Flat feet

Flat feet

What are flat feet

Most people's feet have a space on the inner side where the bottom of the foot is off the ground (the "arch" of the foot). The height of this arch varies a lot from one person to another. Small children do not have an arch: it develops between the ages of 3 and 10. People who have a low arch, or no arch at all are said to have flat feet. Sometimes they are said to have "fallen arches", but as most of these people always had a low arch the term is misleading.

What causes flat feet

Flat feet may be perfectly normal for you. Most people have a space under the inside edge of the foot (the 'arch"). This is what gives the foot print of a heel and then a gap behind the toes when walking along a sandy beach.

In children it develops over time up to puberty. Some people never develop a proper arch and it sometimes runs in families with both feet moving freely. Very occasionally the bones in the foot may not develop properly and they are stuck together or fuse. The foot is normally very obviously stiff and flat during childhood.

However, most people with flat feet tend to have flexible flat feet where the ligaments may be lax and the foot tends to roll in too much or 'over-pronate". When he/she stands on tip-toes, however, the flat foot forms an arch as the heel swings inwards - this is usually normal.

If a flat foot develops later in life, it may be due to a tendon problem that supports the arch (Tibialis posterior tendon) or arthritis in the joints around the heel. This is usually painful.

Do I or my child need treatment for flat feet

Children rarely need any treatment for flexible flat feet. Years ago, many were treated with shoe inserts and exercises. This is usually not necessary as flat feet do not usually cause problems with later life. It is possible to join the army with flat feet! If there is an abnormal shoe-wear pattern or pain then children should be assessed to see is inserts (orthoses) should be considered.

Children with stiff flat feet should be referred to a specialist as surgery may be required to separate or stabilise fused bones.

Adults who develop a flat foot need an orthopaedic specialist opinion. It may be necessary to use a shoe insert and sometimes a brace may help to reduce symptoms (these braces are called Airlift PTTD braces). In advanced cases of Tibialis tendon problems an operation may be required to correct the deformity from progressing. This may involve an operation on the heel bone (calcaneal osteotomy) and transfer of a tendon to reinforce the weak tibialis tendon. (Click here for information on the operation and post-operative period)

Advanced and long-standing deformities can result in arthritis of the joints around the hindfoot. This may then need fusion of the bones (eg triple fusion). This surgery aims to leave the foot pain-free by stabilising the foot and heel joints. (Click here for information on the operation and post-operative period)