Flat Feet (Fallen Arches)

Flat Feet Overview

Flat feet (fallen arches or pes planus) are very common and quite often a complicated foot problem. There are a wide range of causes, symptoms and treatments and no two cases are identical. Flat feet are common in children as the foot’s arch is not yet fully developed and not a cause for concern. Flat feet in adults is not as common as is the case with children and requires investigation, should there exist any symptoms that cause pain, discomfort or an abnormal gait (uneven stride). Treatment, depending on the symptoms involved and the severity of the issue or issues can be either surgical or non surgical. Your podiatrist or chiropractor will advise you on which is preferable or necessary.

Flat Feet Causes

There are many possible causes for flat feet (fallen arches) in adults, the posterior tibial tendon is one of the more likely causes, this tendon in the leg connects the calf muscles to bones on the inside of the foot, running down the lower leg. The posterior tibial tendon’s primary role is supporting the foot’s arch especially during walking. The tendon can tear or wear with age (people over the age of 40 years are quite susceptible to tendon wear and for some reason, women are especially prone to tendon wear) or become swollen or inflamed causing the arch of the foot to collapse and the feet becoming flat, this can sometimes prove very painful. Another common cause of flat foot would be obesity, being overweight can lead to a multitude of feet problems and it is common sense to realize that too much weight can overburden the structures of the foot. High impact sports are a common cause of flat feet (fallen arches) for the same reasons as obesity, sometimes causing inflammation or tears due to the repetitive impacts on the feet. Diabetes, hypertension and arthritis are all known to be causes for flat feet (fallen arches). Adults who had flat feet as children are at an increased risk of developing tears in the posterior tibial tendons.

Flat Feet Symptoms

Flat feet (fallen arches) can cause many different symptoms, pain being an obvious sign. Pain in any of the following areas may be a cause for concern, the inner side of the ankle, there may also be some swelling, the actual arch of the foot, the calf, the knee, the hip, the back or anywhere in the general lower leg area or feet. Sometimes people with flat feet (fallen arches) can experience stiffness in one or both of the feet. One or even both of the feet may be flat to the ground, the arch may be insignificant or in extreme cases non existent. Shoes may tend to wear in an uneven fashion.

Flat Feet Diagnosis

Most professional podiatrists or chiropractors can often diagnose sufferers of flat feet (fallen arches) by just looking at them or following a cursory examination. Sometimes a test, referred to as “wet footprint” test is used to diagnose flat feet. The patient wets his or her feet and then stands on flat even surface, such as a piece of card or paper. A flat foot will leave a footprint exhibiting no signs of an arch when the feet or foot is flat. A kinked flat foot will clearly show a bulge where the inner side of the foot is pushed outward. Normal feet will show no imprint of the inner edge of the foot.

Non Surgical Treatment

In less severe cases of flat feet or fallen arches no surgical procedures may be required. Flat feet that cause no pain tend to be treated with what is known as a conservative treatment (no surgery). If there is no pain then the R.I.C.E protocol may be all that is required. R.I.C.E stands for Rest, Ice, Compression, Elevation. Sometimes stretching exercises may be employed and are often quite successful. Non-Steroid drugs and anti-inflammatory medications are used to ease any pain and discomfort. Shoes may require some form of modification, usually all that is required is an arch support to help support and lift. In the majority of cases an off the shelf insole or insert will be perfect for the job. Custom made insoles are available but the prices are more often than not, not worth the extra cost. Leg braces or leg casts might be prescribed, mainly for night use. If the pain suffered or there is substantial foot damage, your podiatrist or chiropractor may recommend surgery.

Flat Feet Surgical Treatment

In more severe cases of flat feet or fallen arches a surgical operation may be essential. There are several procedures used when dealing with the symptoms of flat feet or fallen arches. Fusing of the foot or ankle bones together might be one option, this procedure is known as ‘Arthrodesis’ and is used in very serious cases. A Bony growth also known as a bone spur may need removal, this procedure is known as excision. Cutting or changing the actual shape of the bone, an ‘Osteotomy‘ may also be performed. A tendons’ protective covering might be in need of cleansing (synovectomy). In some severe situations, there may be a need to add tendon donated from other parts of the body to a damaged or worn tendon in the foot to balance out any pulling from other, stronger tendons in the foot and form what is known as an arch (tendon transfer). Bone may need to be grafted to the affected foot or feet to enable the arch to achieve the correct height, this is known as lateral column lengthening.

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