Flexible flatfeet are considered normal in young children because babies are not born with a normal arch. The arch may not form fully until sometime between ages 7 and 10. Even in adulthood, 15% to 25% of people have flexible flatfeet. Most of these people never develop symptoms. In many adults who have had flexible flatfeet since childhood, the missing arch is an inherited condition related to a general looseness of ligaments. These people usually have extremely flexible, very mobile joints throughout the body, not only in the feet. Flatfeet also can develop during adulthood. Causes include joint disease, such as rheumatoid arthritis, and disorders of nerve function (neuropathy).
Stress fractures, plantar fasciitis, and acute and chronic arthritis are most commonly the result of repetitive micro-trauma injuries. Micro-trauma injuries are caused when the structures of the body are stressed and re-stressed to the point that damage occurs in the tissues. Factors that commonly contribute to this injury can be running on uneven surfaces or surfaces that are too hard or too soft, shoes that have poor force-absorption qualities, or going too hard or too long during repeated exercise bouts.
People suffering from pain in the arch sometimes complain of burning or soreness on the foot sole, which is worse in the morning and after physical activity. There may also be some tenderness when pressure is applied to the sole of the foot or heel. In addition to this, patients tend to complain of more pain when they stand on tiptoe.
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to “raise up on the tip toes” of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic – will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non Surgical Treatment
In mild cases of flatfoot the first line of treatment is often custom orthotics. In patients with a flexible deformity, supporting the arch with a custom arch support will take the strain off the joints and muscles, bringing the heel into a corrected position. Wider shoe gear may be prescribed to accommodate foot pain and motion and stretching exercises to decrease stiffness and stress on the foot. In cases of severe collapse, especially if the patient is not a good surgical candidate or has a mild tear, a brace may be made to accommodate the foot and ankle, thus supporting the arch and ankle.
With flat feet, there is a tendon on the inside of the foot than can often become weakened, injured, split and/or ruptured. This tendon, is called the posterior tibial tendon, and is the main arch supporting tendon. Obviously damage to this tendon can cause collapse of the arch. Some people have genetically inefficient tendon, and tends to be the case in younger people. In mild cases, such as tendon splits, the posterior tibial tendon can be repaired to restore its strength. Acute incontinuity of the tendon can be primarily repaired. Often the posterior tibial tendon is augmented with a tendon transfer of an adjacent tendon to provide both strength and continuity. In any tendon repair, advanced or retensioning of the tendon is performed. In most flat foot surgery a tendon augmentation is often combined with other boney procedures to restore structure and balance to the foot.
Easy Beginner Version. Start with your bare foot on a flat surface, toes spread out. Place a penny under the ball of your foot and the end of a pen under the middle of your arch (sticking out from the inside of your foot). Activate your arch by flexing your arch muscle. You should feel the muscles on the ball of your foot pushing down on the penny, but your arch shouldn’t be pushing down on the pen. These tools help you (1) avoid rolling your foot and (2) avoid pressing down with your toes (as an extra tip, you can slide a business card under your toes before doing the exercise-when you activate your arch, you should be able to slide the business card out easily with your fingers). Do your best to keep your toes relaxed. Advanced Version. Once you’re ready to move on, you can try this advanced version. It builds on the above exercise to incorporate full body twisting and balance, helping you to maintain proper arches while you move. Using the same ideas from above, stand on a flat surface in your bare feet with a penny under the ball of your foot and the end of a pen under your arch. This time, stand with your back a few inches away form a wall or a door. Lift your other leg (the one without the penny or pen) and stand on one foot. Use the wall for balance, if necessary. Lift one arm and stretch it across your body until you touch the wall or door on the opposite side, maintaining a straight back. Keep your foot straight and your arch on the penny but above the pen. Your arch will want to follow the movement and roll off, but you will need to activate it to stay stable during the movement. Lift your other arm and stretch it across the opposite side of your body, still keeping your arch in place.