About flatfoot (pes planus)

What is flatfoot (pes planus)?

You have flatfeet when the arches on the inside of your feet are flattened, allowing the entire soles of your feet to touch the floor when you stand up.

A common and usually painless condition, flatfeet can occur when the arches don't develop during childhood. In other cases, flatfeet develop after an injury or from the simple wear-and-tear stresses of age.

Flatfeet can sometimes contribute to problems in your ankles and knees because the condition can alter the alignment of your legs. If you aren't having pain, no treatment is usually necessary for flatfeet.

What are the symptoms for flatfoot (pes planus)?

A flatfoot may cause no symptoms. Symptoms of flatfoot include pain that may be in the inside arch, heel, or ankle and on the outside of the foot just below the ankle. Patients often complain of generalized foot fatigue as a first signs of flatfoot. Younger patients may complain their inability to keep up with their peers during physical activity. Over time, the flattening of the arch can lead to rolling in of the foot and ankle and tilting outward of the heel. Flatfoot can also cause shin pain (shin splints) and aching of the knee, hip, and/or lower back. Excessive inner heel wear pattern may be seen on shoes.

What are the causes for flatfoot (pes planus)?

As described above, a person may be born with a flatfoot, pediatric flexible flatfoot, or develop it as an adult (adult acquired flatfoot). Less common causes of flatfoot include the following:

  • Tarsal coalitions: A condition where foot joints bridge or grow together restricting or prohibiting movement of that joint.
  • Accessory navicular bone (os tibiale externum): a small extra bone in the posterior tibial tendon that causes a weakening of tendinous support to the arch
  • Ligament laxity in congenital diseases such as Marfan syndrome or Ehlers-Danlos syndrome
  • Charcot arthropathy
  • Trauma
  • Obesity
  • Diabetes
  • Neuropathy
  • Age
  • Pregnancy, due to hormonal changes such as increases in elastin
  • Osteoporosis
  • Overuse

What are the treatments for flatfoot (pes planus)?

Treatment depends on the type of flatfoot, its stage of progression, and the symptoms. Early treatment is advised whether one's condition is a flexible, rigid, or adult acquired flatfoot. Treatments include proper shoe gear, over-the-counter inserts, custom functional orthotics, bracing, casting/immobilization, physical therapy, NSAIDs, weight loss, changes in activities, and surgery.

What are the risk factors for flatfoot (pes planus)?

Factors that can increase your risk of flatfeet include:

  • Obesity
  • Injury to your foot or ankle
  • Rheumatoid arthritis
  • Aging
  • Diabetes

Is there a cure/medications for flatfoot (pes planus)?

Flatfoot (pes planus), commonly called flat feet, is a relatively common foot deformity. A flat foot is defined by the loss of the medial longitudinal arch of the foot where it contacts or nearly contacts the ground. The arch connects the forefoot and hindfoot and is formed of elastic ligaments, tendons, and fascia. Its function is to store mechanical energy within the stretched elastic ligaments during the gait cycle. A flat foot is asymptomatic but can alter the biomechanics of the lower limbs and lumbar spine. There are four types of flat feet: vertical talus, fallen arch, and rigid and flexible flat feet.

Treatment or management
For children
1. Children with flat feet do not require treatment. However, foot orthotics are used to relieve pain secondary to flat feet. Doctors recommend surgery for only rigid flat feet.

For adults
1. Non-Steroid Anti-Inflammatory Drugs (NSAIDs)
2. Doctors recommend adequate rest as the first resort. In addition, NSAIDs can also help with the pain.
3. Counseling for Obesity: Obese persons with flat feet should be encouraged to lose weight as the body weight applies more pressure leading to an elevated burden on the feet.
4. Foot orthotics: Doctors commonly recommend proper shoes that ease the gait cycle. In cases wherein the footwear does not help. Orthotics are devices used to influence the structural and functional characteristics of the neuromuscular and skeletal system. Various orthotics can correct secondary deformities or pains due to flat feet.
5. Surgery: For patients that are resistant to the above treatment options, surgery is the last resort. Flat feet reconstruction is performed to repair ligaments, tendons, and bone structure which leads to reshaping the feet.

Midfoot, heel, lower leg, knee, hip, and or back pain,In advanced cases, altered gait patterns including toe drift
Foot deformity
Proper shoe gear,Over-the-counter inserts,Custom functional orthotics,Bracing,Casting/immobilization,Physical therapy,NSAIDs,Weight loss,Changes in activities,Surgery

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