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The normal human foot as has a 3D structure with arches. One arch is aligned from heel to toes. The second arch is aligned across the foot. Both arches are lower in those with flat feet.

Flat feet can be normal or pathological. Most babies and toddlers have flat feet resulting from a combination of increased joint mobility and fat in their arches. Normal flat feet are symmetric, do not have any movement restriction and are generally painless. Pathological flat feet usually have some symptoms.

What are the symptoms of flat feet? Normal flat feet are usually painless, but mild pain during sports and walking activities may occur. Shoes may wear unevenly and be mildly uncomfortable. Pathological flat feet are frequently painful and sometimes rigid. Older people may develop asymmetric flat feet, meaning that they had normal or slight-flat feet that suddenly collapse into severe flat feet.

What causes flat feet? Flat feet may be congenital. However, flat feet do not cause any symptoms until late childhood. If a toddler or young child presents with painful feet, it may indicate another process is going on. Your pediatrician or orthopedic surgeon should examine a young child with painful flat feet. Older children (10 to 12 years old) and young teens with painful asymmetric flat feet may have a condition called tarsal coalition, which is a separation of the foot bones. Acquired flat feet in adults usually has tissue breakdown that contributes to the deformity. Tendons, ligaments and sometimes joints wearing out can factor into the problem.

How are flat feet diagnosed? Orthopedic surgeons have tools to assess a patient’s feet. A careful physical examination is extremely important and can alone differentiate normal flat feet from pathological ones. For adults and older children, X-Rays might be necessary. MRI examination is usually not needed.

What are treatment options? Simple measures such as in-shoe orthotics and physical therapy are often enough. Orthotics with custom-molded arches made of composite materials can provide support and relieve pain. Shoe inserts help people with flat feet to walk comfortably. Some advanced forms of flat foot disorders may require bracing if simple measures fail to provide relief.

Painful flat feet that fail to respond to non-operative measures may require surgery​ for effective treatment. A number of procedures can be used by your orthopedic surgeon. Depending on the details of the deformity, surgery involving the ligaments, tendons, bones and joints may be necessary.

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