Flat feet, sometimes referred to as “acquired flat foot disorder,” is a condition caused by a collapsed arch.
A healthy arch is formed by the tendons and ligaments in your foot and lower leg, which help to form an upward-pointing curve in the middle of the underside of your foot. Flat feet can sometimes result from a hereditary condition where the arch fails to form in childhood. In adulthood, flat feet are usually caused by chronic and/or untreated stress to the foot.
Common types of excessive foot stress that can lead to arch collapse include:
• Standing or walking for prolonged periods of time in uncomfortable or constraining footwear (high heels, dress shoes)
• Foot injuries, such as sprains or broken bones, that are not properly treated or not given adequate recovery time
• Muscle weakening in the foot, ankles and/or lower leg brought on by aging or weight gain
Common symptoms of flat feet include: the visible absence of an arch under the foot; pain or discomfort in the feet or ankle joints; discomfort walking or standing for long periods of time; difficulty with daily activities. If you have flat feet, you may notice that your foot turns outward at the ankle and that your posture is strained. Your feet are your structural foundation, so flat arches can cause problems throughout your entire skeletal structure and pull your joints out of alignment. Without treatment, fallen arches put additional strain on your body, starting with the ankles and knees. Over time, flat feet lead to more serious issues, pulling your hips, knees and ankles out of alignment and causing excess strain (and pain!) to all related joints. Continuous strain may cause bones to collapse, resulting in symptoms like heel spurs and arthritis.
Once the arch collapses, intervention is required to restore normal foot function. Non-surgical treatments may help to soothe the pain and discomfort caused by flat feet. Your first line of defense is to wear comfortable, supportive shoes with stabilizing insoles. Additionally, orthotic inserts customized to your unique foot and ankle shape may help in realigning the joints and bones in your foot and will make tasks like walking, standing and running more comfortable. Arch inserts and wraps can provide even more stability and help to further diminish associated pain.
For people still in pain after using non-surgical treatment approaches, surgical intervention may be required. Surgery can correct problems that prevent orthotics from being effective—such as deformities, tendon damage or arthritis.
In cases where the collapsed arch is still flexible (hasn’t become stiff), flat foot reconstruction surgery can relieve pain and restore normal function by improving the alignment of the foot and restoring normal load to the surrounding joints and bones. The procedure is done under a general anaesthetic and commonly consists of two separate repairs: a replacement of the tendon on the instep, and a calcaneal osteotomy where the heel bone is cut, repositioned and held in place with a metal screw to improve support to the arch. Other procedures such as bone lengthening, fusions, or isolated tendon/ligament repairs may be required. You will receive a complete evaluation from your orthopaedic foot and ankle surgeon before surgery is recommended.
In cases where the arch has become stiff and inflexible, surgical intervention will require fusing some of the foot joints – known as double or tripe arthrodesis.