Flat Feet / Fallen Arches: Symptoms, Causes, Treatment & Orthopedics

A healthy foot is the foundation of our mobility, but foot deformities such as flat feet or fallen arches are very common. While foot deformities in children are often harmless, flat feet in adults (pes planus) frequently cause significant discomfort. A characteristic feature of the flexed flatfoot is the buckling of the heel and the collapse of the arch of the foot. If conservative treatments such as orthotics no longer help and symptoms interfere with daily life, surgery may be necessary. Learn everything here about the causes, diagnosis by a specialist, and treatments for flat feet in adults.

Definition and Causes of Flatfoot

Around the age of one, a child begins to make its first attempts at standing and walking. In a child with flat feet, an altered foot shape can then be observed. Medically, this is referred to as a flat-footed foot; colloquially, it is known as flat feet.

There are various changes in foot anatomy, as shown in the diagram:

The “knick” refers to an increased angulation of the heel (viewed from above and from the back) toward the outside of the foot compared to normal. The “sagging” refers to the flattening of the longitudinal arch, which is normally located on the inside of the foot.

The causes are often congenital weaknesses in the connective tissue or muscles. Especially in older children, being overweight can play an additional role. Paralysis is rarely the cause.

Symptoms and Diagnosis of Flat Feet

Especially in young children, it is sometimes difficult to distinguish flatfoot from age-related normal findings. Flatfoot often causes no symptoms.

Between the ages of 2 and 5, a mildly pronounced flexion-flatfoot is developmentally normal and generally does not require treatment.

The deformity is usually flexible, meaning the shape of the foot can be passively altered by the examiner. With a rigid flatfoot, this is no longer possible.

Experienced specialists, such as orthopedic surgeons or pediatric orthopedists, diagnose flat feet through visual inspection and functional testing. In cases of severe deformity, an X-ray examination is also helpful.

In specialized clinics, appropriate devices (podoscopes) can also be used to visualize and evaluate the footprint.

Treatment of Flatfoot

The most common form of flatfoot is the flexible, mild-to-moderate flatfoot seen in young children. It usually does not require special treatment.

Semi-annual clinical follow-ups are sufficient. The child should walk barefoot as much as possible and be encouraged to do playful exercises to strengthen the foot muscles. These include, for example, standing on tiptoes and grasping exercises with the toes.

In more severe cases, additional physical therapy may be beneficial.

Insoles are indicated only for severe flatfoot with a collapsed arch. They must be custom-made from a plaster cast and manufactured by an orthopedic technician in consultation with the treating orthopedist. The duration of use should not be too short and may extend over several years.

An orthopedic surgeon should regularly review whether they are still necessary.

Severe forms of flatfoot may warrant surgery. Prerequisites for this are

long-term, prior, and unsuccessful conservative treatment,
clinically significant findings, and
severe pain triggered by weight-bearing.

A variety of soft-tissue procedures (such as tendon transfers) are available. The common principle is to improve the muscular tension that lifts the arch of the foot.

Such procedures should only be considered after the age of 8.

In the most severe cases, particularly those with rigid deformities, surgery on the foot skeleton may even be necessary. This is especially necessary in cases of underlying neurological conditions such as infantile cerebral palsy. The surgery may involve procedures such as fusion with bone wedge resection or the insertion of arch-supporting implants.

Prognosis for Flat Feet

The most common form of flatfoot—the early childhood flexible type—has a good prognosis. Most flat feet do not require special treatment. They often correct themselves by school age as a result of normal growth.

The results of surgical procedures are all the better the more carefully and rigorously the individual indication for surgery has been established.

In severe cases of flatfoot that cannot be treated by other means, it is often not possible to restore a completely normal physiological foot position. In most cases, however, surgeons achieve a significant improvement in the deformity, which alleviates the symptoms experienced by those affected.

Sports and Flat Feet

Particularly in the case of the common childhood flatfoot without underlying comorbidities, the following applies: Sports, when practiced within reasonable limits and for fun, have a positive effect on coordination and muscle strengthening. Medical professionals generally recommend such physical activities.

FAQ: The Most Important Questions About Flat Feet and Clubfoot

What is the difference between a fallen arch, a valgus foot, and flat feet?

A fallen arch is the preliminary stage in which the longitudinal arch collapses. With flat feet, the sole of the foot lies completely flat. A valgus foot describes the outward tilting of the heel. In practice, these misalignments usually occur together as a valgus flatfoot or a valgus fallen arch.

What symptoms does flatfoot cause in adults?

Acquired flatfoot often leads to pain when weight-bearing. Typical symptoms include pain on the inner side of the foot (along the posterior tibial tendon) and under the inner ankle. Pain may also occur along the outer edge (due to pressure from the talus) or in the calf. If left untreated, osteoarthritis of the ankle joint may develop.

Do flat feet in children always require treatment?

No. A flexible flatfoot in children is often normal during childhood. It frequently resolves on its own as the child grows and through exercise of the muscles and ligaments (e.g., walking barefoot). Treatment is usually only necessary if the condition is severe or if the child complains of pain.

How does physical therapy help with flat feet?

Active physical therapy and targeted foot exercises are essential for strengthening the foot muscles and actively raising the arch of the foot. Exercises such as standing on tiptoes help stabilize the foot and can alleviate discomfort caused by foot misalignment.

When is surgery necessary for flat feet?

Surgery is considered when conservative measures (such as orthotics) fail and the patient is experiencing significant distress. The goal of surgical treatment by specialists in orthopedics and trauma surgery is to correct the alignment and restore the longitudinal arch of the foot, often through procedures involving the tendon or the heel bone.

Do orthotics really help?

Yes, orthopedic insoles are the gold standard in conservative therapy. They passively support the longitudinal arch of the foot, relieve pressure on the tendon, and prevent further inward rolling. However, they should always be combined with orthopedic shoes or good footwear and exercise.

What is posterior tibial tendon insufficiency?

This is the most common cause of flat feet in adults. The posterior tibial tendon supports the arch. If it weakens due to wear and tear, excess weight, or inflammation, the foot collapses into a fallen arch or flat foot.

How can I identify flat feet on an X-ray?

On an X-ray taken while the foot is bearing weight, an orthopedic specialist can see that the angle between the talus and the metatarsal bones is flattened. In addition, the bony forefoot is no longer aligned with the hindfoot.

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