If your arches are flat and the feet point outward, you have flat feet. Oftentimes the bones on the middle of the foot may touch the ground when you walk. If you have pain in the heel, arch, or ankle, you may have painful flat feet and need to be seen by a podiatrist for relief.
Flatfeet or fallen arches is when the arch on the inside of the feet flattens and the entire sole of the foot touches the floor when the person stands up. Flat foot is a common, and usually, painless condition, where the arches do not develop during childhood or may be flattened due to an injury or other foot changes. Flatfeet can sometimes cause problems in the ankles and knees because it changes the alignment and functioning of these joints too.
Anatomy: There are two main arches on the bottom of the foot, the long one down the middle of the foot and a side lying one; they are maintained by the shape of the bones, muscles, tendons and ligaments of the feet. The posterior tibial tendon and the spring ligaments are important parts of the foot to maintain the arch, and when they are damaged can lead to flatfeet. It is estimated that 20 to 30 percent of the general population never develops an arch in one or both feet.
Causes of adult flat feet: A flat foot is normal in infants and toddlers, because the foot hasn't yet developed the arches. In most people the arches develop throughout childhood, but in some people the arches never develop. This is one of the most common foot types, and some of these people without arches may or may not have foot pain or problems.
On the other hand, arches can also fall over time (adult acquired flatfoot). Years of wear and tear can weaken the posterior tibial tendon, which runs along the inside of your ankle and maintains the arch. Flatfeet can also develop as a result of an injury, illness/disease such as diabetes, biomechanics (excessive pronation or rolling inwards of the foot), or as part of the normal aging process. Dysfunction and injury to the posterior tibial tendon is one of the most common causes of flatfoot. Other known risk factors include obesity, aging, arthritis and chronic diseases (hypertension and diabetes). Temporary flatfoot can also occur in pregnant women as a result of weight gain and hormonal changes, which can become permanent later. Flatfoot is most common in women over the age of 40.
Symptoms: In individuals with flexible flatfeet the arch will be absent on standing (weight-bearing), however, when standing on tiptoes or when flexing the toes, the arch reappears. These persons may not have any foot pain or complaints. However, some people experience foot pain particularly in the heel or arch area, difficulty standing on tiptoes, swelling along the inside of the ankle, the foot turns outward and can cause pain in the ankles and knees too. If foot pain persists, it is time to see the podiatrist.
Diagnosis: When you go and see the podiatrist, your medical and family history will be reviewed and your feet examined. The podiatrist will also observe your feet from the front and the back. You will be asked to stand on your toes and walk to see the way the foot works. Your shoes will also be observed for wear pattern. X-rays will be taken to examine the joints and bones of the feet.
Treatment: No treatment is necessary for flexible flatfeet, if there is no pain. Often times, over-the-counter insoles and supportive shoes are recommended to assist in supporting the foot structures and prevent future foot pain. For persons experiencing foot pain, rest is important. Your podiatrist will recommend rest and avoiding activities such as walking barefoot, or sporting activities that may aggravate your condition until your feet heal. The use of medications such as non-steroidal anti-inflammatory pain killers can assist with pain relief.
Orthotics: For persons experiencing foot pain, the podiatrist will prescribe shoe inserts (orthoses or orthotic devices). Based on the severity of the flatfoot, these can be over-the-counter arch supports, or custom-designed arch supports that are molded to the contours of the feet and will relieve foot pain. Shoe inserts won't cure the flatfeet, but they will reduce the symptoms, raise the arch, give the support the foot needs to prevent foot pain and help them to work better. Once ordered, orthoses are generally worn for life to support the feet and prevent pain. They will need to be replaced or repaired over time.
Shoes: Wearing the right type of shoe is also important to support the feet. Sneakers or well-constructed supportive shoes with good arches are the best type of shoes to wear. If you are overweight, weight loss is also a very important way to help in the treatment of flatfeet.
Stretching exercises are also important, because some people with flatfeet have a tight or shortened Achilles tendon (heel cord). Exercises to stretch this tendon may help.
Surgery: If disabling foot pain continues, surgery may be needed to provide long-lasting relief. Surgery is necessary to relieve the symptoms as well as improve the foot structure and function. The surgical procedure or procedures are selected depending on the severity of the symptoms, the type of flatfoot, and the degree of deformity. Surgery can be performed to realign tendons, ligaments, muscles and bones, which will create a permanent arch in the foot.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996, or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport, Grand Bahama, telephone 373-7400.

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