What Causes Flat Feet?

Flat feet, also known as pes planus, are a fairly common condition that can affect people of all ages. In essence, it occurs when the foot arch either collapses over time or never develops properly during childhood. This means that when you stand, most or all of your foot touches the ground, as opposed to having a visible arch.

Affecting roughly one in four people, flat feet are a surprisingly common condition. While some experience foot pain and discomfort, particularly during prolonged physical activity, others may not even know they have them [1].

Understanding what causes flat feet and their implications is crucial for maintaining foot health and overall mobility, so we've put together this article to explain the potential consequences and explore effective treatment options and tips for keeping your feet healthy.

Causes of flat feet  

An in-depth analysis of flat feet orthotic solutions reveals that a weakened ligament and tendons in the foot leads to the collapse of the arch [1]. 

But what causes flat feet and this flattening of the arch? Here are the various factors that can contribute to this condition.

Genetic and developmental influences

• Inherited predispositions 

Flat feet can be passed down through families [2]. Genetics plays a role in foot-bones development, though the exact mechanisms are not fully understood. It's important to note that flat feet are common in infants due to their developing arches. Most children develop normal arches by age 5 or 6, but some may not [3].

• Natural foot structure

Some people simply don't develop fallen arches because of their inherent foot structure, which is often a familial trait [2].

Medical conditions affecting the arch

• Rheumatoid arthritis and arthritis

These conditions can weaken the joints in the foot, including those that support the arch. This weakening can lead to a flattening of the arch [2].

• Nervous system or muscle diseases 

Conditions like spina bifida, muscular dystrophy, or cerebral palsy [2] can affect the nerves and muscles that control the feet, leading to flat feet.

• Tendonitis

The posterior tibial tendon is crucial for maintaining the arch and damage to it can cause flat feet. This damage can be caused by tendonitis (inflammation) or dysfunction  [2].

• Physical conditions

Specific conditions where bones or tissues in the foot abnormally connect can lead to flat feet. For example, tarsal coalition is a condition that causes the bones of the foot to fuse together abnormally, resulting in stiff and flat feet [2].

Injury and trauma taking their toll

• Tendon injuries

Posterior tibial tendon injuries, such as complete tears or ruptures, are often caused by overuse or sudden trauma, weakening the support structure of the foot and resulting in flat feet [2].

• Foot and ankle injuries

Various injuries to the bones or tendons of the foot and ankle [2] can disrupt the arch's structure and contribute to its collapse.

• Previous fractures

Fractures in several key areas of the middle part of the foot (midfoot) or the back part of the foot (hindfoot) can increase the risk of developing flat feet later in life, especially if they don't heal properly. Improper healing, where the broken bones don't mend in the correct position, is called malunion and can contribute to a flattened arch [3]. Understanding the distinctions between collapsed arches vs flat feet is crucial to comprehending how each condition uniquely impacts individuals, affecting everything from daily activities to specific health outcomes.

Lifestyle and age-related factors

• Age-related wear and tear

The natural aging process can lead to anomalies [2] such as a decrease in arch height and rigidity.

• Weight 

Studies found a significant link between overweight and obesity and flat feet [5]. 

• Knee pain

In older adults, flat feet are linked to frequent knee pain and damage to the cartilage in the inner part of the knee joint [4]. 

Learn how your feet impact your knee and hips and the broader implications of foot structure on body mechanics.

• Pregnancy

Hormonal changes and weight gain during pregnancy can cause developmental anomalies [2] potentially flattening the arches, sometimes permanently.

Please note that this list is not exhaustive. If you suspect you have flat feet or experience related pain, consulting a healthcare professional is crucial for proper diagnosis and treatment.

Flat feet symptoms

Now that we’ve covered what causes flat feet, let’s look at the symptoms. 

While some people with flat feet experience no problems, others may encounter various symptoms that can affect their daily activities [2]. Here's a breakdown of how flat feet can manifest.

• Pain and discomfort

• Swelling

Flat feet can sometimes cause visible swelling along the inner ankle or arch of the foot [2]. This inflammation is often a response to the additional stress placed on those tissues.

• Altered gait

Flat feet can lead to a condition called overpronation, where the ankles roll inward excessively when walking or standing. This can affect your overall posture and gait, making walking or running feel uneven or awkward [2]. Foot exercises for flat feet offer methods to improve foot health and gait.

• Impact on daily life

Diagnosing flat feet

The diagnosis involves a few steps that help doctors understand how your feet are working, why you might be having issues and what causes flat feet in your case.

Physical Examination

The first step is a physical exam, where the doctor will take a close look at your feet and how you walk.

• Inspection 

The doctor will check your feet while you're standing and sitting. They'll look for a flat arch when you're standing, which might disappear when you're off your feet. They'll also look from behind to see if you have what's called the ‘too many toes’ sign, indicating overpronation. They compare both feet to see if there's a difference between them [3].

• Palpation

The doctor will feel around your feet, pressing on areas like the posterior tibial tendon, the sides of your heel, and the bottom of your foot to check for any tenderness or issues [3].

• Range of motion (ROM)

By moving your foot around, the doctor can see if your flat feet are flexible or rigid. They might use the Hubscher maneuver (or Jack test) to see if they can change the shape of your foot [3].

• Muscle strength testing

You'll likely be asked to do some simple moves, like standing on your toes, to test the strength of certain muscles, especially the ones that help support your arch [3].

• Gait assessment

The way you walk (your gait) can tell a lot about your feet. The doctor will watch for signs like overpronation or a limp, which could indicate pain [3].

Imaging Tests

If more information is needed, the doctor might order some imaging tests:

• X-rays

These give a clear picture of your bones.

• CT scans 

These provide detailed images of the bones and joints.

• MRI scans

These are great for looking at soft tissues like tendons and ligaments.

• Electromyography (EMG)

This test checks the health of your muscles and the nerves that control them [2].

Treatment options for flat feet

Managing flat feet can be straightforward, with several treatment options available, ranging from simple treatments to more involved medical procedures for severe cases.

Conservative treatments

For many people, conservative treatments can effectively manage flat feet and prevent complications.

• Supportive shoes and orthotics

Wearing well-fitted, supportive shoes can make a big difference. Extra Wide shoes and shoes for flat feet can provide relief, especially if you're dealing with pain. Custom-designed arch supports and orthotics can help distribute pressure more evenly across your feet and improve alignment [2]. Orthotics can also improve your gait and balance [1]. Flat Feet Insoles are a key component in providing necessary support and comfort.

• Physical therapy

Physical therapy can be a great way to reduce pain and increase foot flexibility. Exercises and stretches specifically designed for your needs can strengthen weak muscles and improve your balance [3].

• Pain management

Over-the-counter pain relievers like NSAIDs can help manage pain and inflammation. Ankle braces might also be useful for added support and to reduce inflammation until your symptoms get better [2].

• Lifestyle changes

If weight is a contributing factor, losing a few pounds through a healthy diet and regular exercise can ease the pressure on your arches and improve your symptoms [3].

Surgical interventions

If conservative treatments aren’t enough, or if your condition is more severe, surgery might be an option.

• Children

Kids usually don’t need surgery for flat feet unless they have a more rigid form that doesn’t respond to other treatments [3].

• Adults

Surgery might be considered for adults with severe flat feet or for issues like posterior tibial tendon dysfunction that don’t improve with other treatments. Procedures can range from separating fused bones (if that's the cause) to repairing damaged tendons and ligaments [2][3].

Specific conditions

If you have arthritis or a ruptured tendon, a mix of insoles and pain relievers might help manage your symptoms. If these don’t work, surgery could be the next step to fix the foot problem [2].

With the right treatment, you can manage flat feet effectively, reduce pain, and improve your quality of life. Early and proper treatment can help you stay active and avoid foot-related complications down the road [1].

Footwear solutions for flat feet support

Orthopedic footwear can be your partner in maintaining healthy, happy feet. The right shoes can provide essential support and significant relief for those with flat feet. 

Here's what to look for when selecting footwear specifically designed to manage this condition.

• Arch support is king 

Look for shoes with built-in anatomical arch support. Proper arch support helps reposition the bones in your foot back to a healthy arch position and distributes your body weight more evenly [1]. It also helps prevent your foot from rolling inward (flat feet overpronation) and keeps your ankles, knees, and hips aligned. Some specialty shoe brands even offer additional arch-boosting inserts for customized support.

• Removable insoles for customization 

If you have severely flat feet or other foot conditions, you might need special orthotics. Opt for shoes with removable insoles to create space for these custom inserts.

• Extra depth makes room for comfort 

Orthotics and arch supports add volume inside the shoe. To avoid a cramped feeling, choose footwear with a deeper design that comfortably accommodates a shoe insert.

• Stretchy uppers for bunions and hammertoes 

Flat feet can sometimes lead to bunions and hammertoes. A shoe with a soft, stretchable upper will gently hug your foot's unique shape, preventing further pressure on these sensitive areas.

• Cushioned soles for all-day comfort 

Comfortable support starts from the ground up. Choose shoes with a well-cushioned sole that provides ample shock absorption and spring with every step.

• Heel support for pain prevention 

The lack of arch support in flat feet puts extra strain on other parts of your foot, including the heel. Opt for shoes with additional cushioning in the heel area to help promote a more natural gait pattern and evenly distribute pressure across the foot [1].

• Rocker bottom for a smoother stride  

A shoe with a slight rocker bottom can help facilitate your foot's natural rolling motion during walking. This can reduce fatigue and minimize pressure on your flat feet.

Why are orthopedic shoes the best footwear? These shoes offer numerous benefits tailored to address foot conditions like flat feet, providing critical support where it’s most needed. Specialized options like flat feet shoes for women and flat feet shoes for men cater specifically to the anatomical differences between male and female feet, ensuring that each individual receives the optimal support and comfort necessary for managing flat feet effectively. 

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[1] Ewa Bednarczyk, Szymon Sikora, Aneta Kossobudzka-Górska, Krzysztof Jankowski, Yunuhen Hernandez-Rodriguez. Understanding Flat Feet: An In-Depth Analysis Of Orthotic Solutions. Science Direct. March 2024. Accessed July 2024. https://www.sciencedirect.com/science/article/pii/S2773157X23001224#bib5

[2] Adam Felman (medically reviewed by Adam Hotchkiss, DPM). What To Know About Flat Feet. Medical News Today. Updated January 12, 2024. Accessed July 21, 2024. https://www.medicalnewstoday.com/articles/168608

[3] Marc A. Raj, Dawood Tafti, John Kiel. Pes Planus. National Library of Medicine. Updated May 23, 2023. Accessed July 21, 2024. https://www.ncbi.nlm.nih.gov/books/NBK430802/

[4] K. Douglas Gross, David T. Felson, Jingbo Niu, David J. Hunter, Ali Guermazi,5 Frank W. Roemer, Alyssa B. Dufour, Rebekah H. Gensure, Marian T. Hannan. Flat Feet Are Associated With Knee Pain and Cartilage Damage in Older Adults. July 10, 2012. Accessed July 23, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087845/

[5] Tri Suciati, Msy Rulan Adnindya, Indri Seta Septadina, Poppy Putri Pratiwi. Correlation Between Flat Feet And Body Mass Index In Primary School Students. IOP Science. 2019. Accessed July 23, 2024. https://iopscience.iop.org/article/10.1088/1742-6596/1246/1/012063/pdf