Understanding Flat Feet, Its Causes and Treatment

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Flat feet are no joke. In fact, they can be downright painful to your hips, ankles, and knees. As a foot and ankle surgeon, Dr. Michael Barnett knows all about the condition, why it happens, and how it is treated.

What Causes Flat Feet?

“Flat feet is the progressive flattening of the arch of your foot,” he says. “It happens when a tendon in your lower leg, the posterior tibial tendon, stops functioning like it should.” The result can be flat feet, or just one flat foot. It happens in stages:

  1. Pain and swelling of the tendon on the inside of your ankle. “You may notice pain behind the bone of the inside of the ankle or just below the bone on the outside of the ankle. You might think it’s the joint causing the pain,” he says.
  2. The joint just below the ankle which controls side-to-side motion of your foot begins to collapse.
  3. If not treated, this leads to complete arch collapse and possible arthritis throughout the joints in the back of the foot and ankle.

“Most, but not all, people have a parent or a family history of the condition,” says Dr. Barnett. “Yet others with normal or even high arches may have an arch collapse as they age due to damage of the posterior tibial tendon.”

How Is It Diagnosed And Treated?

After chatting with you about your symptoms, Dr. Barnett said a physical exam by your doctor likely will follow. “A standing exam of your feet will indicate how your joints align when supporting your body weight. X-rays show how your joints compress, and if there is cartilage loss or arthritis.”

Your doctor likely will begin with a conservative approach to treatment. Rest, immobilization by wearing a boot, anti-inflammatory medication, ice, and custom-made or over-the-counter inserts for your shoes. “Some patients also can benefit from physical therapy and/or custom braces which support the ankle and hindfoot, although they can be bulky and not tolerated by active individuals,” says Dr. Barnett. 

Surgery, if needed, will depend on your individual situation because not all flat feet are the same. “If your condition is in the early stages, tendon repair and removal of damaged tissue around the inflamed tendon will be done,” says Dr. Barnett. “Most patients have a condition that is more advanced and require tendon transfers, cutting and realigning bones, and placing realigning implants in the foot. In the most severe cases, joint fusions are performed; they correct the deformity but leave a more rigid foot.” For severe cases, recovery can take up to a year or more depending on your health prior to your surgery.

Am I At Risk For Flat Feet?

Your chances of developing a flat foot are greater if have one or more of these risk factors:

  • Obese
  • Overuse of feet
  • Diabetes
  • Previous trauma to the ankle
  • Inflammatory disorders like rheumatoid arthritis or psoriasis
  • Participate in running or jumping sports
  • Cerebral palsy or other neurologic disorders
  • Tarsal coalition (abnormal connection between the bones in your foot)

The pain from flat feet can develop at any age, from teens to the elderly. “Some people live their entire life with flat feet and never know they have it because they have no pain,” says Dr. Barnett.

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