Fallen arches symptoms

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Pes planus is a condition where the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops. This common foot condition is called flatfeet. If you have a flat foot, the arch on the inside of your foot is flattened. Flatfeet usually don't cause a problem. However, flatfeet can contribute to problems in your feet, ankles and knees. Simple corrective devices are available to help prevent complications of flatfeet.

Because your feet support all of your weight and help you balance when you stand, they're subject to substantial pressure and risk of injury.

With flatfeet, you may experience the following signs and symptoms:

• A flat look to one or both of your feet (absence of longitudinal arch of foot when standing)
• Uneven shoe wear and collapse of your shoe toward the inside of your flat foot
• foot pain
• heel tilts away from the midline of the body more than usual
• Lower leg pain
• Pain on the inside of your ankle
• Swelling along the inside of your ankle

Your feet are highly specialized structures. Each foot is made up of 26 bones held together by 33 joints and more than 100 muscles, tendons and ligaments. The intricate alignment of these structures results in the formation of your arches.

As you walk, these springy, elastic arches help distribute your body weight across your feet and legs. Your arches also play an integral role in how you walk. They act as rigid levers for proper mobility, but they must also be resilient and flexible to adapt to various surfaces.

Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches.

But some people never develop arches. This is a normal variation in foot type, and people may or may not have problems without arches. Lax ligaments can cause flatfeet, as can congenital conditions that affect the foot.

Painful flat feet in children are often caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together limiting motion and often leading to a flat foot.

Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean towards each other (after they have been worn long enough for the foot position to remodel their shape).

Arches can also fall over time. Years of wear and tear can weaken the posterior tibial tendon, which runs along the inside of your ankle, from above your ankle to your arch. The posterior tibial tendon is the main support structure for the arch. An overload to this tendon can cause inflammation of the tendon (tendinitis) and even tearing of the tendon. Once the tendon is damaged the foot's arch loses support and can flatten.

Years of wear and tear can weaken your posterior tibial tendon, the main support structure for your arch.

You may lose support in your arches due to:

• Ongoing stresses in your feet. One of these stresses may be long-term wearing of high heels, which can affect your Achilles tendon and change the mechanics of your ankles. Compensation by the posterior tibial tendon may eventually cause it to break down and your arches to fall.
• Obesity.
• Traumatic injury to your foot or ankle.
• Rheumatoid arthritis.
• Diabetes.
• Weakened muscles due to aging or heavy strain placed on the feet.
• Wearing shoes that don’t provide proper arch support.

Your doctor will discuss your medical history and examine your feet. As part of the examination, your doctor will observe your feet from the front and the back and ask you to stand on your toes so he or she can view the mechanics of your feet.

To view the interior structure and bones of your foot, your doctor may request an imaging test of your foot, which may include an X-ray or a magnetic resonance imaging (MRI) scan.

Flatfeet may contribute to or worsen other foot problems, including:

• Inflammation and pain in the ligaments in the soles of your feet (plantar fasciitis)
• Achilles and posterior tibial tendinitis
• Shin splints
• Stress fractures in your lower leg
• Bunions
• Calluses


The biggest signs of flat fleet are discomfort and pain. As the normal arch begins to drop, walking can become very uncomfortable. The foot can also turn outward at the ankle, causing a walk that’s concentrated on the inner boarder of the foot.

Due to the less supportive structure of a flat foot, postural strain and misalignment through the foot, ankle, knee and lower back can cause consistent daily discomfort.

The depression of the arch in the foot also puts more strain on the ligament and tendons that support the foot and ankle, and over time, the bones may collapse. Flat feet can therefore lead to heel spurs, ankle sprains, hip and lower back pain, and even contribute to the development of arthritis.

In many people flatfeet don't cause problems. It may be that your lower extremity alignment accommodates for your flatfeet, and you may not have any pain or symptoms. If flatfeet are causing you problems, you may be able to reduce foot pain by wearing over-the-counter insoles or arch supports. Ask your doctor whether these are appropriate for you.

Custom-designed arch supports, commonly called foot orthotics, are interchangeable among your shoes and may last longer than other more temporary supports. Foot orthotics, which are molded to the contours of your feet, slip into your footwear like other types of ready-made shoe inserts. Orthotics come in three types: rigid, semirigid and soft. The type you may wear depends on what kind of support you're doctor is trying to provide to your feet. Use insoles that support the arch and help stabilize the heel.

Depending on the diagnosis and on the severity of your foot or lower leg symptoms, your doctor may advise you to limit your weight-bearing activities while wearing a walking boot or orthotics. This gives time for the swelling and pain in your feet to subside and allows your feet to regain their full range of motion.

If you have tendinitis of the posterior tibial tendon, you may need to insert a wedge along the inside edge of the orthotic to take some of the load off the tendon tissue. Your doctor also may advise that you wear an ankle brace or a walking boot for a time until the tendon inflammation subsides. In severe cases, you may need tendon surgery. Offer support and stability through the arch.

Once your symptoms have subsided, you may find that you can return to normal activities, including exercise. However, nonweight-bearing exercise, such as cycling and swimming, may be best. In addition, your doctor may advise continued use of orthotics while walking.

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