Flexible Flatfoot
What is flatfoot? Flatfoot is often a
complex disorder, with diverse symptoms
and varying degrees of deformity and
disability. There are several types of
flatfoot, all of which have one characteristic
in common—partial or total collapse
(loss) of the arch.
Other characteristics shared by most types of flatfoot include:
- “Toe drift,” where the toes and front part of the foot
point outward
- The heel tilts toward the outside and the ankle appears
to turn in
- A short Achilles tendon, which causes the heel to lift off the
ground earlier when walking and may act as a deforming force
- Bunions and hammertoes may occur in some people
with flatfeet
Health problems such as rheumatoid arthritis or diabetes
sometimes increase the risk of developing flatfoot. In addition,
adults who are overweight frequently have flatfoot.
Flexible Flatfoot
Flexible flatfoot is one of the most common types of flatfoot. It
typically begins in childhood or adolescence and continues into
adulthood. It usually occurs in both feet and generally progresses
in severity throughout the adult years. As the deformity worsens,
the soft tissues (tendons and ligaments) of the arch may stretch
or tear and can become inflamed.
The term “flexible” means that while the foot is flat when standing
(weight-bearing), the arch returns when not standing. In the early
stages of flexible flatfoot arthritis is not restricting motion of the
arch and foot, but in the later stages arthritis may develop to such
a point that the arch and foot become stiff.
Symptoms, which
may occur in some persons with flexible flatfoot, include:
- Pain in the heel, arch, ankle, or along the outside of the foot
- “Turned-in” ankle
- Pain associated with a shin splint
- General weakness/fatigue in the foot or leg

Diagnosis of Flexible Flatfoot
In diagnosing flatfoot, the podiatric foot and ankle surgeon
examines the foot and observes how it looks when you stand
and sit. X-rays are usually taken to determine the severity of
the disorder. If you are diagnosed with flexible flatfoot but you
don’t have any symptoms, your podiatric surgeon will explain
what you might expect in the future.
Treatment Options
If you experience symptoms with flexible flatfoot, the podiatric
surgeon may recommend various treatment options, including:
Activity Modifications Cut down on activities that bring you pain and avoid prolonged
walking and standing to give your arches a rest.
Weight Loss If you are overweight, try to lose weight. Putting too much
weight on your arches may aggravate your symptoms.
Orthotic Devices Your podiatric surgeon can provide you with custom orthotic
devices for your shoes to give more support to the arches.
Immobilization In some cases, it may be necessary to use a walking cast
or to completely avoid weight-bearing.
Medications Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, help reduce pain and inflammation.
Physical Therapy Ultrasound therapy or other physical therapy modalities
may be used to provide temporary relief.
Shoe Modifications Wearing shoes that support the arches is important
for anyone who has flatfoot.
Surgery In some patients whose pain is not adequately relieved
by other treatments, surgery may be considered.
Flatfoot Surgery
A variety of surgical techniques is available to correct flexible
flatfoot. Your case may require one procedure or a combination
of procedures. All of these surgical techniques are aimed at
relieving the symptoms and improving foot function. Among
these procedures are tendon transfers or tendon lengthening
procedures, realignment of one or more bones, joint fusions,
or insertion of implant devices.
In selecting the procedure or combination of procedures
for your particular case, the podiatric surgeon will take into
consideration the extent of your deformity based on the x-ray
findings, your age, your activity level and other factors. The
length of the recovery period will vary, depending on the
procedure or procedures performed.
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