Patient Education

Flatfoot (Flexible)

Description

Anyone who’s ever played hide and seek knows what a thrill it is to be well- hidden somewhere, perhaps only a breath or two away from the soft shoe scuffs of the seeker, almost bursting out laughing because you know if they just twitched the curtain aside, took one step behind them, or shifted the branch slightly they’d see you, grinning, right before you dashed off to whatever upended pot, tree stump or floor-strewn sweatshirt was ‘safe.’ Possibly jealous of these childhood exploits, the arches in your feet may want to get in on the hide-and-seek action. Enter the condition known as flexible flatfoot.

People with flexible flat feet have arches that disappear when they put weight on their feet, but which reappear when the feet are not weight- bearing, or when they go up on their toes. In fact, this reappearance of the arch while the foot is non-weight bearing is really what separates this type of flatfoot from other types. It’s as though the arches take toe- standing as a general call of olly-olly-oxen-free: time to come out and tease the seeker about how great your hiding place was. In short, the arches pretty much think this is the best game ever.

Flexible flat feet usually appear during childhood or sometimes a little older, and then stick around into adulthood (arches that have gotten into the habit of hide-and-seek like to keep playing indefinitely). While often innocuous, this condition (like any childhood game) can get a bit rough. Because flexible flat feet cause the tendons to stretch more than they’re really designed for, these tendons can become inflamed and cause the condition to get progressively worse over time. Unfortunately, this type of flatfoot usually shows up in both feet, although you may not have painful symptoms in both.

Symptoms

If you’ve got flexible flat feet, you’re going to have feet that appear flat while you’re standing (or that leave wet full footprints when you step out of the shower), but which get an arch when you’re off your feet, or when you stand on your toes. Some other things might also change about the appearance of your foot: your toes and the front of your foot may start to turn outwards (i.e. towards the pinky toe), so that when you look at your foot from behind (or have someone look for you), you’ll see more toes than you should. The bottom of your heel may also tilt outward, and your ankle may turn inward.

When your feet are flat (and your arches have disappeared off to who-knows- where), it changes the way your weight is placed on your foot, and the way you move when you walk. Because of this, people with flexible flat foot may feel pain in parts of their body that are moving or bearing weight abnormally. For instance, in the foot, you may start to feel pain in your heel, arch (when your arches are willing to be found), ankle, or on the outside of your foot. You may also experience pain up into your legs (shin splints, usually), knees, hips, and lower back. Or, to keep things all equal, you may have a general ache in your legs or feet. You may also develop other symptoms such as a tight Achilles tendon, bunions and hammertoes. All fun and games, right?

Diagnosis

Your podiatrist is an excellent arch-seeker, and if you have flexible flatfoot, he or she will be able to coax it out of hiding. Making the diagnosis usually involves observing your foot both while it’s bearing your weight, and while you’re sitting or standing on your toes. Sometimes X-rays are used to find out just how far your flexible flatfoot has progressed.

Treatment

If you’re not experiencing any pain with your flexible flat feet, then treatment may not be required. However, orthotics (prescription shoe inserts) may still be a good idea, to try to prevent future problems. Conversely, if your hideaway arch is causing problems such as pain or other symptoms, there are a few things you can do (or your doctor can do for you) to provide the support you need.

Again, orthotics often help correct the imbalances in the foot, and may be useful in providing extra support and realigning your foot properly. Shoes and shoe inserts that support the arch are particularly helpful for obvious reasons.

In addition, you may wish to eliminate or at least reduce the types of activities that are currently causing you pain, at least until your symptoms die down. (Discomfort and pain from flexible flat feet often occurs with certain types of activity, such as walking, running and prolonged standing.) If being overweight is adding to the stress on your feet, you may wish to talk to your doctor about weight loss. Losing weight may significantly reduce your symptoms.

You can also reduce inflammation in your foot by immobilization (often through use of casts or braces, or sometimes being completely off your feet for awhile), taking anti-inflammatory medication (such as ibuprofen), and undergoing physical therapy, such as ultrasound treatments.

If these methods fail to significantly reduce your pain, then surgery may be the best option to get your arches to stop playing around. Your podiatrist can discuss the options available to you.