Flat Feet: Causes, diagnosis, treatment and prevention

Flat Feet: Causes, diagnosis, treatment and prevention

What are flat feet?

Have you ever been told you have flat feet? The term is often used to describe a foot with a collapsed medial longitudinal arch, or an arch that touches the ground. The scientific name for a flat foot is pes planus. Some people with flat feet experience pain and discomfort in the feet, ankles, knees and hips. Other people who have flat feet do not experience any issues at all. Your Podiatrist is the best person to talk to if you think you might have flat feet.

What if my feet roll inwards when I walk? Is that the same as flat feet?

If you notice that your feet roll inwards, you may have what is called a pronated foot type. You can have a pronated foot type and still have a well defined arch. Some people who have a pronated foot experience pain for varying reasons. So what should you do if your feet roll in? It’s best to visit your podiatrist for a biomechanical assessment, your podiatrist can determine whether further treatment is needed. You may be encouraged to begin a strengthening program or perhaps introduce support into your footwear, such as an orthotic to correct your foot posture and prevent pain/injury in the future.

What causes flat feet?

Flat feet can occur for many different reasons, these include;

  1. Genetic component stemming from birth
  2. Injury to the foot or ankle (broken bones or stretched/torn tendons) for example, posterior tibial dysfunction
  3. Weakness in the muscles in the feet and ankles
  4. Medical conditions such as cerebral palsy and muscular dystrophy can also be the cause of flat feet
  5. Nerve issues can cause collapsing of the medial longitudinal arch

What is Posterior tibial dysfunction?

The posterior tibial tendon is responsible for stabilisation and particular movements of the foot and ankle. Because this tendon is responsible for so many movements, it is often overworked and prone to suffering inflammation and tears. If it is torn/inflamed it will not be able to perform the said movements and the arch may collapse.

What causes PTD?

There are many risk factors for PTD, however, generally it is caused by an injury, such as a fall or twisting of the ankle. Obesity, age (over 40), gender (more prevalent in females) and high impact sports are all considered risk factors for the condition.

How do you know if you have PTD?

Some of the symptoms include; Pain and swelling on the inside of the ankle, pain during exercise and in some cases pain of the outside of the ankle. Many people who experience the condition will see their arch begin to collapse over time.

How can PTD be treated?

  1. Rest from activity – while it is important to continue moving, the tendon needs rest from high impact and strenuous activity.
  2. Icing – Icing can help to decrease inflammation and swelling in an acute injury. It is recommended that icing is done for 20 minutes 2 times per day.
  3. Physical therapy – A very specific strengthening program can be prescribed (by your Podiatrist) to gradually introduce the load back to the tendon. This is usually done once the pain and inflammation has begun to subside.
  4. Moon boot or CAM boot – A boot may be prescribed as a form of immobilization for the foot. When it comes to healing soft tissues or even bones of the foot a CAM boot is the gold standard as it completely offloads the structures which gives them the opportunity to heal.
  5. Strapping/bracing and orthotics – All of these treatment options are designed to take load off the affected structures and thus allowing them to heal effectively.
  6. Steroid injection – A cortisone injection is a strong anti-inflammatory drug. It is often only done as a last resort as the results tend to be mixed among patients and there is also a risk of tendon rupture.
  7. Surgery – After all conservative treatments have been explored and have failed, surgery is sometimes performed. The type of surgery performed varies patient to patient.

How are flat feet diagnosed?

On visiting your Podiatrist, they will complete a series of physical examinations and medical history to determine whether your feet are flat and or problematic. The examinations may include;

  1. A foot posture analysis
  2. A gait analysis (walking and perhaps running)
  3. Muscle and strength testing
  4. Range of motion testing
  5. Radiology – Ultrasound, Xray etc.

Once your Podiatrist has a thorough understanding of your feet and you have been diagnosed with flat feet, your treatment path will be decided.

Are there different types of flat feet?

Types of flat feet do vary among people. Usually your feet will either be described as a flexible or rigid flat foot. So what’s the difference?

A flexible flat foot is a term used to describe a flat foot which is able to function normally during gait, but this does not exude a flexible flat foot from causing pain.

A rigid flat foot is usually the cause of abnormal foot development, this may include coalition (or natural fusing) of joints.

Who is at risk of acquiring a flat foot?

As previously mentioned, you may be genetically predisposed to flat feet, but other risk factors may include;

  1. Obesity – The extra load on the bones, muscles and tendons can cause  them to collapse
  2. Diabetes is a known risk factor for developing flat feet, this is due to the deterioration of nerve function.
  3. Ageing – As we age our feet tend to lengthen.
  4. Pregnancy – During pregnancy the ligaments and tendons tend to be more lax than usual and along with the rapid weight gain seen in pregnancy, the muscles of the feet may begin to collapse.

How are flat feet treated?

Once you have been diagnosed with flat feet, your Podiatrist will design a treatment path specific to your needs. For children, usually an arch will begin to develop as they grow and gain strength. The treatment path for adults may include the following;

  1. Intrinsic muscle strengthening – Your podiatrist may set you up with a strengthening program to address weakness in the intrinsic muscles of the foot. The intrinsic muscles are responsible for the arch and the motor actions of the foot. Weakness of the intrinsic muscles can lead to various pathologies or foot conditions. Some intrinsic exercises include; Towel scrunching, short foot (specific to the arch) or even toe yoga! At Foot Centre Group we encourage many of our clients to begin a strengthening program, as we see great benefit from them on a daily basis.
  2. A stretching program – Research has shown that reduced ankle joint range of motion can contribute to a flat foot. A stretching program may be combined with the intrinsic muscle strengthening to improve foot and ankle function. Along with the strength program, you will likely be encouraged to add these into your daily routine.
  3. A change in footwear – A flat foot needs to be supported with appropriate footwear. Your Podiatrist will be able to give you recommendations on what footwear would be most appropriate for you.
  4. Orthotics – Orthotics are designed to change the plantar pressures in your feet, so they can take the load off the affected structures and help to improve your pain and foot function.

Where can I get help?

Your Podiatrist is the answer! Call Foot Centre Group on 03 9553 0044 or visit footcentregroup.com.au to book your appointment.

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