot problems, including inflammation and pain in the heel area (plantar fasciitis), Achilles tendinitis, posterior tibial tendinitis, shin splints, bunions, and hammer toes. Because flat feet affect skeletal alignment, they may also contribute to pain in the ankles, knees and hips. Talk to your doctor about appropriate treatment for these conditions.

Medical Considerations

Flat feet, fallen arches and overpronation all may cause pain. Flat feet may also set the stage for traumatic injuries, especially to the posterior tibial tendon. Talk to your doctor about appropriate treatment, which may include weight loss (obesity puts additional pressure and stress on the feet); arch supports; anti-inflammatory medications, if tolerated; and rarely, surgery.

Always talk to your doctor if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.

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