There is often no need to see a doctor if you have flat feet that are not causing any problems. However, you might want to arrange for a visit to the doctor if you are experiencing any of the following symptoms:
Flat foot, also known as fallen arches, collapsed arches, or pes planus, is a postural condition where the inner arch of the feet is either very low or has fully collapsed, causing the entire sole of the foot to come into contact with the ground. Sometimes, flat feet can roll over to the inner side of the foot. This is known as excessive subtalar pronation.
As the arches of our feet only develop during childhood, infants and toddlers normally have flat feet. However, some children never develop these arches, leading to flat feet during adulthood as well.
Some people appear to have flat feet while standing with their feet flat on the ground, yet have a visible arch when their feet are off the ground. This is known as having flexible flat feet, whereby the arch only disappears when loaded by the body’s weight. In other patients, the pes planus deformity is rigid, and the foot is flat even when it is not loaded by the bodyweight of the patient.
Flat feet are relatively common, often do not cause symptoms, and only require treatment if they are causing pain.
Flat feet (pes planus) can be caused by:
In adults, both flexible and rigid flat feet usually remain permanently flat unless you choose to undergo surgery to reshape your feet. However, surgery is only recommended as a last resort for treating pes planus, as there are many non-surgical treatment options available for managing the early symptoms of flat feet.
A fairly common condition, pes planus affects an estimated 1 in 5 people in the Asian population.
Risk factors for flat feet include:
Common symptoms of flat feet include:
Some people have low or collapsed arches without ever experiencing any problems. However, flat feet can often cause discomfort or pain, and can sometimes indicate an underlying disorder, such as cerebral palsy, muscular dystrophy or tarsal coalition.
A number of treatment options are available if you find that your flat feet are causing you pain and affecting your quality of life.
There is often no need to see a doctor if you have flat feet that are not causing any problems. However, you might want to arrange for a visit to the doctor if you are experiencing any of the following symptoms:
Your doctor will examine your feet while you stand and walk, inspecting them from the front and the back. You may be asked to stand on the tips of your toes (single heel raise test) so your doctor can fully study the shape and function of your feet, and assess if your flat foot is flexible or rigid.
You will be asked questions about your lifestyle and medical history, and weightbearing X-rays are typically ordered, along with CT or MRI scans if your doctor deems them necessary for a more detailed evaluation of the foot structure and to exclude co-existing conditions.
Flat feet are often treated with orthotics, which are customised shoe inserts that help to support your feet. These can help to relieve pressure when you stand, walk, or run. There are two type of orthotics – corrective insoles are useful for flexible pes planus and as the name suggests, are moulded to correct the shape of your foot and restore the arch; accommodative insoles, on the other hand, are meant for rigid pes planus that cannot be corrected, and reduce pain by relieving pressure on your feet.
Specific exercises, like calf stretches or heel cord stretches, can also be performed to relieve pain or improve the structure of the foot. Muscle strengthening exercises (tibialis posterior strengthening) may also be useful in alleviating foot pain. Your orthopaedic surgeon may recommend several lifestyle changes, such as a diet and exercise program for weight loss to reduce pressure on the feet.
If you are experiencing pain or inflammation, you may be prescribed painkillers or anti-inflammatory medication for these symptoms.
In more serious cases, foot surgery may be necessary to treat flat feet. An orthopaedic surgeon can correct the shape of the foot and restore the foot arches, restoring normal foot structure and gait.
Surgery is often the last resort for treating flat feet and only necessary in serious cases of flat feet, when the foot pain is resistant to exercises and orthotic insoles. You should consult with a subspeciality-trained foot and ankle surgeon, who can advise you on the best treatment options.
Broadly speaking, flexible flat feet can be treated by making cuts to the bones in the heel and midfoot (osteotomies), restoring the shape of your heel and recreating the foot arch, while preserving the movement of the joints of the foot. Often, the tibialis posterior tendon is dysfunctional and requires augmentation with an adjacent tendon to stabilise the arch (tendon transfer). Nowadays, some skilled surgeons are able to perform these procedures using minimally-invasive surgical (MIS) techniques, requiring far smaller skin incisions and causing less soft tissue injury. As a result of MIS surgery, patients benefit from less pain, faster and better recovery, and earlier return to home and to work after surgery, with less complications.
Rigid flat feet, on the other hand, are not amenable to correction by osteotomies due to the typically more severe nature of the foot deformity. Often, the joints of the hindfoot and ankle are arthritic and painful as well. As such, rigid pes planus is usually treated by fusing (joining) the bones of the three major hindfoot joints (triple fusion or triple arthrodesis), which restores heel alignment and the foot arch, but sacrificing movement in the hindfoot joints in the process. This is usually done through a pair of long incisions along the inner and outer sides of the foot, with a significant pain and recovery time.
However, a very small number of surgeons locally are experienced in performing hindfoot triple fusion surgery using arthroscopic “keyhole” surgery, which is far more technically advanced than open surgery, and provides patients with the benefits of less pain, faster recovery, lower complications and better fusion success rates than open surgery. Unlike traditional open surgery, arthroscopic “keyhole” triple fusion can be done as a day surgery case, and patients can safely return home within a day after surgery. Recovery time and return to work and activity is also typically faster than after open surgery.
Regardless of type, will be performed under anaesthesia, and usually involves an overnight stay in the hospital of your choice (for MIS and “keyhole” surgeries). Depending on the type of surgery performed, metal screws or low-profile metal plates may be inserted into your foot to hold the bones in the optimal position until healing is complete.
After the procedure, you will be given a topical anaesthetic and oral medications for the pain. Initial recovery can take 6 to 12 weeks for open surgery (shorter at 4 to 6 weeks for MIS and “keyhole” techniques), during which you will initially be fitted with a cast or long walker boot, and may require the use of a wheelchair or crutches. After the cast is removed (typically after 2 to 4 weeks), your doctor will fit you with an orthopaedic boot to keep your foot immobilised while it continues to heal.
After the initial recovery period is over, you can commence physical therapy to help your ankle and foot regain its motion, stability and strength. Gait training is also important to optimise your walking speed, balance and endurance.
Pes planus, or flat foot, is a condition that can sometimes be prevented with proper foot care (wearing well-padded shoes with good arch support) and by avoiding injury to the foot.
To prevent the worsening of flat feet and manage the pain caused by this condition, avoid high impact sports and activities that put excessive stress on your feet until you have completed your rehabilitation. It is important to undergo a course of physiotherapy to strengthen the muscles of the foot and ankle, and to see a podiatrist for proper orthotic insoles to be fitted to support the heel and foot arches.
If these conservative measures fail, and you find that you need further help managing your flat feet (or if you would just like to know more about the condition), please do not hesitate to approach your orthopaedic foot and ankle surgeon for advice and proper treatment. Early diagnosis and treatment provide the best chance for successful correction of your flat feet, good pain relief and optimal functional outcomes, allowing you to return more rapidly to work, activity and sports!
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