Flatfoot (Pes Planus)

Flatfoot, also called pes planus or fallen arches, is a common foot deformity. It happens when the arch of your foot collapses, so a larger area of the sole of your foot touches the ground while standing or walking. You could be born with flat feet, or you could develop it over time because of tendon damage or other issues.

Your arches are made of bones and connective tissue and they help you walk. They absorb shock and protect nerves and blood vessels in your feet. You could develop flatfoot in one foot or both feet.

You might not have any health issues from flat feet but it could cause discomfort, instability and trouble standing or walking for long periods. In most cases, treatment helps reduce pain and improve mobility and well-being.

Types of flatfoot 

Babies are naturally flatfooted but that’s not a problem. The arches normally start to appear in their feet when they start walking and finish developing around age 10.

With pes planus, the flattened arch may cause your ankle to roll in and your feet to point out. A bone on the inner side of your foot may appear more prominent.

There are several types of flatfoot that can cause symptoms. 

Flexible flatfoot

Flexible flatfoot is common in children and they usually outgrow it but it can continue into adulthood. With it, the foot has an arch that appears when you’re sitting or standing on tiptoes but disappears when you’re standing and supporting your weight with your whole foot. It usually doesn’t cause pain but it can be uncomfortable over time.

Rigid flatfoot

With this rare type, you have no arches even when you’re sitting. It may be hard for you to flex your feet.

Congenital flatfoot

Birth defects or inherited disorders can keep arches from developing or make them too weak to remain in place.

Adult acquired flatfoot (posterior tibial tendon dysfunction or PTTD)

This type develops when the posterior tibial tendon (a tendon that connects the muscle in the back of your calf to the inside of your foot) gets weaker or damaged. It’s also called fallen arches. The name was changed to progressive collapsing foot deformity to better reflect the condition. Other common causes include arthritis, trauma and ligamentous laxity (your ligaments are looser than normal). 

With it, your arch collapses and your foot may become deformed. You may have soft tissue damage, tendon and ligament issues and ankle joint instability. It could be hard to walk or tiptoe. It may start as a flexible deformity but as arthritis of the joints under your ankle (subtalar joint) and in front of your ankle (talonavicular joint) set in due to prolonged deformity, the deformity becomes rigid.   

Causes and risk factors 

Flat feet may be more likely because of:

• Genetics: Some people are born with naturally low arches.
• Injury or overuse: Damage to the posterior tibial tendon, deltoid ligament or other soft tissues may make the structure of your foot weaker. The posterior tibial tendon runs along the inside of your ankle. If it gets weaker it can’t support your arch. This is the most common cause of flatfoot. Midfoot arthritis with or without trauma to the midfoot joints can also cause flatfoot. 
• Obesity: Extra body weight puts pressure on foot and ankle tendons and ligaments.
• Aging: Your risk of flat feet increases as you get older.
• Medical conditions: Having arthritis, diabetes or weak soft tissues may weaken your foot joint and make fallen arches more likely.

Symptoms of flatfoot 

Not everyone with flat feet has symptoms, but you may notice:

• Foot discomfort or pain, usually along the inside of your foot or arch
• Swelling, discomfort and instability in the ankle
• Tightness and stiffness in the Achilles tendon that makes it hard for you to move
• More pain after standing or walking for long periods
• Shin splints
• Changes in your gait (the way you walk)
• Bunions or hammertoes
• Pain in your lower back, hips or knees

Diagnosing flatfoot: When to get care

If you have foot pain that’s not going away, swelling or trouble walking, you should see a health care provider. 

A specialist will likely:

• Ask you about your medical history and your symptoms, including when they started, how severe they are and how they impact your daily activities.
• Examine the shape and position of your foot and ankle from the front and back.
• See how you stand, walk and stand on tiptoes and test how your arch responds to weight.
• Test your foot and ankle strength.
• In some cases, check how the soles of your shoes are worn. It’s a good idea to wear an older pair of everyday shoes to your appointment.
• If needed, order X-rays, ultrasound, CT or MRI to check for tendon, ligament or bone structure issues.

Treatment options for flatfoot 

If you don’t have symptoms, you don’t usually need to treat flat feet. If you do have symptoms, most of the time, surgery isn’t needed. Nonsurgical treatments include:

• Physical therapy: Strengthening and stretching exercises can help your tendons support your arches better and improve your flexibility.
• Custom orthotics and supportive footwear: Special inserts may help realign your arch and reduce pressure so you don’t have as much pain. They don’t cure flat feet but they can help with symptoms by alleviating the tension on arch supporting structures.
• Achilles tendon stretching: Stretches can help reduce tightness and improve flexibility in your foot.
• Pain management: Medications like nonsteroidal anti-inflammatory medications (NSAIDs such as Advil, Motrin), acetaminophen (Tylenol) and ice therapy can reduce discomfort and swelling.

If these treatments don’t help enough with your foot pain and deformity, you may want to consider surgery. Options include one or a combination of the following:

• Tendon repair or transfer to strengthen the posterior tibial tendon. The long tendon to your toes (FDL) is the most commonly used for that purpose with minimal effect on the toes’ mobility and strength.
• Joint realignment through shifting the heel bone to correct severe foot and ankle instability. This can be done through keyhole incisions. 
• Flatfoot reconstruction to reshape the foot for better function and support and reducing pain. If the deformity is rigid, then some of your foot joints may need to be fused together. 

Treatment may be less predictable if you have flatfoot that’s caused by diabetes, arthritis or connective tissue problems.

Long-term outlook and prevention 

With proper care, most people with flexible flatfoot or adult acquired flatfoot can manage their symptoms and stay active. It can help to:

• Get care as soon as you notice symptoms starting to appear
• Wear supportive footwear, which aligns the foot joints. Stiffer shoes with a rocker bottom are generally recommended.
• Maintain a healthy weight to help reduce strain on the tendons and ligaments
• Perform physical therapy exercises to help strengthen soft tissues and prevent long-term complications
• Choose lower-impact activities like swimming, cycling and walking instead of activities where you have to run or jump
• Get regular checkups if you’re at risk of developing flatfoot

Get relief from flatfoot pain 

The pain and trouble moving you may have from flat feet can make it hard to do the things you need and want to do. At Banner Health, our specialists provide expert foot and ankle care to keep you moving comfortably. 

We can provide an accurate diagnosis and personalized treatment plans that include nonsurgical options, as well as surgical treatment for severe cases. If you’re dealing with foot pain, ankle joint discomfort or trouble walking, don’t wait to seek help. We can help you get started on the path to long-term foot health.