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Flat Foot by Ricker Polsdorfer, MD

Definition

A flat foot occurs when the normal arch is lost. It is often associated with the lower part of the legs being angled outwards.

Twenty percent of adults have flat feet, and nearly all babies are born without the normal adult arch. Most flat feet are “flexible,” cause no problems, and do not require treatment. Some of them are “rigid,” produce symptoms, and are best treated. Rigid flat feet that need treatment can be identified by symptoms and by examination of the foot.

Normal Foot Arch

Causes

Flat feet are the mildest of many developmental (congenital) problems of the feet, the causes of which are not known. Lax joints (being “double jointed”) tend to run in families and produce flat feet along with unusual flexibility of other joints. Occasionally, they result from a ruptured ankle tendon, a foot injury, cerebral palsy , spina bifida , or muscular dystrophy .

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chance of developing flat feet:

Familial tendency
Foot injuries
Diseases that cause muscle imbalance, such as cerebral palsy , spina bifida , or muscular dystrophy

Symptoms

If you experience any of these symptoms do not assume it is due to flat feet. These symptoms can be due to many types of foot problems including ill-fitting shoes. If you suffer from any one of them, see your physician or podiatrist.

Pain
Calluses or skin redness
A stiff foot
Weakness or numbness of the foot
Rapid wearing out of shoes
Worn shoes that lean towards each other
Other evidence, such as difficulty running, that indicates the foot is having trouble doing its job

Diagnosis

Your doctor will ask about your symptoms and medical history, and will perform a physical exam. If the flat foot is fixed and symptomatic, you will be referred to an orthopedic surgeon for possible surgical correction.

If either of these tests are positive, the flat foot is flexible and unlikely to need treatment:

The arch appears when standing on tiptoe
The ankle can be flexed at least 15° up from perpendicular to the lower leg

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Physical Therapy, Exercises, and Orthotics

Certain exercises and physical therapy may relieve discomfort. Orthotics are shoe inserts that support the foot. These inserts may help to reduce pain and disability. In mild cases, a well-fitting pair of shoes may be all that is needed. Flat feet, though, due to nerve or muscle disease may need special braces.

Surgery

For rigid flat feet, a surgical procedure can create a satisfactory arch.

Prevention

To help reduce your chances of getting flat feet, take the following steps:

Wear well-fitted shoes with adequate arch support.

RESOURCES:

American Academy of Orthopaedic Surgeons http://www.aaos.org/
American College of Foot and Ankle Surgeons http://www.footphysicians.com/

CANADIAN RESOURCES:

Canadian Podiatric Medical Association http://www.podiatrycanada.org/
Nurses Entrepreneurial Foot Care Association of Canada http://www.nefca.ca/news.php/

References:

Flat feet. British Orthopaedic Foot Surgery Society website. Available at: http://www.bofss.org.uk/html/flat_feet.shtml . Accessed August 7, 2005.
Flat foot. UCSF Children’s Hospital website. Available at: http://www.ucsfhealth.org/childrens/medical_services/ortho/foot/conditions/flatfoot/signs.html Accessed August 9, 2005. Accessed August 7, 2005.
Pes planus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed August 7, 2005.
11/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Rome K, Ashford R, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;(7):CD006311.

Last reviewed September 2011 by John C. Keel, MD

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