The appearance of flat feet is normal and common in infants, partly due to "baby fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Training of the feet, especially by foot gymnastics and going barefoot on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood.
Most commonly fallen arches in adulthood can arise due to Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon plays a pivotal role in holding up the arch of the foot, damage to this tendon results in the arch collapsing. Another cause of acquired flat feet in adulthood may be due to Rheumatoid arthritis as this disease attacks the bone, cartilage and ligaments in the foot causing it to change shape and flatten. Injury to the ligament, fracture and/or dislocation of the bones in the mid foot can all lead to a flat foot deformity. Adult acquired flat fleet can also arise in people who have diabetes or a neurological condition which limits normal feeling in the foot, the muscles in feet switch off, the tendons and ligaments weaken, and the arch eventually collapses.
Arches can be seen as ?rolling downward? or collapsing when walking. Pain may present in lower back, hips or knees. Pain may be present on the bottom of the heels, within the arch, within the ankles or even the forefoot. Swelling can occur. Pain may occur in the anterior leg muscles.
You can always give yourself the ?wet test? described above to see whether you have flat feet. Most people who do not notice their flat feet or have no pain associated with them do not think to see a foot doctor. Flat feet can lead to additional problems such as stiffness or pain, however, especially if the condition appears out of nowhere. If you think you may have flat feet, you should seek medical attention to ensure there are no additional issues to worry about. Your doctor will be able to diagnose you with a number of tests. For example, he or she may have you walk around, stand still, or stand on your tiptoes while you are being examined. Your doctor may also examine your foot?s shape and functionality. It?s important to let your foot doctor know about your medical and family history. In some cases, your doctor may order imaging tests such as x-rays or an MRI (magnetic resonance imaging) to determine a cause of your flat foot. If tarsal coalition is suspected in children, a CT scan is often ordered.
What causes flat foot deformity?
Non Surgical Treatment
There are different modalities of treatment that are available to manage flat feet and fallen arches. The type of treatment that is chosen depends upon how severe the condition is and what symptoms the patients are experiencing. Below is a brief description of the available treatment modalities. In the event that the patient is experiencing swelling of the feet, rest and ice application is usually the initial treatment step. Oral anti-inflammatories may be offered which can help reduce inflammation as well as associated pain. Physical therapy has good outcomes and can include different exercises such as stretches and strengthening of the surrounding muscles. Changes in footwear and activity modification are also important when dealing with a painful flat (pronated) foot. These days, orthotic insoles are easily available either over the counter or through your Podiatrist which can effectively help maintain the arch of the foot and reduce the amount of stress placed on the foot. Podiatrists are able to prescribe a variety of different devices from prefabricated to customized and are trained to determine the most appropriate device for each individual. In order to offer the right kind of orthotic insole, podiatrists may perform a test called gait analysis. This involves asking the patient to walk and videoing the different movements that the foot of forms during the walking. Features such as over pronation can be easily seen on this and orthotic insoles can be prescribed to correct the specific abnormalities that are picked up on this analysis. Overall, orthotic treatment can result in a significant improvement in foot movement and reduction in foot discomfort.
Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
Going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitis. Ligament laxity is also among the factors known to be associated with flat feet. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot found that the longitudinal arches of the bare footers were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes. Focusing on the influence of footwear on the prevalence of pes planus, the cross-sectional study performed on children noted that wearing shoes throughout early childhood can be detrimental to the development of a normal or a high medial longitudinal arch. The vulnerability for flat foot among shoe-wearing children increases if the child has an associated ligament laxity condition. The results of the study suggest that children be encouraged to play barefooted on various surfaces of terrain and that slippers and sandals are less harmful compared to closed-toe shoes. It appeared that closed-toe shoes greatly inhibited the development of the arch of the foot more so than slippers or sandals. This conclusion may be a result of the notion that intrinsic muscle activity of the arch is required to prevent slippers and sandals from falling off the child?s foot.