Flatfoot, also known as “fallen arches” or Pes planus, is a deformity in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved. Rigid pediatric flatfoot however can cause joint pain in the leg when walking or an aching pain in the feet and usually requires intervention.

Causes and Risk Factors

Pediatric flat foot is a common condition that can run in families. It is often caused by loose connections between joints and excess baby fat deposits between foot bones which make the entire foot touch the floor when the child stands up. A rare condition called Tarsal Coalition can also cause flatfoot. In this condition, two or more bones of the foot join abnormally causing stiff and painful flat feet.

Adult acquired flat foot is related to the collapse in the hindfoot due to failure of the posterior tibial tendon and surrounding structures. This is most commonly a “wear and tear of life” issue, but is more common in women and those with higher body mass.

Signs and Symptoms

Those with flatfoot deformity may have one or more of the following signs and symptoms:

  • Inside arch of the foot is flattened
  • Heel bone may be turned outward
  • Inner aspect of the foot may appear bowed out
  • Pain in the foot, leg, knee, hip, or lower back
  • Pain in the heels causing difficultly with walking/running
  • Discomfort with wearing shoes
  • Tired, achy feet with prolonged standing or walking


Your doctor will perform a physical examination and observe the the patient in standing and sitting positions. If the flatfoot is flexible, symmetric, and there is no discomfort ,no further tests or treatment are necessary. If pain is associated with the condition, or if the arch does not form on standing on toes, then X-rays are ordered to assess the severity of the deformity. A computed tomography (CT) scan is done if tarsal coalition is suspected and if tendon injury is presumed a magnetic resonance imaging (MRI) is recommended.

Conservative Treatment

Symmetric flat feet without pain do not require any formal evaluation or treatment. If there is pain or asymmetry, evalutation and weightbearing X-rays are necessary.

  • Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time. Short term immobilization in a fracture walker can also be beneficial.
  • Orthotic devices: Your surgeon may advise on the use an over-the-counter orcustom made orthotic devices that are worn inside the shoes to support the arch of the foot.
  • Physical Therapy: Stretching exercises of the heel can provide pain relief.
  • Medications: Pain relieving medications such as NSAID’s can help to reduce pain and inflammation.
  • Shoe modification: Using a well‐fitting, supportive shoe can help relieve aching pain caused by flatfoot.

Surgery is rarely needed to treat pediatric flatfoot, however, if conservative treatment options fail to relieve your child’s symptoms then surgery may be necessary to resolve the problem. Depending on your child’s condition, various procedures may be performed including tendon transfers, tendon lengthening, joint fusion, and implant insertion.

Adult acquired flatfoot can require more extensive bracing or surgical reconstruction depending on the severity of deformity and the tendon condition. Untreated posterior tibial tendon dysfunction, leads to progressive deformity, hindfoot arthritis, and potential ankle arthritis and collapse. Early surgical correction is usually joint preserving, and aimed at restoring the function of the posterior tibial tendon. Late surgical correction is usually a triple arthrodesis (fusion of the hindfoot) to restore alignment.

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