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Facts about flat feet: How a foot and ankle surgeon can ease your pain

September 14, 2023

Orthopedics Primary Care Healthy Aging
Man with signs of flatfoot foot

Facts about flat feet: How a foot and ankle surgeon can ease your pain 

Do your feet have much of an arch these days?

Many adults – who once had normal arches – will develop a painful condition called progressive flatfoot. If you have trouble with flat feet, consult an orthopedic foot and ankle surgeon for an expert diagnosis and comprehensive treatment plan to help you feel better.

What causes flat feet? And what is progressive flatfoot?

Chances are, you were born with flat feet. By about age two or three, the tissues in your feet tighten and form normal arches. As you grow older, your feet may change again – for many reasons. 

“Each time you take a step, the force on your feet is two to three times your body weight,” explains Jeffrey Levy, D.O., a fellowship-trained foot and ankle orthopedic surgeon with Riverside Orthopedic & Sports Medicine Specialists. “If you also spend a lot of time on your feet, the tendons and ligaments may stretch. Your arches may settle, and your feet appear to be flatter.” 

Flat feet don’t cause problems for everyone – unless they develop progressive flatfoot. To understand how this happens, picture a very important tendon in your lower leg called the posterior tibial tendon. 

“This tendon runs from your calf, stretches down behind the inside of the ankle and attaches to the bones in the middle of your foot. It holds up your arch and supports you as you step off your toes and walk,” explains Dr. Levy. “If this tendon is torn, inflamed or stretched too much, your arch falls. You feel pain in the inner ankle.”


Who is at risk for progressive flatfoot?

Anyone can develop progressive flatfoot. Often, it occurs in women over 50 who simply have an abnormality in the tendon. Conditions that put you at risk for flat feet include: 

  • Excessive weight 
  • Weight gain during pregnancy
  • Diabetes
  • Genetics
  • High blood pressure
  • Ankle fracture
  • Local steroid injections  (Steroids can attenuate or weaken ligaments and cause joins to become unstable. This can result in joint laxity and progress to flat foot.)
  • Inflammatory diseases (such as Reiter's syndrome, rheumatoid arthritis a  nd psoriasis)

Athletes may develop flatfoot after tearing the tendon when playing sports. Runners are also at risk as they place excessive force on the foot.

Signs & symptoms

If you have progressive flatfoot, you may experience: 

  • Tired, achy feet
  • Swelling
  • Weakness
  • Difficulty standing on the toes and walking
  • Lower leg pain

How your doctor diagnoses progressive flatfoot

To diagnose flatfoot, your orthopedic foot and ankle surgeon will first review your medical history and do an exam.

“Typically, we’ll ask you to stand on your bare feet and look at how your foot functions. As flatfoot progresses, the front of the foot will slide to the outside,” explains Dr. Levy. “We may also ask you to stand on your toes or rise up on your heels. We’re looking for any dysfunction of the posterior tibial tendon.”  

Your doctor may also order X-rays, an ultrasound or MRI. 

Treating progressive flatfoot without surgery 

If your progressive flatfoot is still in the early stages, your doctor may recommend nonsurgical treatments:

  • Rest
  • Nonsteroidal anti-inflammatory drugs (aspirin or ibuprofen)
  • A rigid cast or boot to keep your foot immobilized for 6-8 weeks
  • Physical therapy 

You may also need to wear special shoe inserts or arch supports. 

Relieving flatfoot pain with surgery  

If you don’t get relief with nonsurgical treatments, your doctor may suggest surgery – or a series of procedures carefully planned to treat what’s wrong with your foot. 

Your surgeon may: 

  • Clean the tendon area and remove inflamed tissue 
  • Change the alignment of the heel bone 
  • Repair the damaged tendon with fibers from another tendon 
  • Realign the bones and recreate the arch 
  • Fuse certain bones together to eliminate joint movement and prevent condition from getting worse  

To get relief for your progressive flatfoot, it’s a good idea to visit a foot and ankle orthopedic surgeon like Dr. Levy who has special training in his area of practice. 

To make an appointment with Dr. Levy, please call 757-534-9988.

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