Definition
If you have flatfeet, the arch on the inside of your feet is flattened. It's a common and generally painless condition. Sometimes, flatfeet occur because your arches don't develop during childhood. In other cases, flatfeet may occur as you age or after you've had a pregnancy.
While flatfeet usually won't cause any problems, if the condition causes your ankles to turn inward, you may have problems in your feet, ankles and knees. Simple corrective devices are available that can help you prevent some of the complications of flatfeet.
Symptoms
With flatfeet, you may experience the following signs and symptoms:
- A flat look to one or both of your feet
- Uneven shoe wear and collapse of your shoe toward the inside of your flat foot
- Lower leg pain
- Pain on the inside of your ankle
- Swelling along the inside of your ankle
- Foot pain
Causes
Your feet are highly specialized structures. Each foot is made up of 26 bones held together by 33 joints and more than 100 muscles, tendons and ligaments. The intricate alignment of these structures results in the formation of your arches.
As you walk, these springy, elastic arches help distribute your body weight across your feet and legs. Your arches also play an integral role in how you walk. They act as rigid levers for proper mobility, but they must also be resilient and flexible to adapt to various surfaces.
Not all feet are the same
Flat feet are normal in infants and toddlers, because the foot's arch hasn't yet developed. Most people's arches develop throughout childhood, but some people never develop arches. This is a normal variation in foot type, and people without arches may or may not have problems.
Arches can also fall over time. Years of wear and tear can weaken the posterior tibial tendon, which runs along the inside of your ankle, from above your ankle to your arch. The posterior tibial tendon is the main support structure for the arch. An overload to this tendon can cause inflammation of the tendon (tendinitis) and even tearing of the tendon. Once the tendon is damaged the foot's arch loses support and can flatten.
Risk factors
The following are factors that can increase your risk of flatfeet:
- Posterior tibial tendon tear or dysfunction — injury or stress to the posterior tibial tendon may eventually cause it to break down and your arches to fall
- Obesity
- Traumatic injury to your foot or ankle
- Rheumatoid arthritis
- Diabetes
- Pregnancy
- Aging
Tests and diagnosis
Your doctor will consider your medical history and examine your feet. As part of the examination, your doctor will observe your feet from the front and the back and ask you to stand on your toes so he or she can view the mechanics of your feet.
To view the interior structure and bones of your foot, your doctor may request an imaging test of your foot, which may include an X-ray, a CT scan or MRI scan.
Complications
Flatfeet may contribute to or worsen other foot problems, including:
- Inflammation and pain in the ligaments in the soles of your feet (plantar fasciitis)
- Achilles tendinitis and posterior tibial tendinitis
- Shin splints
- Arthritis in your foot or ankle
- Bunions
- Hammertoes
Because flatfeet can affect your body's alignment, the condition may also lead to pain in your ankles, knees and hips.
Treatments and drugs
In many people, flatfeet won't cause any signs or symptoms. It may be that the lower parts of your legs have aligned in such a way as to accommodate for flatfeet. If so, you may not have any pain or other problems.
If the disorder is causing you problems, you may be able to reduce foot pain by wearing over-the-counter insoles or arch supports. Ask your doctor whether these are appropriate for you.
Your doctor may suggest these other treatments and adjustments, depending on your condition:
- Custom-designed arch supports. Commonly called foot orthotics, these are interchangeable among your shoes and may provide more support because they're molded to the contours of your feet. Orthotics come in three types: rigid, semirigid and soft. The type that's right for you depends on what kind of support your doctor is trying to provide to your feet.
- Rest. Your doctor may recommend rest and avoiding activities that may aggravate your condition until your foot feels better.
- Medications. Your doctor may suggest you take over-the-counter pain relievers until your pain subsides.
- Weight loss. If you're overweight, losing weight may help.
- Wedge, in addition to an orthotic. If you have tendinitis of the posterior tibial tendon, you may need to insert a wedge along the inside edge of the orthotic to take some of the load off the tendon tissue.
- Additional foot support. If you're diagnosed with posterior tibial tendinitis, your doctor may also advise that you wear an ankle brace, walking boot or a cast for a time until the tendon inflammation subsides.
- Surgery. In severe cases of posterior tibial tearing, you may need tendon surgery
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