Flat feet is a common condition that usually does not cause problems and does not require treatment. So how is it diagnosed, when is intervention really needed, and in which rare cases is surgery required? an orthopedic surgery specialist, explains: Flat feet are not a pathology but part of a range of normal conditions, just like differences in height or nose size. There is no need to correct the foot structure if there is no pain or limitation.
Have you been told in childhood that you need insoles because you have flat feet? They considered a medical problem that required correction insoles, shoes and treatments.
Today most of the children and the adults living without pain and limitations but there is no need for intervention as long as there are no symptoms.
Congenital Flat Feet: Common but Not Always Problematic
Flat foot (Flat Foot) is a common condition in which the arch of the foot is lower than usual and sometimes almost absent. For some people, it is a normal structure that does not cause problems at all, but for others, it can cause pain, deformities, and affect joint function. In some countries, it is commonly referred to as “duck foot” because the flat shape resembles a duck’s foot.
According to a specialist in orthopedic surgery, ankle, and foot orthopedics, The human foot has existed for 3.5 million years, and in its current form for about 300,000 years. Most of this time we walked barefoot, and there are still people in the world who walk barefoot without pain or problems this is part of the evolutionary-historical perspective.
- Flexible flat feet where the joints are normal, the overall anatomy is normal, but the arch is flat. This is very common among children and adults about 15% of the general population lives this way. Most have no symptoms, live normal lives, and even engage in sports without limitations. In the past, insoles were recommended for children in this condition, but today it is known that there is no need, as insoles do not change the structure of the foot.
- Rigid flat feet a rarer condition where a congenital deformity exists in the bones of the foot. In these cases, the foot is not flexible and sometimes surgery is required. Diagnosis is made by an expert, sometimes with X-rays or CT scans.
Flat feet are not a pathology but part of a range of normal conditions, just like differences in height or nose size. What matters is not the shape, but whether it causes symptoms.
Acquired Flat Feet: Develops Over Time
There are also cases where a person is born with a normal arch, but it collapses over time usually around age 50-60. This condition is called acquired flat feet.
The most common cause of acquired flat feet is degenerative disease of the posterior tibial tendon the main tendon that supports the arch. It is located on the inner side of the calf and connects to the bones of the foot. When this tendon stretches, tears, or loses function, the arch collapses.
This is more common in women aged 50-60 and sometimes associated with overweight. In such cases, pain may occur, and one should see an orthopedic specialist for evaluation.
Symptoms, Diagnosis, and Treatment
Many people with flat feet do not experience any problems. However, when flat feet become symptomatic, possible signs include:
- Pain on the inner side of the foot (where the arch should be)
- Pain on the outer side of the ankle
- Pain in the foot, ankle, or calf
- Accelerated wear of shoes on the inner side
- Difficulty walking or standing for long periods
- In advanced cases external foot deformity
Diagnosis is made through physical examination by an orthopedist and sometimes imaging: X-ray, CT, or MRI if tendon damage is suspected.
Treatment:
The main principle is that treatment is only needed if symptoms exist. There is no need to correct the foot structure if there is no pain or limitation.
In most children, no treatment is necessary. In rare cases of rigid, inflexible flat feet, surgery may be considered.
For adults, treatment options are divided into two main approaches conservative and surgical. Conservative treatment is the first line and suitable for most patients.
It includes custom insoles that support the arch and reduce load, shoes with stable ankle support, and sometimes an ankle brace that stabilizes the foot. Targeted physiotherapy helps strengthen supporting muscles of the foot and ankle, improves balance, and reduces pain. Often, weight reduction and general fitness also significantly improve the condition.
The belief that flat feet inevitably cause lower back or knee pain hasn’t got proven. Despite common perception, there is no evidence that insoles correct or resolve back or knee problems.
When these treatments are insufficient pain gets worse, surgery may be considered. This is a small minority of cases, but for those patients, surgery is very effective. The procedure restores the foot’s structure, corrects the collapsed arch, and sometimes repairs damaged tendons.
Physiotherapy: Strengthening and Relief Only
Physiotherapy does not change the anatomical structure of the foot, so it does not ‘correct’ or ‘cure’ flat feet itself. However, in cases of pain in the feet or ankles sometimes due to prolonged standing physiotherapy can be part of treatment.
In such cases, custom insoles may be recommended, along with exercises to strengthen the arch-supporting muscles and prevent inflammation. The goal of exercises is to improve foot support, reduce load, and prevent pain. Simple exercises include rolling a tennis ball or small water bottle under the foot, arch contraction and release, or targeted stretches. For overweight patients, weight reduction is also important to reduce foot load.