What the causes of flat feet are and how to identify

Flat feet, medically referred to as pes planus or fallen arches, occur when the arch of the foot collapses, resulting in the entire sole making contact with the ground. While this condition is often asymptomatic, it can lead to discomfort, pain, and other complications, especially if it alters the body’s alignment.

Causes of Flat Feet

Flat feet, or pes planus, can develop due to a variety of factors that either prevent the arches from forming properly or cause them to collapse over time. Here are the primary causes:

Genetics: Flat feet often run in families, suggesting a hereditary component. If one or both parents have flat feet, their children are more likely to inherit the condition.
Tarsal Coalition: This is a congenital condition where two or more bones in the foot fuse together, limiting the motion and leading to a flat foot. Tarsal coalition often becomes symptomatic during adolescence.
Posterior Tibial Tendon Dysfunction (PTTD): This is a common cause of adult-acquired flat feet. The posterior tibial tendon supports the arch of the foot, and if it becomes inflamed or tears, the arch can gradually collapse.
Obesity: Excess weight puts additional strain on the arches of the feet, which can cause them to flatten over time, particularly in adults.
Arthritis: Conditions like rheumatoid arthritis can lead to inflammation and damage in the foot’s joints and tendons, contributing to the development of flat feet.
Injury: Trauma to the foot or ankle, such as fractures or severe sprains, can damage the bones and tendons, leading to a loss of arch support and the development of flat feet.
Aging: As people age, the tendons and ligaments that support the foot’s arch can weaken, leading to acquired flat feet, particularly after the age of 40.
Neurological or Muscular Diseases: Conditions such as cerebral palsy, muscular dystrophy, or spina bifida can affect muscle tone and control, leading to flat feet.
Developmental Issues: In some cases, children may not develop the arches in their feet due to developmental issues, leading to congenital flat feet that persist into adulthood.

Understanding these causes is crucial for determining the appropriate treatment and management strategies for individuals with flat feet. Depending on the underlying cause, treatments may include orthotic insoles, physical therapy, lifestyle changes, or surgery.

Symptoms of Flat Feet

Not everyone with flat feet experiences symptoms. However, when symptoms do occur, they can affect various parts of the body due to the altered biomechanics of the foot.

Symptom	Location	Description-
Pain	Arch, heel, ankle	Often worsens after long periods of standing or walking.
Swelling	Inside of the ankle	Particularly if the posterior tibial tendon is involved.
Overpronation	Foot and ankle	The foot rolls inward excessively, leading to additional strain on the knees and hips.
Difficulty Fitting Shoes	Entire foot	People with flat feet may struggle to find shoes that are comfortable, particularly those with high arches.

How Flat Feet Develop

Flat feet can develop at any age, either remaining from childhood or emerging due to factors like age, injury, or health conditions. Understanding the risk factors is crucial for prevention and management.

Risk Factor	Description	Population Affected
Age	Tendons naturally weaken with age, leading to flat feet.	Adults over 40 are more susceptible.
Obesity	Increased weight puts stress on the foot's structure.	Overweight and obese individuals.
Diabetes	Affects circulation and nerve health, impacting the feet.	People with diabetes are at higher risk.
Pregnancy	Hormonal changes and added weight affect foot structure.	Pregnant women, particularly in later stages.

Diagnosing Flat Feet

Flat feet, or pes planus, are diagnosed using a combination of physical examination and imaging techniques.

1. Physical Examination

Visual Inspection: The doctor observes the feet when standing and walking, looking for the absence of an arch and signs of overpronation (excessive inward rolling of the foot).
Gait Analysis: The walking pattern is assessed to detect abnormalities that may indicate flat feet.
Manual Testing: The flexibility of the arch is tested by manipulating the foot, checking for pain, tenderness, and the function of tendons.

Imaging Tests

X-rays: Used to examine the bone structure, identify deformities, and assess the severity of flat feet.
MRI: Provides detailed images of the soft tissues, helping diagnose issues like tendon dysfunction.
CT Scan: Offers a cross-sectional view of the foot, useful for detecting complex bone and joint problems.

Visual identification of flat feet

Other Diagnostic Tools

Footprint Analysis: A simple test that reveals the extent of arch collapse based on the footprint left by the foot.
Functional Tests: Includes activities like standing on toes to evaluate tendon and ligament function.

Patient History

Symptom and Family History: Doctors consider the patient’s history of symptoms, any past injuries, and any family history of flat feet.
This streamlined approach helps doctors quickly determine the presence of flat feet and identify any underlying causes, guiding the appropriate treatment.

Treatment Options for Flat Feet

Flat feet generally do not require treatment, especially if they are not causing discomfort or other issues. It’s common for children to have flat feet until around the age of six, at which point an arch usually develops naturally. In most cases, flat feet do not lead to any significant problems, and they typically do not interfere with daily activities, including sports.

For both children and adults, flat feet are usually not a cause for concern and rarely indicate a serious condition. If flat feet are not causing pain or hindering activity, there’s typically no need to take any action.

You should see a GP if you have flat feet accompanied by pain, stiffness, weakness, or numbness in your feet; if you frequently experience foot or ankle injuries; if you have difficulties with walking or balance; if your flat feet developed suddenly or only affect one foot. These symptoms could indicate that treatment is necessary.

Treatment options for flat feet vary depending on the severity of the condition and the presence of symptoms. The goal of treatment is to reduce pain, improve function, and prevent further complications. Here's an overview of the common treatment options:

1. Non-Surgical Treatments

Orthotic Insoles: Custom-made or over-the-counter insoles provide arch support and help distribute pressure evenly across the foot. They can alleviate discomfort and improve foot alignment. View Algeos range here.
Supportive Footwear: Wearing shoes with good arch support and a firm heel can help manage flat feet symptoms. Avoiding shoes with little support, such as flip-flops, is recommended.
Physical Therapy: Strengthening and stretching exercises for the foot and ankle can enhance muscle function and provide better support for the arch. This includes exercises like heel stretches, toe curls, and arch lifts.
Weight Management: For overweight individuals, losing weight can reduce the strain on the feet, which helps alleviate symptoms.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce pain and inflammation associated with flat feet.

Orthotic Insoles

2. Surgical Treatments

Tendon Transfer: In cases where the posterior tibial tendon is damaged, a tendon from another part of the foot can be transferred to help support the arch.
Osteotomy: This procedure involves cutting and realigning bones in the foot to improve its structure and support the arch.
Arthrodesis: Fusing certain joints in the foot can provide stability and help maintain the arch in severe cases of flat feet.
Lateral Column Lengthening: This surgery adds bone grafts to the outer side of the foot, helping to restore the arch by lengthening the outside of the foot.

3. Lifestyle and Home Remedies

Foot Exercises: Regular exercises that strengthen the foot muscles, such as toe raises and towel scrunches, can help improve arch support naturally.
Rest and Ice: If flat feet are causing pain, resting and applying ice to the affected area can help reduce inflammation and alleviate symptoms.

4. Alternative Treatments

Chiropractic Care: Some individuals find relief through chiropractic adjustments that aim to improve foot alignment and reduce stress on the arches.
Acupuncture: Although more research is needed, some people with flat feet report pain relief and improved function after acupuncture treatments.

Most individuals with flat feet can manage their symptoms with non-surgical treatments, particularly with the use of orthotics and supportive footwear. However, in severe cases where pain or dysfunction persists, surgical intervention may be necessary. It's important to consult with a healthcare provider to determine the most appropriate treatment plan based on individual needs and the specific cause of the flat feet.

Preventing Flat Feet

Preventative measures can help reduce the risk of developing flat feet, especially in those with known risk factors.

Foot Exercise

Preventative Measure	How It Helps	Recommendations
Maintain Healthy Weight	Reduces strain on the arches.	Regular exercise and a balanced diet are key.
Wear Supportive Footwear	Ensures proper arch support and foot alignment.	Choose shoes with good arch support and avoid high heels.
Foot Strengthening Exercises	Strengthens muscles supporting the arch.	Regularly perform exercises like toe raises and arch lifts.
Monitor for Early Signs	Early detection can prevent progression.	Seek medical advice if you notice any changes in foot structure or experience pain.

Conclusion

Flat feet, while often harmless, can lead to significant discomfort and other complications if left untreated. Understanding the causes, symptoms, and available treatments is essential for managing the condition effectively. Whether through non-surgical methods like orthotic insoles and physical therapy or surgical interventions in severe cases, there are numerous ways to address the challenges associated with flat feet. Taking preventative measures, such as maintaining a healthy weight and wearing supportive footwear, can also play a crucial role in mitigating the risk of developing flat feet.

If you have flat feet, you may be able to self-refer to a podiatrist without needing to see a GP first. To find available services, check with your GP surgery's reception, visit their website, search online for NHS podiatrists in your area, or look for a local private podiatrist.