Flat feet
Encyclopedia
Flat feet is a formal reference to a medical condition in which the arch of the foot collapses, with the entire sole
of the foot coming into complete or near-complete contact with the ground. In some individuals (an estimated 20–30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally).
Three studies of military recruits have shown no evidence of later increased injury, or foot problems, due to flat feet, in a population of people who reach military service age without prior foot problems. However, these studies cannot be used to judge possible future damage from this condition when diagnosed at younger ages. They also cannot be applied to persons whose flat feet are associated with foot symptoms, or certain symptoms in other parts of the body (such as the leg or back) possibly referable to the foot.
, tendon
, ligament
and bone
growth. Training of the feet, especially by foot gymnastics
and going barefoot
on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood. A survey of 297 school children at Allahabad
, Uttar Pradesh
, India
revealed that 40.32% of children under 5, 22.15% of children between 5 and 10, and, 15.48% of children older than 10 suffered bilateral flat foot.
Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents or other adult caregivers to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks.
Children who complain about calf muscle pains or any other pains around the foot area, may be developing or have flat feet. Pain or discomfort may also develop in the knee joints. A recent randomized controlled trial
found no evidence for the efficacy of treatment of flat feet in children either for expensive prescribed orthoses (shoe insert
s) or less expensive over-the-counter orthoses.
. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot, found that the longitudinal arches of the barefooters were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes.
, or as part of the normal aging process. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin
(elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
If a youth or adult appears flatfooted while standing in a full weight bearing
position, but an arch appears when the person dorsiflexes (stands on heel or pulls the toes back with the rest of the foot flat on the floor), this condition is called flexible flatfoot. This is not a true collapsed arch, as the medial longitudinal arch
is still present and the Windlass mechanism still operates; this presentation is actually due to excessive pronation of the foot (rolling inwards), although the term 'flat foot' is still applicable as it is a somewhat generic term. Muscular training of the feet, while generally helpful, will usually not result in increased arch height in adults, because the muscles in the human foot are so short that exercise will generally not make much difference, regardless of the variety or amount of exercise. However, as long as the foot is still growing, it may be possible that a lasting arch can be created.
An easy and traditional home diagnosis is the "wet footprint" test, performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. In more extreme cases, known as a kinked flatfoot, the entire inner edge of the footprint may actually bulge outward, where in a normal to high arch this part of the sole of the foot does not make contact with the ground at all.
Rigid flatfoot, a condition where the sole of the foot is rigidly flat even when a person is not standing, often indicates a significant problem in the bones of the affected feet, and can cause pain in about a quarter of those affected. Other flatfoot-related conditions, such as various forms of tarsal
coalition (two or more bones in the midfoot or hindfoot abnormally joined) or an accessory navicular (extra bone on the inner side of the foot) should be treated promptly, usually by the very early teen years, before a child's bone structure firms up permanently as a young adult. Both tarsal coalition and an accessory navicular can be confirmed by x-ray
. Rheumatoid Arthritis can destroy tendons in the foot (or both feet) which can cause this condition, and untreated can result in deformity and early onset of Osteoarthritis of the joint. Such a condition can cause severe pain and considerably reduced ability to walk, even with orthoses. Ankle fusion is usually recommended.
Treatment of flat feet may also be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back. Treatment may include using Orthoses such as an arch support
, foot gymnastics
or other exercises as recommended by a podiatrist/orthotist or other physician. In cases of severe flat feet, orthoses should be used through a gradual process to lessen discomfort. Over several weeks, slightly more material is added to the orthosis to raise the arch. These small changes allow the foot structure to adjust gradually, as well as giving the patient time to acclimatise to the sensation of wearing orthoses. Once prescribed, orthoses are generally worn for the rest of the patient's life. In some cases, surgery can provide lasting relief, and even create an arch where none existed before; it should be considered a last resort, as it is usually very time consuming and costly.
recruits that tracked the recruits over the course of their basic training found that neither flat feet nor high arched feet had any impact on physical functioning, injury rates or foot health. If anything, there was a tendency for those with flat feet to have fewer injuries. Another study of 287 Israel Defense Forces
recruits found that those with high arches suffered almost four times as many stress fractures as those with the lowest arches. A later study of 449 U.S. Navy special warfare
trainees found no significant difference in the incidence of stress fractures among sailors and Marines with different arch heights.
Sole (foot)
The sole is the bottom of the foot.In humans the sole of the foot is anatomically referred to as the plantar aspect. The equivalent surface in ungulates is the hoof.- Human sole :...
of the foot coming into complete or near-complete contact with the ground. In some individuals (an estimated 20–30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally).
Three studies of military recruits have shown no evidence of later increased injury, or foot problems, due to flat feet, in a population of people who reach military service age without prior foot problems. However, these studies cannot be used to judge possible future damage from this condition when diagnosed at younger ages. They also cannot be applied to persons whose flat feet are associated with foot symptoms, or certain symptoms in other parts of the body (such as the leg or back) possibly referable to the foot.
Flat feet in children
The appearance of flat feet is normal and common in infants, partly due to "baby fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscleMuscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
, tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
, ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
and bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
growth. Training of the feet, especially by foot gymnastics
Foot gymnastics
Foot gymnastics are games and exercises intended to strengthen the muscles of legs and feet, improve the motion sequences of walking and sports, support therapy of varicose veins and dorsal pain...
and going barefoot
Barefoot
Barefoot is the state of not wearing any footwear. Being barefoot is regarded as a human's natural state, though for functional, fashion and social reasons footwear is worn, at least on some occasions...
on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood. A survey of 297 school children at Allahabad
Allahabad
Allahabad , or Settled by God in Persian, is a major city of India and is one of the main holy cities of Hinduism. It was renamed by the Mughals from the ancient name of Prayaga , and is by some accounts the second-oldest city in India. It is located in the north Indian state of Uttar Pradesh,...
, Uttar Pradesh
Uttar Pradesh
Uttar Pradesh abbreviation U.P. , is a state located in the northern part of India. With a population of over 200 million people, it is India's most populous state, as well as the world's most populous sub-national entity...
, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
revealed that 40.32% of children under 5, 22.15% of children between 5 and 10, and, 15.48% of children older than 10 suffered bilateral flat foot.
Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents or other adult caregivers to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks.
Children who complain about calf muscle pains or any other pains around the foot area, may be developing or have flat feet. Pain or discomfort may also develop in the knee joints. A recent randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
found no evidence for the efficacy of treatment of flat feet in children either for expensive prescribed orthoses (shoe insert
Shoe insert
A shoe insert is a removable insole which accomplishes any of a number of purposes, including daily wear comfort, foot and joint pain relief from arthritis, overuse, injuries, and other causes, orthopedic correction, smell reduction, athletic performance, or even increasing the wearer's height or...
s) or less expensive over-the-counter orthoses.
Treatment
Going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitisPlantar fasciitis
Plantar fasciitis is a painful inflammatory process of the plantar fascia, the connective tissue on the sole of the foot.Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix...
. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot, found that the longitudinal arches of the barefooters were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes.
Flat feet in adults
Flat feet can also develop as an adult ("adult acquired flatfoot") due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanicsBiomechanics
Biomechanics is the application of mechanical principles to biological systems, such as humans, animals, plants, organs, and cells. Perhaps one of the best definitions was provided by Herbert Hatze in 1974: "Biomechanics is the study of the structure and function of biological systems by means of...
, or as part of the normal aging process. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin
Elastin
Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...
(elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
If a youth or adult appears flatfooted while standing in a full weight bearing
Weight bearing
In orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
position, but an arch appears when the person dorsiflexes (stands on heel or pulls the toes back with the rest of the foot flat on the floor), this condition is called flexible flatfoot. This is not a true collapsed arch, as the medial longitudinal arch
Arches of the foot
-External links:* * *...
is still present and the Windlass mechanism still operates; this presentation is actually due to excessive pronation of the foot (rolling inwards), although the term 'flat foot' is still applicable as it is a somewhat generic term. Muscular training of the feet, while generally helpful, will usually not result in increased arch height in adults, because the muscles in the human foot are so short that exercise will generally not make much difference, regardless of the variety or amount of exercise. However, as long as the foot is still growing, it may be possible that a lasting arch can be created.
Diagnosis
Many medical professionals can diagnose a flat foot by examining the patient standing or just looking at them. On going up onto tip toe the deformity will correct when this is a flexible flat foot in a child with lax joints. Such correction is not seen in the adult with a rigid flat foot.An easy and traditional home diagnosis is the "wet footprint" test, performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. In more extreme cases, known as a kinked flatfoot, the entire inner edge of the footprint may actually bulge outward, where in a normal to high arch this part of the sole of the foot does not make contact with the ground at all.
Treatment
Most flexible flat feet are asymptomatic, and do not cause pain. In these cases, there is usually no cause for concern, and the condition may be considered a normal human variant. Flat feet were formerly a physical-health reason for service-rejection in many militaries. However, three military studies on asymptomatic adults (see section below), suggest that persons with asymptomatic flat feet are at least as tolerant of foot stress as the population with various grades of arch. Asymptomatic flat feet are no longer a service disqualification in the U.S. military.Rigid flatfoot, a condition where the sole of the foot is rigidly flat even when a person is not standing, often indicates a significant problem in the bones of the affected feet, and can cause pain in about a quarter of those affected. Other flatfoot-related conditions, such as various forms of tarsal
Tarsus (skeleton)
In tetrapods, the tarsus is a cluster of articulating bones in each foot situated between the lower end of tibia and fibula of the lower leg and the metatarsus. In the foot the tarsus articulates with the bones of the metatarsus, which in turn articulate with the bones of the individual toes...
coalition (two or more bones in the midfoot or hindfoot abnormally joined) or an accessory navicular (extra bone on the inner side of the foot) should be treated promptly, usually by the very early teen years, before a child's bone structure firms up permanently as a young adult. Both tarsal coalition and an accessory navicular can be confirmed by x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
. Rheumatoid Arthritis can destroy tendons in the foot (or both feet) which can cause this condition, and untreated can result in deformity and early onset of Osteoarthritis of the joint. Such a condition can cause severe pain and considerably reduced ability to walk, even with orthoses. Ankle fusion is usually recommended.
Treatment of flat feet may also be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back. Treatment may include using Orthoses such as an arch support
Arch support
An arch support is a piece of material designed to provide support for the arch of the foot. An arch support may be placed on top of the shoe's insole, or may be part of the insole....
, foot gymnastics
Foot gymnastics
Foot gymnastics are games and exercises intended to strengthen the muscles of legs and feet, improve the motion sequences of walking and sports, support therapy of varicose veins and dorsal pain...
or other exercises as recommended by a podiatrist/orthotist or other physician. In cases of severe flat feet, orthoses should be used through a gradual process to lessen discomfort. Over several weeks, slightly more material is added to the orthosis to raise the arch. These small changes allow the foot structure to adjust gradually, as well as giving the patient time to acclimatise to the sensation of wearing orthoses. Once prescribed, orthoses are generally worn for the rest of the patient's life. In some cases, surgery can provide lasting relief, and even create an arch where none existed before; it should be considered a last resort, as it is usually very time consuming and costly.
Running
It is generally accepted by professionals that a person with flat feet tends to overpronate in his or her running form. Pronation is a natural form of shock absorption during running and walking, when the ankle rolls inward and the weight distribution in the foot shifts medially. Overpronation is excessive pronation; it disrupts the alignment of the leg and may result in injuries due to over-stressing of the knee and leg. With normal, or neutral, running shoes, a person who overpronates in his or her running form may be more susceptible to shin splints, back problems, and tendonitis in the knee. Running in shoes with extra medial support or using special shoe inserts, orthoses, may help correct one's running form by reducing pronation and may reduce risk of injury.Military studies
Studies analyzing the correlation between flat feet and physical injury in soldiers have been inconclusive, but none suggest that flat feet are an impediment, at least in soldiers who reached the age of military recruitment without prior foot problems. Instead, in this population, there is a suggestion of more injury in high arched feet. A 2005 study of Royal Australian Air ForceRoyal Australian Air Force
The Royal Australian Air Force is the air force branch of the Australian Defence Force. The RAAF was formed in March 1921. It continues the traditions of the Australian Flying Corps , which was formed on 22 October 1912. The RAAF has taken part in many of the 20th century's major conflicts...
recruits that tracked the recruits over the course of their basic training found that neither flat feet nor high arched feet had any impact on physical functioning, injury rates or foot health. If anything, there was a tendency for those with flat feet to have fewer injuries. Another study of 287 Israel Defense Forces
Israel Defense Forces
The Israel Defense Forces , commonly known in Israel by the Hebrew acronym Tzahal , are the military forces of the State of Israel. They consist of the ground forces, air force and navy. It is the sole military wing of the Israeli security forces, and has no civilian jurisdiction within Israel...
recruits found that those with high arches suffered almost four times as many stress fractures as those with the lowest arches. A later study of 449 U.S. Navy special warfare
United States Naval Special Warfare Command
The United States Naval Special Warfare Command was commissioned on April 16, 1987, at Naval Amphibious Base Coronado in San Diego, California...
trainees found no significant difference in the incidence of stress fractures among sailors and Marines with different arch heights.