What Are Flat Feet (Pes Planus, Fallen Arches)? What Causes Flat Feet?

Most people have a gap under the arch of their foot when they are in a standing position. The arch, the inner part of the foot is slightly raised off the ground. People with flat feet or fallen arches either have no arch, or it is very low.

The feet of people with flat feet may roll over to the inner side when they are standing or walking, and the feet may point outwards as a result.

A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees.

Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.

According to Medilexicon's medical dictionary, pes planus (flat feet) means "a condition in which the longitudinal arch is broken down, the entire sole touching the ground."

What are the signs and symptoms of flat feet or fallen arches?

A symptom is something the patient feels and reports, while a sign is something other people, including the doctor may detect. An example of a symptom may be pain in the ankle, while a sign may be a swelling.

Symptoms may vary and generally depend on the severity of the condition. Some have an uneven distribution of bodyweight and find that the heel of their shoes wears out more rapidly and more on one side than the other. The most common signs or symptoms of flat feet are:

• Pain in..
  
  
  ..the ankle (inner side), there may also be swelling
  ..the foot in general
  ..the arch of the foot
  ..the calf
  ..the knee
  ..the hip
  ..the back
  ..the general lower leg area


• People with flat feet may also experience stiffness in one or both feet.


• One or both feet may be flat on the ground (either no arch, or very slight arch).


• Shoes may wear unevenly.

What are the causes of flat feet?

• Family history - experts say fallen arches can run in families.


• Weak arch - the arch of the foot may be there when no weight is placed on it, for example, when the person is sitting. But as soon as they stand up the foot flattens (falls) onto the ground.


• Injury


• Arthritis


• Tibialis posterior (ruptured tendon)


• Pregnancy


• Nervous system or muscle diseases - such as cerebral palsy, muscular dystrophy, or spina bifida.


• Tarsal Coalition - the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. Most commonly diagnosed during childhood.


• Diabetes


• Age and wear and tear - years of using your feet to walk, run, and jump eventually may take its toll. One of the eventual consequences could be fallen arches. The posterior tibial tendon may become weakened after long-term wear a tear. The postario tibial tendon is the main support structure of the arch of our feet. The tendon can become inflamed (tendinitis) after overuse - sometimes it can even become torn. Once the tendon is damaged, the arch shape of the foot may flatten.

Our feet are incredibly well specialized structures. There are 26 different bones in each foot, held together by 33 joints and more than 100 muscles, tendons and ligaments (in each foot). They way they weave and align together determine the formation of our arches.

The aim of the arches is to give us spring and distribute our body weight across our feet and legs. The structures of the arches of our feet determine how we walk - they are rigid levels which allow us to move smoothly. However, the arches need to be sturdy as well as flexible to adapt to various surfaces and stresses.

During childhood it is normal to have flat feet. This is because our feet form during our childhood. In other words, having what appears to be flat feet during early childhood does not necessarily mean that it will persist throughout the individual's life.

People with very low arches or what appear to be no arches at all may experience no problems.

What are the risk factors for flat feet?

A risk factor is something that increases the likelihood of an illness or condition developing. For example, people who are obese are more likely to develop diabetes type 2 compared to slim people. Therefore, obesity is a risk factor for diabetes.

The following risk factors are linked to a higher probability of having flat feet:

• Obesity
• Diabetes
• Getting older (aging)
• Pregnancy
• Rheumatoid arthritis
• Foot or ankle injury
• Posterior tibial tendon tear or dysfunction

How are flat feet or fallen arches diagnosed?

People who have flat feet without signs or symptoms that bother them do not generally have to see a doctor or podiatrist about them. However, if any of the following occur, you should see your GP or a podiatrist:

• The fallen arches (flat feet) have developed recently
• You experience pain in your feet, ankles or lower limbs
• Your unpleasant symptoms do not improve with supportive, well-fitted shoes
• Either or both feet are becoming flatter
• Your feet feel rigid (stiff)
• Your feet feel heavy and unwieldy

Most qualified health care professionals can diagnose flat feet just by watching the patient stand, walk and examining his/her feet. A doctor will also look at the patient's medical history. The feet will be observed from the front and back. The patient may be asked to stand on tip-toe while the doctor examines the shape and functioning of each foot.

In some cases the physician may order an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan.

What are the treatment options for fallen arches (flat fleet)?

Some patients with flat feet may automatically align their limbs in such a way that unpleasant symptoms never develop. In such cases treatment is not usually required.

• Pain in the foot that is caused by flat feet may be alleviated if the patient wears supportive well-fitted shoes. Some patients say that symptoms improve with extra-wide fitting shoes.


• Fitted insoles or orthotics (custom-designed arch supports) may relieve pressure from the arch and reduce pain if the patient's feet roll or over-pronate. The benefits of an orthotic only exist while it is being worn.


• Patients with tendonitis of the posterior tibial tendon may benefit if a wedge is inserted along the inside edge of the orthotic - this takes some of the load off the tendon tissue.


• Wearing an ankle brace may help patients with posterior tibial tendinitis, until the inflammation comes down.


• Rest - doctors may advise some patients to rest and avoid activities which may make the foot (feet) feel worse, until the foot (feet) feels better.


• A combination of an insole and some kind of painkiller may help patients with a ruptured tendon, as well as those with arthritis.


• Patients with a ruptured tendon or arthritis who find insoles with painkillers ineffective may require surgical intervention.


• Patients, usually children, whose bones did not or are not developing properly, resulting in flat feet from birth, may require surgical intervention to separate fused bones (rare).


• Bodyweight management - if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with flat feet who successfully lose weight experience considerable improvement of symptoms.

What are the possible complications of flat feet or fallen arches?

As fallen arches can affect the way a person's body is aligned when standing, walking or running, the risk of subsequent pain in the hips, knees or ankles is significantly greater.

People with other foot problems may find that flat feet either contribute to them or make symptoms worse. Examples include:

• Achilles tendinitis
• Arthritis in the ankle(s)
• Arthritis in the foot (feet)
• Bunions
• Hammertoes
• Plantar fasciitis (pain and inflammation in the ligaments in the soles of feet)
• Posterior tibial tendinitis
• Shin splints