Flexible Flatfeet

Dr. Baravarian discusses adult flat foot and the treatment options available.

A flexible flatfoot is a very common form of flatfoot that usually originates in childhood and lasts throughout adulthood, typically worsening without treatment. The deformity in flexible flatfoot involves a mild, gradual collapse of the foot’s arch, and almost always occurs in both feet.


The successful treatment of flexible flat feet depends on an accurate diagnosis and proper procedure selection.


Our surgeons have decades of combined experience and helped develop the techniques used in the surgical correction of flat feet. They have the highest success rates in the country.

What Causes Flexible Flatfeet?

The motion in the joints that causes the foot’s arch to fall is called pronation (where foot rolls inwards causing the arch to flatten). Too much pronation leads to a flat foot, and is considered a disorder, especially when the condition is painful. It is called “flexible” flat foot because the foot’s arch collapses only when the foot bears weigh (e.g. while standing). The condition is also known as normal flatfoot, or pes planovalgus.


In many cases of flatfoot, the Achilles tendon and/or calf muscle are too tight, which brings the heel off the ground too early with each step. This change in gait can exacerbate the problem by increasing pressure on the arch and collapsing the foot alignment.


Posterior tibial tendon dysfunction is another cause of flat feet. The posterior tibial tendon creates the arch and supports the foot when you push off your toes when walking and running. Any injury to this tendon, which runs on the arch side of ankle and foot, can affect its ability to maintain an arch in the foot and can result in a flat foot.


Characteristics and Symptoms of Flexible Flatfoot

Many people with flat feet do not experience any symptoms and may not require treatment. However, moderate or severe cases may cause pain and disability. Some symptoms include:

  • Aching pain in the arch, heel, ankle, or the outside edge of the foot
  • Shin splint (pain running up the shin bone, especially when bearing weight)
  • Ankle rolling inward
  • Foot and leg fatigue after a few hours of standing or walking
  • Hip, knee, or lower back pain
  • Patients with flatfoot may experience “toe-drift,” a condition in which the toes gradually begin to point outward. This tendency can cause bunions and hammertoes in some patients.


Diagnosing Flexible Flatfoot

If your feet are causing you problems, visit your foot and ankle specialist for an exam. The doctors at University Foot and Ankle Institute will take a close look at the structure of your feet and examine how your foot moves and changes shape while sitting, standing, or taking steps. An X-ray can help the doctor understand the severity of the condition. If a tendon or ligament tear is thought to be possible, an MRI may be ordered.


Conservative Treatment for Flexible Flatfoot

If you receive a diagnosis of flexible flatfoot but are not experiencing any symptoms, your doctor may recommend no treatment for the time being. He or she will explain what symptoms to look out for and how to prevent them or address them when they arise.

Most cases of flexible flatfoot can be treated conservatively. There are several non-surgical options that you can use to relieve your discomfort:

Supportive shoes. One of the easiest ways to relieve the discomforts of flatfoot is by wearing well-fitting shoes with a firm sole. Ask your foot and ankle specialist for recommendations, or have your shoes modified to fit your feet.

Orthotic inserts. Another easy yet effective treatment for flatfoot is to wear orthotic inserts. These can be bought over the counter, or you can have custom orthotics made for you by your foot and ankle specialist.

Modify painful activities. Cut back on activities that are causing you pain. If you are a recreational runner or walker, talk to your foot and ankle specialist about modifying your exercise routine. If you must stand or walk for several hours each day, take frequent breaks so you can rest your arches. Our goal is to keep you moving and allow you to do what you want. Therefore we will try anything possible to not have you limit your activity.

Pain relief medications. Our doctors recommend using NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen to ease inflammation and relieve achy feet.

Lose excessive weight. People who are overweight or obese might find some relief with weight loss. Excessive weight puts pressure on your arches, causing pain and exacerbating the condition. For example, one pound of added belly weight places 12 pounds of added weight on the foot.

Physical therapy. Our licensed physical therapists can recommend ultrasound or other therapeutic techniques to help with everyday aches and pains.


Regenerative Treatment for Flatfoot

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.

Bone marrow stem cell therapy. Bone marrow cells are responsible for the healing of all damaged tissue in the body. A bone marrow concentration can be injected into the damaged tendon, ligament or bone region of the arch to allow the body to heal itself. This is common on the arch ligaments and the posterior tibial tendon tear or scar tissue regions.


Surgery to Treat Flexible Flatfoot

In severe cases, conservative treatments cannot target the underlying issue causing you discomfort. In these cases, our specialists may recommend surgery. There are several surgical techniques that can be used to address the problem.


In adults, the most common cause of collapse is due to the posterior tibial tendon tear and needs to be treated with multiple procedures. By just repairing the tendon, you're not realigning the foot, and therefore, the foot can collapse again. With adult flatfoot, there is normally a tightness in the calf and/or the Achilles that needs to be addressed.


During surgery the posterior tibial tendon is repaired and in some cases will be augmented with a tendon transfer. Our surgeons then realign the foot in a stable tripod position. This allows for all points of the foot to be on the ground in the same position, creating an arch on the foot.


Your surgeon will select the procedure or combination or procedures to best help you depending on your age, activity level, and the severity of your condition.


Pediatric flat foot conditions may require realignment of the foot with boney procedures. These include lengthening of the heel bone, lengthening of a tight calf or Achilles tendon and possible realignment of the arch bones.

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