Our feet are incredibly well specialized structures. There are 26 different bones in each foot, held together by 33 joints and more than 100 muscles, tendons and ligaments (in each foot). They way they weave and align together determine the formation of our arches. The aim of the arches is to give us spring and distribute our body weight across our feet and legs. The structures of the arches of our feet determine how we walk - they are rigid levels which allow us to move smoothly. However, the arches need to be sturdy as well as flexible to adapt to various surfaces and stresses. During childhood it is normal to have flat feet. This is because our feet form during our childhood. In other words, having what appears to be flat feet during early childhood does not necessarily mean that it will persist throughout the individual's life. People with very low arches or what appear to be no arches at all may experience no problems.
Flat feet are often a congenital problem which has no specific cause. They can however occur after an injury, especially conditions such as Tibialis Posterior Syndrome or more traumatic injuries such as fractures or mid-tarsal joint sprains. The other thing to look out for is Overpronation. Often this is confused with having flat feet (or a fallen arch) although it is not technically the same thing. If an individual does not have flat feet but does overpronate then the arch of their foot appears to be normal when standing. However, when they walk the arch collapses and the foot rolls in excessively. This is more difficult to spot than flat feet. It is estimated that between 60 and 80% of the population overpronate!
Symptoms that should be checked by a pediatrician include foot pain, sores or pressure areas on the inner side of the foot, a stiff foot, limited side-to-side foot motion, or limited up-and-down ankle motion. For further treatment you should see a pediatric orthopedic surgeon or podiatrist experienced in childhood foot conditions.
If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.
Why do arches fall?
Non Surgical Treatment
Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality. Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.
Rarely does the physician use surgery to correct a foot that is congenitally flat, which typically does not cause pain. If the patient has a fallen arch that is painful, though, the foot and ankle physicians at Midwest Orthopaedics at Rush may perform surgery to reconstruct the tendon and "lift up" the fallen arch. This requires a combination of tendon re-routing procedures, ligament repairs, and bone cutting or fusion procedures.