Janey Lindau

Feet Trouble Data Base

Alleviating Fallen Arches


Flat Feet

A quarter of Americans have flat feet. While most people with flat feet don't have serious problems as a result, for some, flat feet can cause disabling foot pain as well as knee pain, shin splints, Achilles tendinitis, and plantar fasciitis. A person with foot or leg pain should pay particular attention to whether one foot is flatter than the other.


There are many different causes of flat feet, which can be separated into two main categories. The first category, congenital flat foot, is a condition that one is born with or is predisposed to at birth. This type includes the completely asymptomatic, pediatric flexible flat foot-by far the most common form of congenital flat foot. Flexible means that an arch is present until weight is put on the foot, at which time the arch disappears. This foot type is a result of the fact that all people are born with different physical features. Some people have bigger noses than others, just as some people have flatter feet (of course, there is no known correlation between the two). Any alteration in the many building blocks of the foot can influence its shape. At the other end of the spectrum, yet within the same category of congenital flat foot, exist several rare, more severe forms of flat foot. These severe conditions include Vertical Talus, Congenital Calcaneal Valgus, and Tarsal Coalitions - all of which are more rigid (no arch with or without weight on the foot) and definitely symptomatic. Luckily, these are much less common, but can usually be identified by specialists at the time of presentation and treated appropriately. The second category, acquired flat foot, develops over time, rather than at birth. Many different factors can contribute to the development of flat feet. These include the types of shoes a child wears, a child's sitting or sleeping positions, compensation for other abnormalities further up the leg, or more severe factors such as rupture of ligaments or tendons in the foot. Very commonly, the reason for flat feet is that the foot is compensating for a tight Achilles tendon. If the Achilles tendon is tight, then it causes the foot to point down, or to plantarflex (as occurs when stepping on the accelerator of your car). Even minimal amounts of plantarflexion can simulate a longer leg on that particular side, assuming that the other foot is in the normal position. The body therefore tries to compensate by pronating, or flattening out the arch, thereby making up for the perceived extra length on the affected side.


Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.


Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.

pes planus orthotics

Non Surgical Treatment

Treatment for flat feet and fallen arches depends on the severity and cause of the problem. If flat feet cause no pain or other difficulties, then treatment is probably not needed. In other cases, your doctor may suggest one or more of these treatments. Rest and ice to relieve pain and reduce swelling, stretching exercises, pain relief medications, such as nonsteroidal anti-inflammatories, physical therapy, orthotic devices, shoe modifications, braces, or casts, injected medications to reduce inflammation, such as corticosteroids. If pain or foot damage is severe, your doctor may recommend surgery.

Surgical Treatment

Flat Feet

Procedures may include the following. Fusing foot or ankle bones together (arthrodesis). Removing bones or bony growths, also called spurs (excision). Cutting or changing the shape of the bone (osteotomy). Cleaning the tendons' protective coverings (synovectomy). Adding tendon from other parts of your body to tendons in your foot to help balance the "pull" of the tendons and form an arch (tendon transfer). Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening).


Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.