Common Causes of Flat Feet in Adults and Children

What are flat feet?

Flat feet is a descriptive term for one or both feet with a reduced arch profile when compared to a normal arch. Essentially, it describes an arch that flattens on standing where the heel is pointed outwards towards a valgus position and the foot can generally point towards the outer sides when standing

Why do arches matter?

The human arch of the foot is a dynamic stabiliser of the whole lower limb and body, including providing postural support. When the arch flattens, the shin bones and the leg as a whole internally rotate to the hip. This can affect the spinal position and result in slouching. The muscles in the legs and the back fire in different directions, which do not optimise your gait or posture and thus cause injury and pain.

Common Causes of flat feet in Children

There are various factors, including genetic factors. You may be born with a lower arch profile.

Congenital Factors

Not all arch profiles are problematic, whereas those that develop either due to congenital factors or due to injury may contribute to pain and deformity.

It’s common in Afro-Caribbean population to have flat feet, which is normal, and under the age of four years old children generally tend to have lower arches.

Other congenital conditions include tarsal coalition where the cells in the womb do not separate and the bones of the hind foot are fused together and do not separate resulting in a rigid flat foot. This can be either cartilaginous or bony rigidity and can cause pain in young adolescents and carry on through life if not treated.

Other problems include tendon and ligament damage which can happen over time through injury or stretched causing the rupturing or tearing of these structures and dropping of the arch. Hypermobility including benign joint hypermobility and conditions such as Ehlers-Danlos syndrome. General wear and tear can also result in flat feet.

Developmental Factors

Developmental factors, poor footwear or problems during growth in terms of avascular necrosis where the navicular might get damaged or die. Not wearing appropriate footwear could also be one of the reasons.

Neuromuscular or Skeletal Condition

Finally, neuromuscular conditions where you develop spastic flat foot due to injury or congenital problems.

Common Causes of Flat Feet in Adults

Posterior tibial tendon dysfunction

The tibial tendon is the main tendon supporting the arch and disease to this tendon can occur, which results in either degenerative condition of tendon or gradual injury or overuse.

The tendon runs from the back of the leg and serves to the navicular bone thus supporting the arch. This seems to affect more women than men. It’s a gradual process where initially the tendon might just be inflamed and over time resulting in tear, lengthening and rupture which are gradual processes of progressive flat foot deformity requiring surgical intervention in most cases.

Aging and Wear & Tear

Ageing, wear and tear, degenerative changes, arthritis develops in the midfoot or hindfoot on subtalar or talonavicular joint, this gradually results in a stiff and progressive flat foot.

Obesity and Lifestyle Factors

Obesity and lifestyle factors, increased weight puts excessive strains on ligaments and tendon structures around the arch. Ligaments such as spring ligament and plantar fascia get injured and stretched and flat foot develops.

Previous Injuries

Previous injuries, tear to the deltoid ligament or tear to the posterior tibial tendon can occur in sports or traumatic episodes.

Medical Conditions

Medical conditions, rheumatoid arthritis or benign hypermobility such as Ehlers-Danlos can result in flat feet. Rheumatoid arthritis can particularly cause tendon damage including the tibialis posterior tendon and arthritis of the talonavicular or ankle joint which can result in stiff and progressive flat foot and disease.

When to visit a podiatrist or a foot doctor

If a flat foot causes fatigue symptoms in the leg, if you feel like you slouch or you have improper gait, then it’s important to go see a podiatrist or foot specialist or foot surgeon. Inappropriate footwear where the inside of shoes worn more than the outside can be a sign and it’s important to seek a specialist. There may be simple things that one can do including appropriate footwear with good arch support or having a gait analysis and orthotics manufactured by a podiatrist.

Specialist imaging such as X-ray or MRI may be requested.

Gait analysis can determine whether your pattern of walking is appropriate or causing problems up in the kinetic chain.

FAQs

What causes flat feet in children?

Usually benign but conditions like tarsal coalition should be excluded. Poor footwear can worsen these kinds of conditions.

Are flat feet common in adults?

About 10 to 20% of adults have flat feet, not all are problematic or pathological, but painful feet do need treating and assessment. These can cause progressive problems and early treatment could prevent long-term problems.

What is the best treatment for flat feet?

Start with appropriate footwear such as trainers with supports, use orthotics, and in the cases where there’s progressive problems you may need a brace or a boot temporarily. Surgery is indicated when conservative measures fail.

This could include a small implant via keyhole surgery in the sinus tarsi known as arthroeresis procedure for flexible flat feet or major osteotomies to cut and reset bones or fusion of the arch bones, including soft tissue repair may be needed.

Can arches be rebuilt?

Yes, arches can be rebuilt through exercise such as picking up a towel from the toes, calf stretching, and strengthening of the feet. Surgery can also rebuild the arch but requires a prolonged recovery period and is used for cases where conservative treatment fails.

Can flat feet be surgically corrected?

It can be performed and more recent advances have improved the technology. It involves a prolonged recovery period. It is reserved for feet that cannot be treated without surgery or without conservative management.