Flat Feet

Flat feet (pes planus) is a condition where the arch on the inside of the foot collapses, causing the entire sole to contact the ground. While some people are born with flat feet and have no issues, others develop adult-acquired flatfoot deformity (AAFD), most commonly from posterior tibial tendon dysfunction.

Flat feet can lead to strain on the ankles, knees, hips, and lower back by altering your body's alignment. At Mountain Spine & Orthopedics, our foot and ankle specialists use advanced imaging and gait analysis to create personalized treatment plans—from custom orthotics to flatfoot reconstruction surgery—that support your arches and help you move comfortably.

When symptomatic, flat feet cause progressive problems that worsen without treatment.

• Pain in the arch, heel, or ankle
• Tired, achy feet after prolonged standing or walking
• Swelling along the inside of the ankle
• Difficulty standing on tiptoes
• Pain extending to the calf, knee, or back
• Rapid shoe wear along the inner edge
• Feet that "roll inward" when walking (overpronation)
• Toes pointing outward when standing

• Genetics: Inherited foot structure
• Age: Posterior tibial tendon weakens over time
• Injuries: Ankle sprains, fractures, or tendon tears
• Obesity: Excess weight strains the arch
• Diabetes: Affects tendon health
• Rheumatoid arthritis: Inflammatory damage to joints
• Pregnancy: Hormonal changes loosen ligaments
• Hypertension: Reduces blood flow to tendons

Diagnosing flat feet involves a physical exam where our specialist observes your feet as you stand and walk. We perform the single-leg heel rise test to assess posterior tibial tendon function.

If pain is present or acquired flatfoot is suspected, we use weight-bearing X-rays to examine bone structure and alignment. An MRI evaluates tendon and ligament damage, particularly the posterior tibial tendon.

Treatment depends on whether flat feet are flexible or rigid, and the severity of symptoms.

Non-Surgical Treatment

• Orthotics: Custom arch supports are the cornerstone of treatment
• Supportive shoes: Stability or motion-control footwear
• AFO bracing: Ankle-foot orthosis for moderate to severe cases
• Physical therapy: Strengthen posterior tibial and intrinsic foot muscles
• NSAIDs: Reduce pain and inflammation
• Activity modification: Avoid prolonged standing on hard surfaces

Surgical Treatment

When conservative measures fail, flatfoot reconstruction surgery may include tendon repair or transfer, calcaneal osteotomy, and in severe cases, joint fusion.

Pain associated with flat feet arises from the increased strain on tendons, ligaments, and joints due to lack of arch support and resulting overpronation. The posterior tibial tendon works overtime to support the collapsed arch, leading to tendonitis and eventual degeneration.

Without treatment, flat feet can cause secondary problems including plantar fasciitis, shin splints, and knee pain.

If you're prone to flat feet, these strategies can help manage symptoms and slow the progression of arch collapse.

• Wear supportive shoes: Stability shoes with firm heel counters
• Use orthotics: Custom or OTC arch supports
• Maintain healthy weight: Reduces arch strain
• Stretch regularly: Achilles and calf stretches
• Strengthen foot muscles: Towel curls and arch exercises
• Address symptoms early: Before the deformity becomes rigid
• Avoid prolonged barefoot walking: On hard surfaces

If foot pain or fatigue associated with flat feet is impacting your comfort or mobility, schedule an appointment at Mountain Spine & Orthopedics. Our team can provide a detailed evaluation and outline suitable treatment strategies.