Flatfoot (Pes Planus)

  • Medical Author:
    Philip A. Radovic, DPM, FACFAS

  • Medical Author: Kyoung Min Han, DPM, AACFAS
    Kyoung Min Han, DPM, AACFAS

    Dr. Kyoung Min Han is a podiatrist (foot and ankle specialist) practicing in Southern California. Dr. Han completed her undergraduate education at the University of California, San Diego, and went on to the New York College of Podiatric Medicine to pursue her medical training. She returned to her native Southern California to complete a three-year foot and ankle surgical residency, followed by subspecialty training in a sports medicine fellowship.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is flatfoot?

When the entire sole of the foot is in contact or near contact with the ground while standing, it is considered a flat foot. The result is that there is little to no arch to the foot. Flatfoot is a common disorder. It is a complex deformity, and there are types and stages that vary in degree of symptoms and disability. Flatfeet are also referred to as pes planus, posterior tibial tendon dysfunction, and fallen arches.

What are the different types of flatfoot?

There are two general types of flatfoot: flexible flatfoot and rigid flatfoot. In flexible flatfoot, the foot has a normal arch at rest (not standing or walking), but it disappears once it comes in contact with the ground. If there is no arch, whether sitting or standing, they have a "rigid" or "true" flatfoot.

Flexible flatfoot is sometimes called "pediatric flatfoot" because it is first apparent in childhood. Congenital or rigid "true flatfoot" (talipes planovalgus) is much less common in children. Of note, almost all infants appear to have a flatfoot due to the fat pad on the sole of their feet and that the arch does not develop until 5 or 6 years of age.

When a rigid flatfoot develops in adults, it is called "adult acquired flatfoot" or "posterior tibial tendon dysfunction." This type of flatfoot develops because of the weakening of the tibialis posterior muscle tendon, which is a major supporting structure of the foot arch. It is a condition that leads to flattening of the arch and rolling in of the ankle. It is a progressive deformity with early symptoms of pain and swelling at the inside arch of the foot and ankle. It eventually may lead to arthritis of the foot and ankle joints.

Flexible flatfoot is usually in both feet whereas posterior tibial tendon dysfunction or adult acquired flatfoot can occur in one or both feet.

Flatfoot Symptom

Shin Splints

Shin splints are injuries to the front of the outer leg. While the exact injury is not known, shin splints seem to result from inflammation due to injury of the soft tissues in the front of the outer leg.

Shin splints are a member of a group of injuries called overuse injuries. Shin splints occur most commonly in runners or aggressive walkers.

What are other causes of flatfoot?

As described above, a person may be born with a flatfoot, pediatric flexible flatfoot, or develop it as an adult (adult acquired flatfoot). Less common causes of flatfoot include the following:

  • Tarsal coalitions: A condition where foot joints bridge or grow together restricting or prohibiting movement of that joint.
  • Accessory navicular bone (os tibiale externum): a small extra bone in the posterior tibial tendon that causes a weakening of tendinous support to the arch
  • Ligament laxity in congenital diseases such as Marfan syndrome or Ehlers-Danlos syndrome
  • Charcot arthropathy
  • Trauma
  • Obesity
  • Diabetes
  • Neuropathy
  • Age
  • Pregnancy, due to hormonal changes such as increases in elastin
  • Osteoporosis
  • Overuse

What are flatfoot symptoms and signs?

A flatfoot may cause no symptoms. Symptoms of flatfoot include pain that may be in the inside arch, heel, or ankle and on the outside of the foot just below the ankle. Patients often complain of generalized foot fatigue as a first signs of flatfoot. Younger patients may complain their inability to keep up with their peers during physical activity. Over time, the flattening of the arch can lead to rolling in of the foot and ankle and tilting outward of the heel. Flatfoot can also cause shin pain (shin splints) and aching of the knee, hip, and/or lower back. Excessive inner heel wear pattern may be seen on shoes.

How do health care professionals diagnose flatfoot?

One may look at their feet to see if they have an arch when standing barefoot for a general assessment. A foot specialist will provide an in-depth evaluation usually including X-rays to determine the precise type of flatfoot, its cause, and potential treatments. A doctor may perform a thorough study of walking pattern, called gait analysis, to determine the severity of flatfoot.

What is the treatment for flatfoot?

Treatment depends on the type of flatfoot, its stage of progression, and the symptoms. Early treatment is advised whether one's condition is a flexible, rigid, or adult acquired flatfoot. Treatments include proper shoe gear, over-the-counter inserts, custom functional orthotics, bracing, casting/immobilization, physical therapy, NSAIDs, weight loss, changes in activities, and surgery.

What is the prognosis of flatfoot?

Prognosis depends on the type and severity of the flatfoot. Many people with pediatric or flexible flatfoot function without any signs or symptoms and are unrestricted in their levels of activity. These people do perfectly well without any treatments. If there are symptoms, however, they are often successfully managed with conservative care. Adult acquired flatfoot or true rigid flatfoot tends to be progressive, leading to functional disability and progression of symptoms that interfere with normal daily activities. Therefore, proper diagnosis and early treatment is vital to having a good prognosis.

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Medically Reviewed on 9/26/2018
References
REFERENCES:

American College of Foot and Ankle Surgeons

American Podiatric Medical Association
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