One of the most important parts of the foot is the arch.
Our arches help to absorb shock when walking, and it also flexes with the terrain to keep our feet stable on all surfaces.
Fallen arches—or flat feet—can result in your feet rolling inwards—to the medial side. It’s known as overpronation, and it can lead to injury, joint strain, and discomfort.
Many people with fallen arches find relief in stability shoes. They’re designed to prop the arch up and prevent it from collapsing.
But what causes fallen arches? Let’s have a look at the different types of flat feet, how to diagnose it, and what to do to treat it.
What Are Fallen Arches?
A fallen arch—also known as flat foot—is a condition in which a person has either no arch or a very low arch. People who have fallen arches or flat feet will find that the entire sole of their foot is in contact with the ground.
The medical term for a fallen arch or flat foot is Pes Planus. This occurs when the medial longitudinal arch—the gentle inner curve of the foot—is flat, lowered, or hasn’t developed normally. There are several tendons, ligaments, bones, and muscles in the medial longitudinal arch that work together to form the arches in your foot.
When you stand, run, walk, or jump, the medial longitudinal arch is responsible for absorbing impact and distributing body weight evenly.
One of the most common reasons for fallen arches is the deterioration or weakening of the posterior tibial tendon. This is the tendon that runs along the inside of your ankle and connects the calf muscle to the bones in the sole of your foot.
It’s also the tendon that’s responsible for holding up the arch and supporting the foot while walking.
Different Types of Fallen Arches/Flat Feet
When we look at arch types, most people will think along the lines of high, medium—normal—or low arches.
But there are also different types of flat feet: flexible, rigid, and adult-acquired.
Flexible Flat Foot
You’ll be able to see the arch in the foot when the foot is resting—not on the ground—or when it’s lifted off of the ground.
But once you put your foot back on the ground, the arch will flatten and your whole foot will be in contact with the ground.
Rigid Flat Foot
If no arch is visible either when the foot is in a resting position—sitting with no weight on the feet—or when you stand and place the feet on the ground, then you have a rigid flat foot. This is commonly associated with a weakened posterior tibial tendon.
Adult-Acquired Flat Foot
Fallen arches aren’t always hereditary. Sometimes the arch unexpectedly collapses or drops.
This is often a result of an injury in which the foot structure that supports the arch is damaged, like a tear to the posterior tibial tendon.
Diagnosis
While you can usually determine if they have flat feet themselves, it would be best to see a podiatrist to determine the underlying cause. The podiatrist may do a visual exam of your feet or they may request an imaging test to evaluate the structure of the foot.
One of the following visual examinations can be done to determine the cause behind flat feet:
The Wet Footprint Test
This test is done by having you place your foot into a shallow pan filled with water so that the sole of your foot is completely wet. You’d then step onto a piece of cardboard or a brown paper bag, which is placed on a level surface.
This allows you—or the podiatrist—to see the outline of your foot shape. The thicker the print is between the ball and heel of the foot, the flatter the foot is.
Shoe Inspection Test
Look at the sole of their shoes for unusual wear patterns.
If you have more wear on the inside—medial side—of the shoe, especially in the heel, then you could have flat feet. You may notice that the upper of the shoe will lean inward and over the sole of the shoe.
The “Too Many Toes” Test
The podiatrist—doctor—will have you stand and then stand behind you and will look to see how many toes are visible from behind the foot.
If you have normal pronation, then only the pinky toe should be seen. However, if you overpronate, then the doctor may see three or four toes peeking out to the sides.
The Tiptoe Test
This test is used to see what type of flat feet you have. The doctor will have you stand on your toes and will look for an arch.
If there’s a visible arch then you have flexible flat feet and if there’s no arch then you have rigid flat feet.
If your podiatrist has requested an imaging test, then you’ll have one of the following:
- X-rays or Computed Tomography—CT—scan, as these types of scans are used to evaluate the alignment of the foot bones and irregularities.
- Magnetic Resonance Imaging—MRI—provides detailed images that can be used to evaluate soft tissue or bone damage.
- Ultrasound is able to provide detailed images of soft tissue damage.
Causes of Flat Feet and Fallen Arches
There are a number of conditions that can cause flat feet.
You may have flat feet due to an abnormality with the structure of the foot from birth, or it may have been inherited—passed from the genes of the parents to the genes of the child.
An accident or an injury to the foot or ankle in which bones are dislocated or broken, or where tendons are stretched and torn, can cause fallen arches. Health conditions like rheumatoid arthritis can also lead to flat feet.
You’re more likely to have flat feet if you have a neurological or muscular condition such as spina bifida, cerebral palsy, or muscular dystrophy. But flat feet can also develop as we get older, as the wear and tear over the years can cause the posterior tibial tendon to weaken.
People who are overweight—obese—are at a higher risk of developing fallen arches, as their feet are placed under excessive pressure. This causes the tendons, ligaments, and muscles to weaken over time.
The feet of pregnant women can change due to hormones. This can loosen the ligaments, which can lead to flat feet.
Symptoms
Some people may notice that their feet feel tired, especially along the inside of the arch. You may experience pain in the heel or arch of the foot, and this pain can increase with activity. Swelling may occur on the inside of the ankle or on the bottom of your feet.
The pain can also affect your lower leg. If the way you’re walking has changed, this can place the knee and hip joint under pressure; this can cause pain in the knee, hip, and lower back.
Your feet may feel stiff and some movements can be more difficult to do than others, such as standing on your toes.
Treatments
Should you be experiencing fatigue or pain in your feet and legs, then you should rest them until they feel better.
Avoid doing activities that aggravate the condition or that are high-impact. If you do want to exercise, choose low-impact activities like swimming, walking, or biking.
You can ice the painful area using ice packs, as this will provide relief from pain and can reduce swelling. It’s best to avoid heat, as it can make the pain and inflammation worse.
To help alleviate the pain and swelling, you can also use over-the-counter pain medication like Ibuprofen or Advil.
Orthotic devices such as arch supports may help to relieve pressure on the arch of the foot, help control overpronation and reduce the feeling of fatigue and pain. Depending on the severity of your fallen arches, your podiatrist may recommend custom-designed arch supports that you can place in your shoes to provide relief.
Wearing stability or motion-control shoes that control overpronation can prevent your feet and legs from becoming fatigued and alleviate pain. The shoes should also absorb shock and provide adequate arch support, which will help to distribute your body weight evenly throughout the foot. If you have fallen arches, plantar fibroma shoes will help.
Stretching exercises can help to strengthen and lengthen the arches of your foot. This can alleviate pain, as well as reduce foot and leg fatigue. Your doctor may even recommend physical therapy, as it will help to stabilize the integrity of the foot and correct muscle imbalances.
Depending on the severity of your symptoms, your doctor may recommend an injection such as corticosteroids. This will help to reduce inflammation, stiffness, and pain.
If the pain becomes severe and starts to interfere with your daily activities, your doctor may then recommend surgery.
Surgery
Your doctor would recommend surgery that’s based on the root cause of the fallen arch, your symptoms, and your age.
Not only can surgery provide lasting relief from pain, but it can also create an arch in the foot if one wasn’t there before.
Flat feet can be treated by two of the most common types of surgery.
Reconstructive Surgery
This surgery will realign the foot by fusing certain joints—or multiple joints like the tarsometatarsal or naviculocuneiform joint—and repositioning tendons.
Sometimes if they can’t reposition a tendon, then the surgeon may use the flexor digitorum longus—FDL—tendon which flexes your toes. He will transfer it so that it can help strengthen the posterior tibial tendon.
A Subtalar Implant To Support The Arch
This type of surgery uses an implant that is placed in the subtalar joint, which then stabilizes and corrects the foot.
Exercises That Increase Arch Flexibility and Strength
The following foot exercises help to strengthen the muscles of the foot and increase arch stability. This will help to provide better support and protection overall for your foot.
- Heel stretches
- Golf or tennis ball rolls
- Arch lifts
- Calf raises
- Stair arch raises
- Towel curls
- Toe raises
- The Yoga Pose – Downward Dog
