Fallen Arches What To Expect


Flat Foot

Most infants exhibit flat feet, but this is normal since most infants still have baby fat, which hides the arch formation. As the child grows and learns to walk, the soft tissues in the foot begin to tighten and form the arch. In most cases, the child will grow out of the condition and develop an arch before reaching adolescence. It?s important to remember that the muscles, bones, tendons, and ligaments are still in development. Children who complain of pain and have flat feet may suffer from a condition known as tarsal coalition. Tarsal coalition occurs when two or more bones in the foot fuse together. This causes great pain while walking, and shoes with arches are not helpful and can make the condition worse.


Flat feet are a common condition. In infants and toddlers, the arch is not developed and flat feet are normal. The arch develops in childhood. By adulthood, most people have developed normal arches. When flat feet persist, most are considered variations of normal. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible, or painful flat feet may be associated with other conditions and require attention. Painful flat feet in children may be caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together. This limits motion and often leads to a flat foot. Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, in which the ankle bones lean inward toward the center line. When the shoes of children who pronate are placed side by side, they will lean toward each other (after they have been worn long enough for the foot position to remodel their sole). Foot pain, ankle pain, or lower leg pain (especially in children) may be a result of flat feet and should be evaluated by a health care provider. Adults can develop a flat foot when they are 60 - 70 years old. This type of flat foot is usually on one side.


The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem. Congenital vertical talus. The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body. Tarsal coalition. Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains. Lateral subtalar dislocation. Because this often is caused by a traumatic, high-impact injury, the foot may be significantly swollen and deformed. There also may be an open wound with bruising and bleeding.


Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.

high arch feet

Non Surgical Treatment

Treatment of flat feet really depends on how far the damage has progressed. Conservative treatments often include immobilization (often by cast or brace) to reduce inflammation. Your doctor may also recommend anti-inflammatory medication (like ibuprofen) to get your inflamed tendon to calm down a bit. Orthotics can also offer significant relief. If these treatments fail to significantly improve symptoms, then surgery may be your best option to get the structure of your body back where it needs to be. Your podiatrist can discuss surgical options with you in great depth.

Surgical Treatment

Adult Acquired Flat Feet

Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.