Flat feet / fallen arches (over pronation)

In newborns and infants, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch becomes visible when children begin standing on their toes.
The arch continues to develop throughout childhood and by adulthood most people have developed 'normal' arches. 

On standing a flat arch will be seen and the foot may roll over to the inner aspect.

Symptoms vary depending on the severity of the condition.
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Flat feet are generally related with pronation, (an inclination of the ankle bones toward the centre line).
Most people suffer from excessive pronation due to flat feet when walking, running and standing.
Though the foot may appear normal when
sitting down, with a clear arch present under the foot, over-pronation becomes noticeable when standing or walking as a result of weight bearing.
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Shoes of people who pronate, when placed side by side, will lean toward each other (after worn long enough for the foot position to remodel their shape).

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior.
This condition arises when the tendon becomes inflamed, stretched, or torn.
Left untreated, it may lead to severe disability and chronic pain.
People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.
Cerebral palsy, spins bifida and muscular dystrophy can also lead to a flat foot condition.

SYMPTOMS:

• Pain in the arch, feet, ankles and legs aggravated by standing, walking and running.
• Leg cramps and pain at times during the night.
• Fatigue during activity or simple walking.
• Weakness in the legs during running.
• Stiffness and pain in the lower back, especially in the morning.
• Lack of interest in participating in sports or activities that require running.

SIGNS:

• Flat arch when standing is most common. The arch may look normal when seated.
• Many arches appear normal when standing but the front part of the foot points out compared to the rearfoot.
• When looking at the feet from behind the heel bone appears to turn out.
• Knock-knees.
• Feet and ankles look abnormal. Bulging of the bone on the inside of the ankle and foot.
• Abnormal gait with the feet excessively turned out.
• Abnormal shoe wear.

RELATED PROBLEMS:

• Development of bunions, hammertoes, heel spurs, neuromas and sagging joints.
• Knee and leg problems.
• Severe collapse of the foot necessitating reconstructive bone surgery.
• Limited activity causing weight gain and poor cardiovascular fitness.
• Muscular tightness in the foot, legs and back.
• Osteoarthritis in the foot, ankle, knees, hips and back.
• Back pain

TREATMENT:

• History and physical examination to identify areas of pain and underlying causes.
• Proper shoe gear to support the foot.
• Orthotics (insoles) custom made to the foot to support the foot and entire extremity.
• Physical therapy to strengthen weak muscles and stretch tight muscles.
• Supportive taping, bracing.
• Surgery if all efforts at conservative care have failed to alleviate a person’s problem.

​Orthotics (insoles) custom made to the foot to support the foot and entire extremity.

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