What is it?
Flexible flatfoot is common and often inherited. Adult-acquired flatfoot usually results from weakening of the posterior tibial tendon, which supports the arch; over time the arch collapses and the heel shifts outward. Rigid flatfoot in children may come from a coalition, where two bones are abnormally joined.
What causes it?
- Inherited foot structure
- Posterior tibial tendon dysfunction
- Tarsal coalition in children
- Arthritis or prior injury
- Weight gain
What does it feel like?
- Pain along the inside of the ankle and arch
- Fatigue in the feet and legs
- Pain on the outside of the ankle as the heel shifts
- Uneven shoe wear
- One arch collapsing more than the other
How is it diagnosed?
Standing exam, gait assessment, and weight-bearing X-rays. MRI or ultrasound evaluates the posterior tibial tendon.
When should you see a podiatrist?
- A flatfoot that has become painful
- An arch that is collapsing on one side
- Swelling along the inside of the ankle
- A child who complains of foot pain or avoids activity
Nonsurgical treatment
- Custom orthotics
- Support the arch and control heel position.
- Supportive shoes
- Stable heel counters and firm midsoles.
- Bracing
- For advanced tendon dysfunction.
- Physical therapy
- Strengthening of the posterior tibial tendon and calf.
When is surgery considered?
Surgery is considered for painful flatfoot that has not improved with orthotics and bracing, particularly when the deformity is progressing.
Flatfoot reconstruction typically combines tendon repair or transfer with bone cuts that realign the heel and arch; fusion is used for rigid or arthritic deformity.
Related procedures
What is recovery like?
Reconstruction usually requires several weeks of non-weight-bearing, then a boot and physical therapy. Full recovery commonly takes six months to a year.
Frequently asked questions
Do flat feet need treatment?
Only if they are painful or progressing. Painless flexible flat feet usually need nothing more than good shoes.
Should my child wear orthotics?
Not routinely. Orthotics are considered for children with pain or specific structural problems.