What Is Flatfoot?

Summit foot and ankle orthopedic surgeon Samuel Russ, M.D., discusses the definition, causes, and treatment for flatfoot.

Although you may know the term “flatfoot,” chances are you don’t know exactly what it is, what causes it, or how to treat it. Samuel Russ, M.D., received specialized training in flatfoot during his foot and ankle orthopedic surgery fellowship. We asked him to give us the lowdown on flatfoot.

What causes flatfoot?

“There are several reasons, but the most common reason is that a large tendon (posterior tibial tendon) on the inside of your ankle fails,” Dr. Russ said. “It could be because of an injury, or it could be because of degeneration over time.”

Because the posterior tibial tendon’s job is to hold up the foot’s arch, the arch can fall if the tendon fails. When that happens, not only does the foot look flat to the ground rather than arched on the inside, it can also cause pain.

Why is flatfoot a problem?

“There are multiple reasons a falling arch can cause pain. The torn or degenerative tendon itself can cause pain. In addition, there is a combination of deformities that are commonly observed. As the arch sags, the heel often shifts outward in relation to the rest of the foot and leg. This position can be particularly painful,” Dr. Russ said.

Initially, the changes in the foot are flexible, which means that the foot can be corrected to the appropriate position manually or with an orthotic. As the flat foot progresses, however, it can become rigid as the joints of the foot develop arthritis. When evaluating a person with a falling arch, Dr. Russ can determine the degree of deformity and whether the foot is flexible or rigid with a physical exam and X-rays.

How do you treat flatfoot?

In terms of prevention, stretching the calf muscles is important to prevent all kinds of foot problems, including flatfoot. “As the foot gets flatter, it can roll off to the side as you step, which can cause the Achilles tendon to shorten,” Dr. Russ said.

At first, Dr. Russ tries conservative, noninvasive measures. They include:

Off-the-shelf or custom orthotics — to correct the deformity and support the arch
An aggressive calf and Achilles tendon stretching program

Most people can become pain-free with an orthotic and a stretching program. “If that is enough, the treatment stops there,” Dr. Russ said. “But in general, at some point the condition will progress to the point where a patient will need surgery.”

A good rule of thumb, according to Dr. Russ, is the rule of thirds. One-third of people will need surgery after six months, one-third can go two to three years before needing surgery, and one-third of people can last up to 10 years.

“Using conservative treatment methods, you can gain quite a bit of time before you need surgery,” Dr. Russ said.

Surgical treatment options for flexible flatfoot include a surgery called “The All-American” to correct flatfoot and preserve motion. Rigid flatfoot deformities require the joints in the foot to be fused.

“My goal is always to make sure patients don’t progress to the rigid stage. It’s always better to keep the joints moving if we can,” Dr. Russ said.

If you’re worried about your foot’s arch — whether it’s high or low — schedule a consultation with one of Summit’s foot and ankle specialists. “It’s always better to intervene sooner rather than later,” Dr. Russ said.

Summit Orthopedics offers personalized foot and ankle expertise

Our fellowship-trained foot and ankle physicians understand that your mobility depends on the health of your feet and ankles. Summit Orthopedics specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely get you back on your feet and on your way.

Start your journey to optimal foot health. Find your foot and ankle expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.