University Foot & Ankle Institute
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Flat Feet in Adults and Children: causes, symptoms & treatments

Flat Feet, Collapsed Arch

Flat feet is a condition where one or both feet don't have a normal arch.   While flat feet can be a problem or just a normal finding, it is important to note when painful flat feet hurt and are left untreated, it usually leads to additional problematic conditions.


UFAI, the best care available for your flat foot care


Our team of specialists works in the most conservative manner to get you back to your life and activity in the most cost-effective and non-invasive manner possible.


If surgery is necessary, we are among the world leaders in understanding and fixing the symptomatic flat foot.  Our doctors assisted in the design of many of the surgical procedures and orthopedic products used in flat foot surgery.  That expertise, combined with our state-of-the-art surgical facilities and comprehensive team approach will get you back on your feet in no time.


A note of thanks to you in the treatment of my foot. While I don't know the outcome yet. I would like you to know that I appreciate your expertise as well as your manner. I feel that I can connect with you, which is important. You are very good at the Medicine as well as well as the human part of it, I feel fortunate. B. T.

The Different Types of Flat Feet (collapsed arch)


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A normal flat foot (pes planovalgus) is a mild collapse or flattening of the arch of the foot. The motion in the joints that move the foot from a higher arch to a lower arch is called pronation. Too much pronation leads to a flat foot. While a pronated foot is not a cause for concern, a painful flat foot is, and fortunately it can often be easily treated.


A moderate collapse of one foot is when the flattening of one foot is more pronounced than the other, it is often due to a tendon tear on the arch side of the foot (posterior tibial tendon tear). This painful collapse can lead to arthritis and further collapsing of the arch.


A fixed flat foot is when the foot is permanently fixed in a flat position. This condition, known as coalition, happens when two bones in the foot grow together and cannot move, resulting in a lack of motion. Over time, the flat foot position causes painful arthritis due to the abnormal position of the foot.



How Does Flat Feet Differ in Children?


Pediatric flat feet are a common and usually non-surgical problem. Children with flat feet may have pain during exercise; you may see them withdraw from sports and other physical activities. Most children with flat feet are born with the condition and 80 – 90 percent will develop a healthy, strong arch by the time they reach 6 years of age. However, a collapsed arch causes the leg and knee to turn inward, which may result in foot, back and knees problems. 


There are additional conditions that stem from flat feet, so it is very important that children with flat feet are properly evaluated to avoid further pain and deformities.



What Causes a Flat Foot?


Flat feet are generally passed on by genetics. However, there are cases where trauma or overuse of the foot can lead to a collapse of the arch. The posterior tibial tendon is the very strong tendon that helps to hold the arch. If this tendon is damaged, becomes weakened, or tears, the arch will begin to fall over time. This causes pain and dysfunction (posterior tibial tendon dysfunction).


A tight Achilles tendon (equinus) is another contributing force leading to a collapsed arch. When the Achilles is tight, the heel is off the ground more often and the foot must compensate by flattening to reach the ground. Increased weight and improper shoe gear can also lead to flat feet.



What Does Having Flat Feet Feel Like?


Typical symptoms include:

  • A general fatigue and discomfort in the foot and ankle after long periods of standing and increased activity on the foot.  
  • Pain in the middle of the foot and along the joints that support the arch. 
  • In some cases, pain can extend to the calf, knees and back. 
  • Some patients are unable to walk without a great deal of pain.
  • Swelling may occur if there is an associated tendon tear in the collapsed arch.



Conservative Treatment Options for a Flat Foot


In mild cases of flatfoot the first line of treatment is often custom orthotics. In patients with a flexible deformity, supporting the arch with a custom arch support will take the strain off the joints and muscles, bringing the heel into a corrected position. Wider shoe gear may be prescribed to accommodate foot pain and motion and stretching exercises to decrease stiffness and stress on the foot.


In cases of severe collapse ─ especially if the patient is not a good surgical candidate or has a mild tear ─ a brace may be made to accommodate the foot and ankle, thus supporting the arch and ankle.



If conservative measures don't work, what are the less-invasive treatment options?


Restorative medicine options have dramatically decreased the need for surgery and improved our current treatments for flat feet.  Restorative medicine is the ability to increase the body’s own capability in healing damaged tendons or ligaments.  In the case of a posterior tibial tendon tear, or scar tissue formation, restorative options are used to help heal tendon damage.  It is important to remember to support the region both during and after recovery to prevent further injury.


Platelet Rich Plasma

Platelet rich plasma therapy is a mainstay of the treatment of tendon injuries.  The platelet material is drawn from the patient’s blood. The growth factors found in the patient’s whole blood are injected into the area of the damaged tendon and to help heal.


Amniotic Stem Cell Injection

Amniotic stem cell injection therapy is quickly becoming a go-to treatment for damaged tendons and ligaments.  Amniotic cells are very strong and healthy and can help increase the growth factors necessary for healing.  The posterior tibial tendon and arch are injected with the cells, which alert the body to bring additional healing cells to the damaged region.


Tenex Procedure

The Tenex procedure is an excellent choice for cases of chronic scar tissue or damaged tendons.  A very small incision is made and the Tenex probe, which is the size of a large needle, is placed into the damaged tendon area.  Under ultrasound guidance, the damaged tendon region is broken up and scar tissue removed.  This allows for new tissue to fill in the damaged area and begin healing the tendon.



Flat Feet Surgery: what are the options?


There are several steps necessary to help correct a symptomatic flat foot.  They are divided into flat feet in children and collapsed flat feet in adults, each requiring different treatments.


Surgical treatment of a Pediatric Flat Foot

In children, two types of surgery are performed.  First an implant is placed between the bones of the foot, which help support the arch, much like an internal orthotic support.  This may be combined with a lengthening of the tight Achilles tendon, a common source of pain and arch collapse.  If the collapsed arch is severe, there may be the need to lengthen the heel bone to correct the heel’s support of the leg. There may also be a need to reposition the arch to contact the ground better.  These procedures are combined with an Achilles tendon lengthening and together help to correct the arch and heel alignment.  


Surgical treatment of an Adult Flat Foot

In adults, the most common cause of collapse is due to the posterior tibial tendon tear.  In such cases, the tendon must be repaired and a second tendon may be added to the posterior tibial tendon for strength and added support.  If the foot is found to be very flat, bone realignment procedures or possible bone fusion procedures may be used to realign the foot.  If the calf or Achilles tendon are found to be tight, they may be lengthened to allow better motion at the ankle and less arch strain.  The forefoot may also be in a poor position and stabilization of the arch may be necessary to increase forefoot contact to the ground.


If there is severe collapse of the foot and the tendon is badly torn, it is best to repair the tendon and correct the flat foot alignment to avoid further arthritis and foot abnormality. This is done through a surgical procedure, which has had excellent outcomes at University Foot and Ankle Institute.


Surgical treatment of Tarsal Coalition

A very small number of flat feet in children and adults are due to a coalition or two bones that never naturally divided. In such cases, the flat foot position is corrected by removing the bone bridge between the two bones and realigning the bones of the foot, if necessary.



See our patients' before and after photo gallery of flat feet surgeries here.



Choose UFAI for the treatment of Flat Feet


The successful treatment of flat feet depends on an accurate diagnosis and proper procedure selection. University Foot and Ankle Institute has the latest testing and diagnostic technology for proper analysis of the foot and ankle.  From on-site MRI, X-ray, and Ultrasound to the latest weight-bearing 3D CT imaging, we can accurately diagnose the source of the issue.


Once the proper cause of pain is identified, our team of physical therapists, bracing specialists, and orthotic manufacturers use the most comprehensive restorative treatment options available to allow the body to heal itself and to avoid surgery.


Our surgeons have decades of combined experience and helped develop techniques used in the surgical correction of flat feet.  They are often called to teach other doctors how to perform these procedures.



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