Is Having Flat Feet a Problem?

By Lee Evans, D.P.M., DMOS

First of all, what is a flatfoot? Flatfoot, is a condition where the arch of the foot collapses or rolls in during standing or walking. Having flatfeet by itself is not necessarily a problem. Some people live their entire life with flatfeet and never have a problem. However, there are numerous conditions in children and adults that are manifestations or side effects of having flatfeet.

So, when should a parent be concerned about is child’s flatfeet? First, and probably most important, if a child has a flatfoot on only one foot it may be an indication of a larger or more systemic problem and should be evaluated. Some neurological problems can manifest themselves with a unilateral or one sided flatfoot. Beyond this, kids with flatfeet that are asymptomatic may not be concerning at all. However, kids with collapsing arches will many times have other foot and ankle issues.

1. Ankle pain in a child with a flatfoot can be a consequence of the arch collapsing and placing extraordinary rotator pressures on the ankle.

2. Heel pain in kids is common in kids due to growth plate stresses, but even more common in kids with flatfeet. As the foot flattens the Achilles tendon shortens and the plantar fascia stretches placing additional stress on the growth plate that resides on the back of the heel bone. The condition known as Severs Disease or Calcaneal Apophosistis is common in girls and boys between 9 and 13.

3. Arch pain is very common in kids with flat feet. As the foot rolls in the tendons that are designed to hold the arch up get placed on stretch leading to inflammation and tendonitis.

4. In some instances ankle pain is not ankle pain at all but actually subtalar pain. The ankle is responsible for up and down movement of the foot. The subtalar joint sits underneath the ankle joint and is responsible for in and out movement of the foot. If the foot collapses too much during standing, walking, and running, then the outside of the subtalar joint starts to hurt due to the abnormal stress placed upon it.

5. Many other conditions of the forefoot are indirectly affected by a collapsing arch. Bunions, hammertoes, metatarsalgia, stress fractures just to name a few.

So how do we treat flatfeet? When our grandparents were you they may have been told to wear their shoes on the wrong feet for correction. Some may have been placed in casts or wore a stainless steel insert. Today with the advent of shoe technology, there are anti-pronator shoes for running and walking. There are various over the counter inserts with varying degrees of stiffness and support. A custom orthotic that is made from a mold or cast will provide very good support that is individualized to the individuals foot. The materials that are used today allow for shifting of the orthotic from shoe to shoe. The benefit is that since the insole can be moved, it is not necessary to buy a anti-pronator shoe for all occasions.