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Flat Feet – Causes, Prevention, and Treatment

by drgangemi on March 21, 2012

Flat feet, also known as “fallen arches” are often viewed as problematic simply because they look abnormal – the main arch of the foot, the medial longitudinal arch, has collapsed. Though flat feet are by no means normal, they are often the result of some other underlying condition or weakness rather than a problem with the actual arch itself that has collapsed. Conventional treatment involving foot support either via supportive footwear, orthotics, or some other bracing system is usually more disadvantageous than beneficial and surgery is rarely the answer.

Different Types of Flat Feet

A normal foot has an apparent arch while non-weigh bearing (sitting, lying) and also when they are weight bearing (standing, walking, running). There are two types of flat feet, rigid flat feet (RFF) and flexible flat feet (FFF).

An individual with RFF has no arch at any time – weigh or non-weight bearing. RFF is usually caused by some underlying pathology. A condition called tarsal coalition is the most common reason for RFF and occurs when two or more of the seven tarsal (foot) bones fuse together. Trauma, infection, and neuromuscular and autoimmune disorders (such as Rheumatoid Arthritis) can also result in RFF.

An individual with an arch non-weight bearing which fatigues or collapses when they stand or the foot is stressed is said to have FFF. FFF is most often due to ligament laxity (the ligaments connecting the bones together have weakened) or due to muscle or tendon weakness. The tibialis posterior muscle has a major impact on the medial longitudinal arch as it provides much of its support. Therefore, a problem with this muscle can result in FFF as well as other problems associated with tibialis posterior dysfunction – shin splints, plantar fasciitis, and injuries associated with overpronation.

Development of a Normal Foot and Gait

Flat feet are normal in a toddler; as they get older the tendons in the foot strengthen and tighten to form the medial longitudinal arch, often by the age of three to six. Some never fully develop this arch in the foot, most often due to poor footwear, so they develop FFF. A childhood disease or injury could result in RFF.

A natural gait then develops in a child once they being to walk, and then run. If the child is left to move barefoot or in moccasin-type unsupportive footwear their gait will not be disrupted by external means. When they walk they will quietly land and roll off their foot and when they run they will naturally land mid or forefoot, efficiently dispersing shock and generating power, strength, and balance.

A child who moves with modern-day shoes or braces (orthotics) will always alter their gait abnormally. It is very awkward for them and their proprioception (body position) and kinesthetic sense (nervous system response to “feeling” the ground) are hindered. Ligament laxity and tibialis posterior muscle weakness can and does often occur resulting in FFF.

As you can see, optimum foot development occurs barefoot.

Shoes and Orthotics Negatively Affect the Foot

I always chuckle when I hear the terms “corrective shoes” or “corrective, functional orthotics”. These are misnomers – they provide support of the dysfunction, never any correction. I won’t discuss the major pitfalls with either as there is plenty of information on the SockDoc site regarding the negatives of orthotics and the benefits of barefoot and minimalist-type footwear.

There are studies and clinical evidence showing that treating FFF with orthotics doesn’t change the course of arch development. Actually, though strengthening the entire foot and lower leg is important for the health and fitness of everybody and especially a person with flat feet, the arch may not change significantly if there are anatomical changes that have occurred during development. In other words, it may be too late (the person may be too old) to see  FFF regain its weight-bearing arch. However, this should not be of concern as there is no correlation between an arch height and injury, pain, or performance.

In 2009 Pediatrics published a study of 218 kids aged 11 to 15 and found “no disadvantages in sport performance originating from flat feet”. The kids who had flat feet accomplished all 17 motor skills as well as the group with “normal” feet.

Another study of 246 US Army recruits found that trainees with low or flat arches actually had a lower risk of injury than those trainees with high arches during their 12-week infantry training.

So although one would not want to just ignore their FFF, or especially their child’s FFF, it shouldn’t be any cause for alarm, and especially no reason to wear supportive shoes or an orthotic – either will simply make the problem worse. Orthotics and arch supports that are used to treat flat feet and fallen arches don’t support the arch of the foot where it actually needs to be supported. To properly support any arch, from a bridge over water to the arch of the foot, either end of the open space should be supported. In the case of the foot, the heel and the forefoot should be supported, not the space in-between the ends of the arch. These devices only promote more weakness and dysfunction and DO NOT change the course of arch development.

Natural Prevention and Treatment of Flat Feet

Though most FFF are asymptomatic (no pain or discomfort), they should still be addressed as it is not normal to have flat feet. Obviously it is always ideal to prevent a problem rather than treat it after it occurs, especially if FFF is being treated post-foot development. As mentioned earlier, barefoot is the best way to prevent FFF and a host of other foot and gait imbalances. To truly strengthen the entire foot and all the arches, it’s important to position the foot correctly at all times so when wearing something on the feet, footwear should be flat, firm, and flexible. This means that the shoe should not have a significant, or any, heel to toe drop, there should be little to no cushion or padding in the sole, and the shoe should not be rigid anywhere – it should bend throughout the shoe and in any direction. The shoe should also be wide at the toe box allowing the toes to naturally splay apart.

Standing and walking barefoot are two easy ways to start treating flat feet naturally. Balancing on one leg and light jumping while barefoot will further progress the normal development of the foot; and finally running while barefoot is the ultimate way to naturally and most effectively strengthen the muscles, tendons, and ligaments of the lower leg and foot. Of course a child running barefoot is much less likely to have FFF than a shod child.

Sometimes other interventions and therapies are needed for flat feet. In the case of RFF, which is much less common than FFF, treating the cause of the problem is recommended. If the RFF is causing problems (such as pain) then in some cases, depending on the individual, surgery or a supportive orthotic may be beneficial. Trigger point work and other therapies can also be very beneficial for RFF and especially FFF to help in the rehabilitation of the supporting structures of the foot. The tibialis posterior muscle is the muscle I most often have to treat for flat feet due its importance with arch support. Check out the Sock Doc video on Plantar Fasciitis for more information on how to find and treat trigger points for this muscle, as well as more information as to why the tibialis posterior can fatigue aside from improper footwear or gait mechanics.

From → Health Concerns

63 Comments

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  1. hi,
    Nice article. But Can you tell me is there craniosacral therapy is useful or not?
    Thank you

    • Sure I think therapies that address the nervous system have a powerful impact on the entire body.

  2. Renee permalink

    Do you feel that epsom salt bath (100 per cent natural mineral) would help with plantar fascitis? Although you did mention it really isn’t an inflammation issue there, I felt crippled walking out of work last night, holding on to any object in sight on my way through the parking lot to my car after being on my feet 8 hours. I have PF and despite trigger points, 0 percent shoes and staying away from aleve and advil, my feet were screaming. How do you feel about “yoga toes”, a neat little gadget that separates the toes while you elevate them and read sock – doc blogs. ; )

    • I think Epsom salt baths are fine but I doubt they will help PF. If you haven’t watched the video over at the sock-doc site head over there and see that. I mention a product called Correct Toes – that’s what I use. I think they’re much more effective than yoga toes.

      • Tahir permalink

        i am 25 years old and i want to join army but have a flat foot problam.please tell me who we can solve this problem?

  3. Catherine Mallorie permalink

    A very exciting and empowering article Dr Gangemi. Do you know of people in the UK who are thinking along the same lines as you that I could contact to work with my FFF? Thank you and all the best, CM

  4. kadijah permalink

    Hi My daughter is 10yrs old. she has bee complaining of foot pain and her xray show an accessory navicular bone. She was practically raised barefeet. She only started wearing shoes while she is in school and they are the five finger shoes by Vibram. AKA barefoot shoes. She still has pain and her posture and gait seems to be compromised. We were considering the Hyprocure treatment or orthotics but after reading your article, Im not sure what to do.

    • Never hurts to get a second opinion. You can send me an email and I’ll let you know if I know anyone in your area. I’ve never seen someone who had the HyPoCure done, so I can’t comment based upon experience. But I have seen many people who have fused bones in their feet where surgery failed them and others who were told surgery was the only cure and it wasn’t the case.

    • karen permalink

      hi i have a sore ankle and i was diagnosed as having fallen arches i dont know what to do i am in the process of buying ortho heels by the physio i am interested in your article about barefeet could this help my problem and do i wear a vivo barefoot shoe for a walk i am not a runner just an average person who likes exercise i am petrified of having flat feet and the arches completely collapsing i can stand but cannot stride as my arch will generate pain due to a ligament pulling so i walk general not hurried could this be cured by walking barefoot in time

      • Orthotics cannot correct fallen arches, that’s impossible. More information on the sock-doc site too.

  5. Ed Bowman permalink

    Doc, kudos to you for taking the time to give good, solid advice to all of these people in pain..I am 61 years old and have been diagnosed with Tibialis Posteria Dysfunction Syndrome. I work 6 days a week and do most of my walking on concrete. I have put Dr. Scholls Foot Pads with arch support in all of my shoes and sneakers. I have been wearing an aircast for arch and ankle support for about 2 months now but the pain is not getting any better. I am 6’3″ and weigh 220 lbs. my wife and I are very active, we play volley ball, snow ski, Jet Ski and ride a Harley when time allows. I play golf several times a month, and altho I hate taking a cart, I need a cart to finish my round because I can’t walk 18 holes, 9 holes maybe, but no way can I walk 18 holes. The pain started at the base of my great toe then migrated to my arch and has settled just above my right ankle above my arch. Should I be doing the toe curls? Should I be doing more? I want to be able to play ball with the grand kids again, and I want to walk 18 holes again.

  6. Sharon permalink

    Do you have a video of someone lightly jumping on one foot for strengthening fallen arches?

  7. nobriga permalink

    hi sorry but i started to read this then got confused with what you were saying. so basically i have one foot that’s flat, the other has a low arch. i can’t even stand with my feet flat on the ground for longer than a few minutes without pain and i tried orthothics from my doctor and my feet still hurt. is there anything i can do to eliminate the pain from my feet? this pain affects my lower back as well and it’s a serious problem seeing as how i want to enlist into the army. i’m able to walk and run for hours and my back is fine without a little discomfort in my feet but my legs and knees are fine it’s only when i keep my feet planted in the same spot do they hurt a lot. so again, is there anything i can do to remedy it? thanks

    • Check out the info on the sock-doc site about how to help strengthen your feet. Also I’d recommend you look for a doc or therapist (chiropractor, PT, rolfer, or holistically-minded podiatrist) to help you figure out why your feet hurt. Don’t assume though that it is from the flat feet. Though it may be, often the foot has lost the arch from the muscle weaknesses in the lower leg and foot and those can be corrected – but the arch may not come back, though the pain can be resolved. Orthotics, of course, will never actually correct this.

  8. John D permalink

    This is a very informative arrticle Dr Gangemi!

    I would like to know if you would still recommend low heel-to-toe drop and minimal cushioning shoes for RFF?

  9. John D permalink

    Rigid Flat Feet.

    Most people are now recommending minimalist shoes for flat feet to get the muscles stronger. I’m assuming most of them have Flexible Flat Feet in contrast with my case where even if I tiptoe, no arch would be seen.

    I’m just curious if I can get my foot muscles strengthened even if the bones in it act it’s “splinting” my foot muscles.

    • This one is hard for me to comment on because I’ve only seen a few people with Rigid FF, where I’ve seen a lot with FFF.

      But I’d say that in both cases, definitely in FFF, you can strengthen the foot muscles by going barefoot and in min-type shoes, but in a rigid FF you’re not going to develop an arch.

  10. Matt permalink

    Thank you for opening my eyes to a new approach. For four years I’ve been unsuccessfully trying to treat shin splints with custom orthotics and supportive running shoes and doing everything else experts recommend. I’ve been told the right orthotic will solve the problem. After four years I’m despairing, but maybe I’ve just been following the wrong school of thought. Do you know how I can find help treating chronic shin splints from a barefoot perspective?

    • Matt – plenty of info on barefoot and shinsplints over on my Sock-Doc site. My Shin Splint Video there too.

  11. Cecil Wayman permalink

    I’m 66 and have worn orthotics for several years for what a podiatrist described as a collapsed arch (left foot.) He proposed a surgery involving swinging my heel back in and screwing it in place with a bolt, shortening the stretched tendons, and putting me in a cast for 6 weeks. What complicates things is that I also have compromised veins from a bout with DVT, and I doubt that surgery would be as uncomplicated as he seems to think. Unfortunately, my pain is pretty strong, and it limits the amount to which I can walk. I’m extremely frustrated. Do the suggestions on this site apply to my condition, or am I just stuck with the pain?

    • Check out the articles on the Sock-Doc site.

      • Cecil Wayman permalink

        Actually, I had already read the articles you’re suggesting. My concern is that while I have had flat feet since birth, my left arch is observably collapsed even further, the heel swings to the outside, and nothing that I have read on your website or elsewhere leads me to believe that this condition is correctable by anything short of surgery… yet, as I previously explained, surgery poses way too many risks for me. So are you suggesting that being barefoot and/or wearing appropriate shoes can at least make me pain free? Is there any evidence that doing so can in any way correct the condition I’m reporting? Thank you.

        • I’m suggesting that going barefoot and doing the exercises I show in the Foot Strength Video are a good start to improve foot health and strength. Since I don’t know you I don’t know how far you’ll get with just that. Ideally you’d want to see a doc who knows how to assess and treat your condition.

  12. Trudy permalink

    Hi,
    Great article! I started running longer distances last year. I was wearing Nike Free shoes but had an assessment done by a podiatrist and was told I have the worst feet on the scale. I have FFF and toe in with my left foot. I got the orthotics and ran with them for much of last year. I had chronic toe pain and they felt terrible!. I stopped wearing them in the fall and after completing a half marathon 2 weeks ago in stability shoes without my orthotics my feet are a mess (severe pain on the outsides of both feet and blisters). I am told that I need to wear my orthotics or get motion control shoes. My feet were never sore before wearing orthotics. I feel most comfortable in flat shoes. I ordered a pair of zero drop shoes today. I don’t want orthotics. Do you have any suggestions for me?

    • I’d say you’re already on the right track. Check out the Sock-Doc articles though for a lot more on orthotics and what healthy feet really mean.

  13. Nadine irving permalink

    I am having really bad pain in the bottom of my foot where my arch is could I have fallen arches I have always had a problem with my left leg due to a large strawberry birth mark that runs full length. Also with problems with my hips thanks.

  14. rwan permalink

    hey !
    iam 15 years old girl and i have flat feet but it doesn’t hurt me at all and i tried the shoes which support the arch and now i wear insoles but nothing changed is there any thing i can do ? because it really makes me uncomfortable i can’t wear any shoes i like and it sucks

    • Well as the article states I would never recommend wearing arch supports of any kind for flat feet. All those will do is weaken your feet especially as you’re growing.

  15. How does idiopathic toe walking fit into the picture? Both my children have toe walked since they were toddlers and are on their toes the second they are barefoot, the youngest (6yrs) even in shoes. I have been told they have extremely flexible/hypermobile, flat feet, but that toe walking will shorten their tendons. The oldest (12yrs) is ‘duck-footed’ with turned out feet and finds it nearly impossible to run. I’ve been brushed off by more physicians than I can count about their issues.

    • For kids it’s best to find a doc (usually a chiropractor or naturally-minded podiatrist) who can help you figure this out as well as help with your kids’ rehab. The toe walking is often related to sensory disorders; I’ve seen plenty of kids who stopped toe walking once their diet was changed and certain nutrients were taken.

  16. Vipin permalink

    Hi Doctor. Wonderful article. My name is Vipin and I am 26 years old. I have FFF on my right feet and it hurts my knee as well as my back a lot. I try to straighten (position) it and walk but it tends to hurt a lot more. Now I have come down with Gaut and going through treatment. Both the issues together is crippling me down. I used to be an athlete and it hurts on an emotional level as well. Do you have any advice for me?
    I really appreciate how you find time to reply to everyone.

    Regards,
    Vipin

  17. Victoria permalink

    Hi Doctor,

    I just stumbled across this site while doing research about orthotics. I have a recently diagnosed accessory navicular bone on both of my feet. My podiatrist recommended plastic orthotics, which I now use in both of my shoes. Without them, after extended time on my feet (hiking, walking, even just standing), my arches start to hurt a lot. The only way I can describe the pain is that it makes me want to step on ledges and rocks to kind of massage my arch (if that makes any sense). After reading this article, I am a bit wary of utilizing my orthotics. Do you think they can cause me harm in the long run? Or should I continue to use them in order to keep my symptoms in check? Thanks!

  18. Eric Nelson permalink

    Hey, I’m 18 I have flat feet, is it possible to get my arches built up so I have normal support? I don’t believe in impossible when it comes to anything related to what the body can do when being taken care of correctly.

  19. Drew Cummings permalink

    Hi Doc,
    I have a friend who developed flat feet apparently during pregnancy (approx 6 years ago), sometime following she was prescribed orthodics and like most believes what she is told by ‘experts’. She runs regularly and is aiming at a marathon this year so while it doesn’t hamper her, she is still convinced she needs them to run. I have tried to explain that they are not doing anything to help and have even gotten her out onto a park to run a few km’s barefoot (which she did easily!).
    Do you have any suggestions for a path forward away from orthodics?
    Thanks,
    Drew.

  20. Muhammad permalink

    Hi, I’ve had problems with my flat feet for a couple of years, and I’ve had orthopedic insoles for the past 5 years. The insoles definitely took away the pain when I am walking, but when I play basketball or any sport, sometimes the pain is so severe in my arches, I can’t even walk after. I’ve even had to be carried from the car to a couch in my house because I could not put any weight on my feet. Is there anything else I can do to prevent or even lower the pain while playing sports. I love playing but within 30mins my arches and lower feet are aching and burning.

  21. kamran permalink

    Dear Sir,
    i have a Problem in both of my feet for the past 5 Years and i ihave been going to different doctors BUT no results……Symptoms are as follows:

    1. when i walk up in the morning i have too much pain in my Heel, specially real side of the heal.
    2. i get tired very fast
    3. by the end of the day i have no energy left in me.

    looking forward for your advise.

    thanks

  22. Tonisha permalink

    I think i have FFF! I will be getting surgery on my ankles to create somewhat of an arch so my question is how long will the recovery be

  23. Tonisha permalink

    When i walk the middle of my feet feel like they are splitting and hurt really bad. I have small feet so when i buy my shoes i have to shop in the kids section so i don’t have a big variety and support for my ankles and feet.

  24. I’m young and have flat feet and I don’t know if it is serious, I also play soccer. I went to a foot doctor and he wrapped my feet up in tape, it was kept on for about 6 weeks. After that it still did not feel better and I have done that process twice. Can anything be done to make an arch in my foot? Also the outside of my foot a bone is slightly sticking out with minor bruising on the inside and outside of my feet, please help!

  25. I have flexible flat feet, I didn’t wear corrective footwear as a child, and wore shoes in a normal way (at school etc). I have always had flat feet, they’ve never worsened or improved. My father also has flat feet. This has lead me to the conclusion that it is hereditary to an extent.

    I really disagree with you when it comes to orthotics, I suffer from ankle and back pain as a result of my lack of arches and orthotics really help with this.

    I have been told in the past that it is the fault of my childhood footwear, and this is just not true, and in fact slightly irritating. As a sufferer of flat feet, orthotics help.

  26. Jessica permalink

    Hi.I am 26 year old female. I’ve always suffered from a flexible foot which made me pronate. I have an arch yet falls flat upon stepping down.I had navicular accessory and misaligned heels.last year I had the kidner procedure and hyprocure done. It was a last resort thing.I had gone through a few pairs of orthotics since I was 18,I couldn’t walk barefoot and my feet constantly hurt, especially where the extra bone was and any area around it. They’re not a hundred percent better though I’d say fifty percent. I don’t expect after 25 years of having this issue for one year to Cure it. My heels still turn out but no where as bad as before. My feet hurt while being on them all day as my job calls for it. I went to road runner and bought new stability shoes and foot balance insoles but really worried if o start wearing insoles again my feet will get worse. They feel good under get but not sure what to do. The tighter and more snug the site

  27. Frank Adams permalink

    Hello: I have adult acquired flatfeet that has developed into PTTD or Posterior Tibial Tendinitis. The pain is very severe where the tendon goes around the back of the ankle. Inserts and support shoes do relieve pain but not the problem. I have started to do light running with shoes but focusing on ball of foot strike and proper technique but the pain near the ankle is devastating. I am a backpacker and want to develop into a trail runner without heavy support shoes. What do you suggest.

    but the pain is not in the arch but the Peroneus L

  28. Anna permalink

    Hi! My brother has RFF and he has worn heavily arched orthotics his entire life. He was born with flat feet which were inherited from my grandmother. She currently wears braces on both her feet and can barely walk.
    The situation is that my brother and my mom (FFF) have flat feet. I have low arches and am currently trying to go barefoot and it is helping so much with my foot problems! Because of this, I’ve tried to convince my mom and brother to go barefoot, but they refuse to believe that it could help. Are there any doctor-written articles concerning this condition, especially with RFF?
    I really want my brother’s feet to heal up, but I havent found any articles to support this and both he and my mom refuse to believe anything not written by a doctor.
    Thanks!

  29. PIYUSH permalink

    Sir, I have flat foot. Can upls tell how to cure it as I want to go for army .
    some natural and easy methods pls

  30. Brandy permalink

    What do you think are the best brand of sneakers out there for flat feet. I have tried different shoe brands. Adidas, Sketchers, Payless and i find that none of them support my feet when i am standing or walking all day at work. I was born with my feet pigeon toed in and always had foot problems, when i was 13 i had corrective surgery and the doctor placed a plastic piece inside my ankle because he said a bone was missing when i was born. My left foot was done and i never have any problems with that foot at all. I had my second surgery done when i was 19 and that took longer to heal, i was suppose to get physical therapy with that foot but was unable to go due to not having any transportation to get there. Since having that surgery on my right ankle, i still have pain in it when i walk a lot through out the day or I’m standing for long periods of time. The doctor told me i need to have orthotics but i couldn’t afford them at the time. Since you say orthotics are bad for your feet. What do you suggest i wear on my feet so i won’t have any pain in them at the end of the day

Trackbacks and Pingbacks

  1. Barefoot Running & Walking: Minimalist Running, Shoes & Foot Health | Sock-Doc
  2. Overpronation Of The Foot | Pronation, Overpronation & Foot Injuries

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