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Flat feet may not seem like a big deal, especially for children and teenagers who don’t feel any pain from them. However, flat feet (also called fallen arches) can cause serious pain and damage to the foot over time.

UPMC experts tailor treatment and prevention approaches for people with flat feet. We aim to address pain, support an active lifestyle, and prevent long-term foot problems.

What Are Flat Feet?

A healthy foot touches the ground around its outer edge but not in the inner middle part of the foot. The arch is the physical structure that holds this part of the foot off the ground. The arch is what makes the distinctive shape of a footprint.

People with flat feet have arches that fall when they put weight on the foot. Fallen arches make the bottom of the foot flat or cause the inner middle part of the foot to touch the floor. In some cases, flat feet can hurt after many years (or even decades).

According to StatPearls, about one-quarter of people have flat feet. “If flat feet don’t cause any pain, they may not need treatment,” says John Dresser, DPM, a podiatrist at UPMC in North Central Pa.

What Causes Flat Feet?

The most common cause of flat feet is genetics. Usually, when a child is 5 or 6, the tissues in the feet tighten and harden to form the arch. But with flat feet, the arch doesn’t form properly.

People may also get flat feet later in life. This risk is higher for people who have:

• Diabetes-related changes in the foot.
• Increased flexibility in the ligaments and tendons of the foot due to pregnancy.
• An injury to tendons or ligaments that support the foot.
• Excess weight putting increased pressure on the arch.
• Rheumatoid arthritis, in which the immune system attacks the tissue in the joints, causing inflammation.

What Long-Term Problems Do Flat Feet Cause?

A fallen arch stretches the posterior tibial tendon, which connects the top of the arch to the ankle. This stretching can cause pain and swelling or even tear the tendon.

Within the foot, fallen arches compress joints toward the front and back of the foot. Compressed joints can lead to pain and swelling. “A fallen arch increases pressure on the joints of the foot, and over time, that can cause arthritis,” says Dr. Dresser.

Treatments for Flat Feet

Treatment depends on many factors, mainly:

• How long you’ve been living with flat feet.
• How much pain you feel.
• The structure of your foot.
• Your age.

Treatment options may include customized orthotics, steroid injections, immobilization, and physical therapy. In some cases, surgery may be necessary.

Nonsurgical treatments for flat feet

Orthotics and other nonsurgical treatments can correct the foot position and prevent long-term damage. “Usually, a rigid arch support is adequate to treat fallen arches, especially if we catch it early enough,” says Dr. Dresser.

Customized orthotics

The first treatment for flat feet is usually customized orthotics. At UPMC, we tailor inserts using a 3D impression of your foot. From that impression, we create rigid orthotics that mold to your feet and support your arch.

If your orthotics are plastic or carbon fiber, you’ll need to replace them each year to ensure they continue supporting your foot. To prevent long-term damage, wear your orthotics as much as possible when standing or walking, including indoors.

Physical therapy for flat feet

Physical therapy can strengthen the muscles that support the ankle and foot, reducing pressure on the arch. With orthotics, it can also help reduce pain from flat feet.

People recovering from flat foot surgery also need physical therapy to restore strength in the foot and ankle for everyday activities.

Injections for flat feet

Steroid injections into the foot joints can reduce pain and inflammation. These shots can also help treat arthritis from flat feet and may help someone avoid or delay surgery.

Immobilization for flat feet

A boot that keeps the foot and ankle still can help the tendon heal. The boot, along with orthotics and physical therapy afterward, may help some people avoid surgery.

Surgery for flat feet

If a patient has not responded to nonsurgical treatments, surgery may be recommended. Before surgery, doctors evaluate the structure of the foot and ankle using an MRI, CT scan, or both. “The surgery we do is very patient-dependent and dependent on where the deformity is in the foot,” says Dr. Dresser, noting that fallen arches can put pressure on joints toward the front of the foot, the back of the foot, or both.

The main surgical options are fusions, osteotomies, and tendon repair surgery. With all flat foot surgeries, general anesthesia will put you to sleep.

After the surgery, you’ll need to avoid putting weight on the foot for about eight weeks. You may need to use crutches or, if you need extra support, a wheelchair. The surgeon will do two operations — one on each foot — so that the first foot can recover before the next surgery.

Fusion surgery for flat feet

Doctors suggest fusion surgery for older people with significant pain from fallen arches that doesn’t improve with other treatments.

For people with flat feet, symptoms of arthritis in the feet can show up early, when they’re in their 50s or 60s. This happens due to the extra pressure on the joints, especially if they haven’t consistently worn orthotics.

To address this problem, the surgeon removes the damaged cartilage tissue and fuses bones at the joint. Depending on the level of arthritis, the doctor may need to fuse one or more joints in the foot.

After fusion surgery, the foot is less flexible than before. However, people can still walk normally. “Because the surgery dramatically improves pain, people are often more active after fusion surgery,” explains Dr. Dresser.

Osteotomy surgery for flat feet

In osteotomy surgery, the surgeon cuts or lengthens bones in the foot to create an arch. Doctors choose this surgery for younger patients who have healthy joints in the foot but significant pain. Because this type of surgery preserves the joints in the foot, the foot retains its flexibility.

This type of surgery often uses sterilized bone from a donor. Because this bone doesn’t contain live cells, the chances the body will reject it are extremely low.

Tendon transfer surgery for flat feet

Tendon transfer surgery may become necessary if the tendon that connects the top of the arch to the lower leg has sustained too much damage.

In a tendon transfer surgery, the surgeon replaces the damaged tendon with a healthy one. The tendon comes from another part of the leg and isn’t necessary for everyday function.

When to See a Doctor for Flat Feet

You should see a doctor for flat feet if you notice:

• Pain in the inner ankle or foot, especially after walking or engaging in other activities.
• Feet that turn out when you walk.
• Heels that wear more on the outer side than the inner side.

UPMC specializes in all types of flat foot reconstructive surgery. We discuss your surgical and nonsurgical options and long-term prevention plans to choose the best treatment plan for you.