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Flat feet

Introduction

Flat feet

Having flat feet, or 'fallen arches', means that your feet have low or no arches and press almost completely flat against the ground.

The arch, or instep, is the middle part of the foot that's usually raised off the ground when you stand, while the rest of the foot remains flat on the ground.

In young children, this arch isn't always visible because of the baby fat and soft tissue in their feet. It usually develops and appears as they get older.

However, some people never really develop this arch. Sometimes, this is because they inherited flat feet from their parents.

Are flat feet a problem?

Flat feet are usually nothing to worry about. Many people with flat feet don't have any associated problems, so treatment isn't necessary.

However, flat feet can sometimes be associated with:

  • pain in the feet, ankles, lower legs, knees, hips or lower back
  • the feet rolling inwards too much (overpronation) – this can cause shoes to wear out quickly and lead to injuries
  • an underlying problem with the bones, muscles or connective tissues in and around the feet (see below)

Treatment may be recommended if you have any of these problems.

When to seek medical advice

Consider seeing your GP if you have flat feet and your:

  • feet are painful, even when wearing supportive, well-fitting shoes
  • shoes wear out very quickly
  • feet appear to be getting flatter
  • feet are weak, numb or stiff

Your GP will examine your foot and may be able to advise you about treatments that can help. If necessary, they may be able to refer you to a podiatrist (a specialist in foot problems) or orthopaedic surgeon on the NHS to discuss possible treatments.

What causes flat feet?

Many people simply inherit flat feet from their parents.

Occasionally, flat feet can be the result of:

  • the feet bones not forming properly in the womb
  • loose connective tissue throughout the body, such as in Ehlers-Danlos syndrome or joint hypermobility syndrome
  • a condition affecting the muscles and nerves, such as cerebral palsy, spina bifida or muscular dystrophy
  • the connective tissue in the foot becoming stretched and inflamed – possibly as a result of overuse, unsupportive footwear, an injury, increasing age, obesity or rheumatoid arthritis

Treatments for flat feet

Flat feet only need to be treated if you have an associated problem, such as pain, overpronation or an underlying health condition.

Non-surgical treatments are often recommended first, although surgery may be needed in some cases.

Non-surgical treatments

Your GP or podiatrist may recommend:

  • wearing supportive shoes that fit well
  • wearing specially made insoles (orthotics) inside your shoes to support your feet and stop them rolling inwards
  • taking painkillers if you have any discomfort
  • losing weight if you're overweight
  • stretching the muscles and connective tissues in your lower legs to help stop your foot rolling over – you may be referred to a physiotherapist, who can recommend some exercises to try

These treatments won't change the shape of the feet, but may help relieve some of the problems associated with flat feet.

If these measures don't help, you may be referred to an orthopaedic surgeon to discuss whether surgery is an option.

Surgery

Surgery is normally only considered if the treatments above haven't helped or you have an underlying problem that can be corrected with an operation, such as abnormally developed bones in the feet.

The surgical procedure recommended for you will depend on the cause of your flat feet.

For example, bones that are abnormally shaped or joined together may need to be straightened or separated, while flat feet caused by a problem with your connective tissues may be treated by lengthening or repairing the affected tissues.

Your surgeon will talk to you about the operation you may need and what this involves.

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Symptoms

Flat feet do not usually cause problems, but they can put a strain on your muscles and ligaments (the tissue that links two bones together at a joint). This may cause pain in your legs when you walk.

If you have flat feet you may experience pain in any of the following areas:

  • inside of your ankle
  • arch of your foot
  • the outerside of your foot
  • calf (the back of your lower leg)
  • knee, hip or back

Some people with flat feet find that their weight is distributed unevenly, particularly if their foot over-pronates. If your foot over-pronates, it is likely that your shoes will wear out quickly. Over-pronation can also damage your ankle joint and Achilles tendon (the large tendon at the back of your ankle).

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Causes

Having low or no arches is normal for some people. In these cases, flat feet is usually inherited and the feet are fairly flexible.

Occasionally, flat feet can be caused by an abnormality that develops in the womb, such as a problem with a joint, or where two or more bones are fused together. This is also known as tarsal coalition and leads to the feet being flat and stiff.

Flat feet that develops in later life can be the result of a condition that affects the joints, such as arthritis, or an injury to a muscle, tendon or the joints of the foot.

Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. This is because over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this occurs include cerebral palsy, spina bifida and muscular dystrophy.

Adult-acquired flat feet often affects women who are over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time.

It is not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. You are more at risk if you are obese, have high blood pressure (hypertension) or diabetes.

Recent research has found a link with changes to this tendon and an increase in a type of protein called protelytic enzyme. These enzymes can break down some areas of the tendon, weakening it and causing the foot arch to fall. Similar changes were also seen in other conditions, such as Achilles tendonitis.

This could have important implications for treating flat feet, as medication that specifically targets these enzymes could provide an alternative to surgery.

However, further research is needed and this type of treatment is thought to be about 10-15 years away.

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Diagnosis

When to see your GP

See your GP if you or your child have flat feet and:

  • they are causing pain, even when wearing supportive shoes that fit well
  • shoes wear out very quickly
  • your feet appear to be getting flatter
  • yours or your child's feet are weak, numb or stiff

Your GP may refer you to a podiatrist (foot specialist).

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Treatment

Treatment is not usually needed for flat feet because they do not usually cause any significant problems.

If your feet ache, the achiness can usually be relieved by wearing supportive shoes that fit properly. You may need to wear shoes that are wider than normal.

If your feet over-pronate, you may need to wear a special insole (orthotic device) inside your shoes to stop your feet rolling inwards when you walk or run. These will usually need to be made and fitted by a podiatrist.

In rare cases, surgery may be needed where a child has flat feet due to a problem they are born with (a congenital abnormality). The foot may need to be straightened, or the bones may need to be separated if they are fused together.

Painkillers and insoles are the first treatment options for flat feet that are caused by a joint problem, such as arthritis, or a torn tendon. If the injury or condition is severely affecting your feet, surgery may be recommended.  

In cases where flat feet are the result of a condition that affects the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed. Again, in severe cases, an operation may be required to straighten your feet.

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Selected links

NHS Direct Wales links

Bunion

Heel pain

External links 

Feet for Life  - The Society of Chiropodists and Podiatrists

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 26/10/2015 10:01:02

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