Flat feet

Alternative names

Pes planovalgus; Pes planus; Fallen arches; Pronation of feet

Definition

Pes planus is a condition where the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops.

Causes, incidence, and risk factors

Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches.

When flat feet persist, the majority are considered variations of normal. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible, or painful flat feet may be associated with other conditions and require attention.

Painful flat feet in children may be caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together, limiting motion and often leading to a flat foot.

Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Foot pain, ankle pain, or lower leg pain (especially in children) may be a result of flat feet and should be evaluated by a health care provider.

Symptoms

• absence of longitudinal arch of foot when standing
  
• foot pain
  
• heel tilts away from the midline of the body more than usual
  

Signs and tests

Examination of the foot is sufficient for the health care provider to make the diagnosis of flat foot. However, the underlying cause must be determined. If an arch develops when the patient stands on their toes, then the flat foot is called flexible and no treatment or further work-up is necessary.

If there is pain associated with the foot or if the arch does not develop with toe-standing, X-rays are necessary. If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your health care provider may recommend an MRI.

Treatment

Flexible flat feet that are painless do not require treatment. If pain due to flexible flat feet occurs, 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 as they correct for the positional abnormality.