By Basem Hakim, DPM, AACFAS

Flatfoot is a condition when one or both feet have little or no arch.

All babies have flat feet, and they will develop an arch by the age of 6. About 20% will stay flat-footed by the age of 10. Some adults will have their arches collapse, and these are usually referred to as fallen arches. 

Types of flatfeet include flexible, rigid, and adult-acquired. Flexible flatfeet are the most common, in which both feet have arches while you aren’t standing, and the arches disappear upon standing.  It starts in childhood and worsens with age, and the tendons and ligaments may overstretch, swell and tear. 

Rigid flatfeet are when you don’t have an arch, whether sitting or standing. It also starts in childhood, may affect one foot or both feet, gets worse by age and is more painful. 


Adult acquired flatfoot is when you unexpectedly lose your arch in one foot or both feet, which results in outward turning of the foot, and becomes more painful, most commonly caused by inflammation of the posterior tibialis tendon, which supports the arch. 

You may experience symptoms with flatfoot, including pain in the arches, ankles and heels, as pain and stiffness that increase with walking and prolonged standing. Also, patients may have leg cramps, foot or leg fatigue, and toe drift where the toes look outwards.

Along with a physical examination, your doctor will request X-rays which are very important to confirm flatfoot diagnosis.

Treatment depends upon the patient’s symptoms, goals, the severity of the deformity, and the presence of arthritis. Your doctor will recommend starting with conservative treatment first to limit the progression of the deformity and alleviate the pain, which includes supportive shoes, orthotics, leg braces, and custom-made shoes. Physical therapy helps to stretch the ligaments to improve their mobility and flexibility, and sometimes NSAIDs may be needed to ease inflammation and pain. Surgery will only be reserved for cases with delayed presentation and advanced conditions that don’t improve with conservative treatment methods. 

If you experience any of the mentioned symptoms, I recommend making an appointment with your doctor as early as possible to get help before the deformity advances with more damage to your tendons and joints. 

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