All You Need To Know About Flatfeet and High Arched Feet

Adult acquired flatfoot deformity (AAFD) is a condition that leads to a fallen arch with one’s foot pointed outward. It is caused by a range of foot problems.

Orthotics, braces and physical therapy are able to treat most cases, no matter the cause of flatfoot. If all else fails, surgery can be performed to effectively treat the pain and deformity.

In this article, we will cover a brief outline of the issues that can lead to AAFD. More in-depth information on the typical conditions that may lead to an acquired flatfoot and their treatment options can be found in separate articles.

What are the symptoms of adult acquired flatfoot?

A person suffering from flatfoot may experience one or more of these symptoms, depending on the cause of their condition:

  • Pain along the course of the posterior tibial tendon lying on the inside of the foot and ankle. This can be linked to swelling on the inside of the ankle.
  • Pain that worsens with activity. Activities that are high impact and intensity, such as running, can be very difficult. Some patients even find it hard to walk or stand for long hours. They may also have difficulty with balancing and jumping on one leg.
  • Pain on the outer side of the ankle. When the foot collapses, the heel bone may shift position and as a result, put pressure on the outside ankle bone (fibula). This causes pain, which can also be caused by arthritis in the heel.
  • Painful, bony bumps on the top and inside of the foot. This is especially prevalent in patients with an old injury or arthritis at the centre of the foot. This can make shoewear very difficult. At times, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
  • A large bump or swelling on the bottom of the foot. Diabetics may only notice this symptom. Because their sensation is affected, they may not have any pain. This large bump can cause skin problems and ulcers if proper diabetic shoewear is not used.
  • The “too many toes” sign. This is another common symptom of flatfoot, where even the big toe can be seen from the back of the patient’s foot. In a normal foot, only the fourth and fifth toes should be visible.

What causes adult acquired flatfoot?

As mentioned above, there are various health conditions that can cause a painful flatfoot.

Posterior tibial tendon dysfunction (PTTD)

The most common cause of AAFD is damage to the posterior tibial tendon. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot. Its main function is to hold up the arch and support the foot when walking. Once the tendon is torn or inflamed, the arch will slowly collapse.

Women and people over the age of 40 are more likely to develop issues with the posterior tibial tendon. Hypertension, obesity and diabetes are some other risk factors. If one has had flat feet since childhood, the risk of developing a tear in the posterior tibial tendon is higher. Additionally, those who are involved in high-intensity sports such as soccer, tennis or basketball may have tears of the tendon from repetitive use.

Arthritis

Another cause of a painful flatfoot is inflammatory arthritis, such as rheumatoid arthritis. This kind of arthritis affects not only the cartilage in the joints, but also the ligaments that support the foot. On top of the pain it brings, inflammatory arthritis also causes the foot to change in shape and become flat. It can affect the back or middle of the foot, both of which can result in a fallen arch.

Injury

The ligaments support the bones and prevent them from moving. When the ligaments in the foot are injured, the joints can fall out of alignment. If the ligaments are torn, the foot will become flat and painful. Although this usually occurs in the middle of the foot, known as a Lisfranc injury, it can also occur in the back of the foot.

Besides ligaments injuries, dislocations and fractures of the bones in the midfoot can also lead to a flatfoot deformity.

Diabetic collapse (Charcot foot)

Diabetic patients and people with a nerve issue that limits normal sensation in the feet can have arch collapse. An arch collapse of this kind is usually more severe than that seen in patients with normal feeling in the feet. This is because these patients do not feel pain as the arch collapses. On top of the ligaments not holding the bones in place, the bones themselves can fracture and disintegrate at times — all this without the patient feeling any pain. As a result, the foot may be severely deformed and very challenging to correct with surgery. The best solution to this problem is to use braces or special shoes.

Summary

Adult acquired flatfoot is one of the most common conditions that affect the foot and ankle. There is a range of treatments available from nonsurgical methods, such as braces and orthotics, to surgery. Depending on the cause of AAFD, doctors will come up with a treatment plan for each individual.