What are Flat Feet?

Flat Feet are a fairly common condition, encountered in roughly 25% of the world’s population. Commonly people have a space on the interior (instep or inner  ) side of the foot, where the sole or bottom of the foot is off the ground; this is called the arch of the foot. How well this arch is developed varies from person to person. People with a very low arch or no arch at all are said to have Flat Feet (also refered to as Fallen Arches, Collapsed Arches, Pronation of the Foot, Pes Planus, Hypermobile Feet, Pes Planovalgus, and Physiologic Flat Feet). The term fallen or collapsed arches is somewhat misleading because for many people, this is how their arches always were.

The arch of the foot is created by the tightening of the muscles and ligaments present in the foot structure. These muscles and ligaments support the many bones of the foot; the role of the arches is to create the optimum foot/leg position that allows an even distribution of the weight of one’s body across the feet and legs. Our body’s inability to construct this arch leads to a less-than-optimal posture of not only the legs, but the entire body. Usually, the flatter the feet, the more seriously affected is the Posture. Apart from having flat feet, here are several medical conditions associated with flat feet.

Following are a few images of Flat Feet and how they compare with Normal Feet.

Normal Foot Position In a Normal Foot, the weight o the body is distributed straight  down  through the foot structure.
Flat Feet (Excessive Pronation) In the Flat Foot, because of the Over-Pronation (the ankle rolls inwards), the weight is not distributed as effectively to the foot; more weight is transferred to the inside of the sole.
Flat feet - Normal Feet Comparison (Frontal View) Front-view of the Flat Foot compared to the Normal foot position. Notice the shifting of the ankle position towards the interior of the foot.
The next image is a lateral view of  the arch region in a Flat Foot and how it compares with a Normal Foot.
Flat feet - Normal Feet Comparison (Lateral View)
Following are a couple of pictures of  flat feet viewed from the side an from the front.
Flat Feet Pictures - Lateral View
Flat Feet Pictures - Frontal View

Types of Flat Feet

There are two main types of flat feet: flexible and inflexible.

Flexible Flat Feet

This is by far the most common condition. The foot may appear flat when standing in a weight-bearing position (normal standing), but when pulling back the toes an arch forms. If you don’t know what pulling back the toes (or dorsiflection) means, drop a napkin on the floor and try to grab it with your toes while still supporting your weight on both feet.

Although this condition can be painless, in time, due to aging, physical activities and other factors can trigger secondary conditions associated with pain, not only in your foot, but also ankles, knees, hips, back. This is all due to the incorrect posture induced by the flat feet. You can think about it like this: while you are young, your body is strong and can repair / regenerate fast damaged or inflamed tissue, especially in the joints and back and it is likely you won’t suffer. As you get older or more overweight or increase the stress on your joints through work or physical activity, the bad posture creates wear and tear in the joints and muscles; Because the body is not able to repair itself fast enough, the result is chronicle pain. The joints are not the only ones affected by a bad posture. Imbalances in the strength of the different muscles also develop. Bottom line: the better the body is balanced, the less stress on joints and muscles ergo – less pain.

Inflexible (rigid) Flat Feet

Is an abnormal condition (less than 3% of cases) and may indicate bone abnormality in the foot due to disease or injury. Flat feet that are inflexible and painful may result from a condition called tarsal coalition. Tarsal coalition occurs when two bones in the foot fuse together. This results in a highly inflexible foot and pain during walking, and shoes with arches may make the condition even worse. Children who exhibit flat feet and complain frequently of foot pain should be evaluated by a doctor, and normally undergo surgical treatment in their pre-teen years to correct the fusing. Surgery needs to be undertaken while the foot is still growing in order to be effective.

Causes of Flat Feet

Flexible flat feet develop very early in life and may represent a genetic predisposition. There are studies that imply this condition starts before birth. Flat feet can also develop as an adult (”adult acquired flatfoot”) due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics, or as part of the normal aging process. Flat feet can also occur in pregnant women, due to our body’s normal tendency to devlop increased tissue elasticity during pregnancy. If developed by adulthood, flat feet generally remain flat permanently.

Treatment of Flat Feet

For flexible flat feet: Classical treatment: supportive (arch support) orthoses or orthotics. Inovative treatment: proprioceptive – Posture Control Insoles. Exercises for flat feet are also said to help strengthen the foot muscles. Wearing the right kind of shoes suited for flat feet also makes a big difference.

For inflexible flat feet: usually surgery.

Diagnosis of Flat Feet

It is recommended to have a specialist diagnose the condition and recommend treatment. If you think you have Flat Feet, there are self-diagnose techniques such the wet footprint performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. Morton’s Foot website also presents a straightforward self-diagnose for flexible flat feet. You can also read more about the Wet Foot Test, a helpful method for determining if you have Flat Feet.