Condition, Causes and Symptoms

Flat feet (also called pes planus, fallen arches or pronated foot) is a formal reference to a medical condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground.

In some individuals (an estimated 20–30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally).

In pes planus, there is improper biomechanical alignment, therefore the individual with pes planus loses the function of the medial longitudinal arch (MLA).

If the MLA is absent or non-functional in both the seated and standing positions, the individuals has “rigid” flatfoot.

If the MLA is present and functional while sitting or standing up on toes, but disappears when walking, then it is called “supple or collapsible” flatfoot. This condition can be correctable with well-fitting arch supports/insoles.

Flat feet in children

Flat feet of a child are usually expected to develop into high or proper arches, as shown by feet of the mother.

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.

Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks. Children who complain about calf muscle pains or any other pains around the foot area may be developing or have flat feet. Pain or discomfort may also develop in the knee joints.

Flat feet in adults

Flat feet can also develop as an adult (“adult acquired flatfoot”) due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics, or as part of the normal aging process. This is most common in women over 40 years of age. Known risk factors include obesity, hypertension and diabetes. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin (elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.

The most common form of bad foot biomechanics is over-pronation due to flat feet or fallen arches, which is the dropping of the arches and rolling inwards of the feet and ankles, and is the most common foot problem affecting sports people and an estimated 70% of the general population.
This condition presents itself in varying degrees of severity, with some people over-pronating more than others. The fact that so many of us suffer from over-pronation due to fallen arches can be contributed to the hard, flat surfaces we walk on daily. As the foot and calf muscles tire due to years of wear and tear, the arches of the foot steadily drop and finally collapse. This may lead to tired feet, loss of impact absorption, foot cramps, ankle pain and swelling, blisters and calluses, achillies tendinitis, shin pain, heel spurs, loss of stability, sprain and stress fractures. The changes in foot biomechanics may even be a factor for low back pain and neck pain. Other factors that play a role include age, weak ankles, and excess body weight. As a result, over-pronation is much more prevalent in people in their fifties and older, and also in overweight persons.

Over-pronation doesn’t pose a serious problem in many cases, especially for younger people. However, abnormal foot function caused by over-pronation can lead to serious foot problems like heel pain, heel spurs, plantar fasciitis, metatarsalgia – even knee pain and lower back pain in some instances.

Treatment

Treatment of flat feet may also be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back. Treatment may include using Orthoses such as an arch support, foot gymnastics or other exercises as recommended by a footcare specialist. In cases of severe flat feet, orthoses should be used through a gradual process to lessen discomfort. Over several weeks, slightly more material is added to the orthosis to raise the arch. These small changes allow the foot structure to adjust gradually, as well as giving the patient time to acclimatise to the sensation of wearing orthoses. Once prescribed, orthoses are generally worn for the rest of the patient’s life.

 In some cases, surgery can provide lasting relief, and even create an arch where none existed before; it should be considered a last resort, as it is usually very time consuming and costly.