Flat Feet (Pes planus)

The human foot is an engineering marvel, made up of 26 bones, 33 joints. 19 muscles, and more than 100 ligaments. Two arches -- a longitudinal one in the midfoot and a short one in the forefoot -- act as bony bridges to support the foot and function as shock absorbers.

Flat-footedness occurs when the longitudinal arch is flattened, so that the entire sole of the foot rests on the ground. The condition is common during early childhood, when the arch is tilted in with baby fat. As the ligaments in the foot grow stronger, however, the arch normally develops to the point at which a wet imprint on a flat surface will show an empty space between the ball of the foot and the heel. This space is bounded only by an impression of the outer edge of the foot. In flatfooted individuals, the space does not exist.

A flat foot with a flexible arch does not usually cause problems, but rigid, or structural, flat-footedness -- in which the arch is nonexistent because the foot bones are improperly aligned -- may be disabling. Flat feet resulting from the abnormal development of a bony bridge in the place where a normal joint or space should form can also cause walking difficulties. These unusual conditions generally become apparent between the ages of 8 and 15.

Diagnostic Studies and Procedures

Many primary-care doctors can diagnose flat-footedness on the basis of X-rays and close examination of the bare foot. Podiatrists and orthopedists who specialize in foot problems sometimes use a computerized gait analysis in assessing bone alignment during walking and other foot movement. Other procedures used in diagnosing flat-footedness, especially in children, include checking the flexibility of the arch after taking a footprint and examining the pattern of wear on shoes.

Medical Treatments

Most flat feet do not require medical treatment. However, some conditions that develop during childhood may need surgical correction. For example, if misaligned bones are creating flat-footedness, they can be surgically realigned. Similarly, abnormal bony growths can be removed. The earlier an operation is performed, the better the results will be.

Podiatrists often prescribe orthotic devices for flat feet, especially for runners and others whose feet are subjected to considerable stress. Made from metal and rigid plastic, these devices can support weak ligaments, muscles, and foot joints. Some types can also alleviate pain or compensate for legs of uneven length. The devices are custom-made from plaster molds of the feet.

Alternative Therapies

Foot Massage and Reflexology. Treatments that combine massage, hydrotherapy, and reflexology can alleviate foot pain.

Physical Therapy. Exercises designed to strengthen the muscles in the foot may be combined with orthotics.

Self-Treatment

If the flat feet are causing discomfort, orthotic inserts, foot cushions, pads, supports, and lifts can help to alleviate it. Before investing in custom-made devices, however, try creating your own by cutting and reshaping nonprescription foot products, available in drugstores and shoe-repair shops.

Make sure your shoes fit properly and have built-in arch supports. This is especially important for exercise shoes. Also, select shoes designed specifically for your physical activity, running shoes are not appropriate for extensive walking and vice versa.

Women with flat feet should avoid high heeled shoes. Ideally, the heel should be one inch high or less. If you feel compelled to wear shoes with higher heels, at least make sure they have an arch support and are large enough to accommodate a half insole to help keep your foot in place.

Whenever possible, walk barefooted. Walking in the sand is especially good for strengthening foot muscles.
Do foot exercises that are designed to strengthen arch muscles. Wiggle your toes and then rotate your ankles 10 times to the left and 10 times to the right. Practice picking up a marble or cotton ball with your toes, doing it 20 limes with each foot.

You can also try foot massage methods used by reflexologists and massage therapists. After soaking your feet in warm water or a foot Jacuzzi, manipulate the soles and heels with firm circular motions. "Walk" your thumb across the sole horizontally, pressing firmly at the base of each toe.

Other Causes of Flat Feet

Some circumstances contribute to so-called fallen arches. These include obesity, arthritis, fractures, and a job that requires long hours of standing.