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The arch of the foot usually develops between the age of 3 and 5 years. Flatfoot, also known as fallen arches or pesplanus, is a deformity in which the arch that runs along the sole of the foot is not formed (in children) or collapses to the ground (in adults due to various foot problems). Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment unless pain is involved, while rigid flatfoot usually requires intervention.

Causes and risk factors

Pediatric flat foot is a common condition that can run in families. It is often caused by abnormalities between joints while your baby is developing in your womb. A rare condition called tarsal coalition can also cause flatfoot, where two or more bones of the foot join together abnormally causing stiff and painful flat feet. In adults, flat foot can develop from stretched, damaged, torn or inflamed tendons, fracture or dislocation, rheumatoid arthritis or nerve problems.

Signs and symptoms

Flatfoot deformity may have one or more of the following signs and symptoms:

  • Inside arch of the foot is flattened
  • Heel bone may be turned outward
  • Inner aspect of the foot may appear bowed out
  • Pain in the foot, leg, knee, hip or lower back
  • Pain in the heels causing difficultly with walking/running
  • Discomfort with wearing shoes
  • Tired, achy feet with prolonged standing or walking


The doctor will perform a physical examination of the affected foot and observe it while standing, on tip-toe and sitting positions. The wearing on the shoes may also be observed. X-rays, computed tomography (CT) scan and magnetic resonance imaging (MRI) may be ordered.

Conservative Treatment

If there is no pain, apart from regular monitoring, no treatment is required. To relieve symptoms, the following non-surgical treatments may be suggested:

  • Activity modification: Avoid participating in activities that cause pain such as walking or standing for long periods of time.
  • Orthotic devices: Wear custom-made orthotic devices inside the shoes to support the arch of the foot.
  • Physical therapy: Perform stretching exercises of the heel for pain relief.
  • Medications: Take medications such as NSAIDs prescribed by your doctor to reduce pain and inflammation.
  • Shoe modification: Wear well‐fitting, supportive shoes that can help relieve aching pain caused by flatfoot.

If conservative treatment options fail to relieve flatfoot symptoms, surgery may be necessary. Various procedures may be performed including cutting and realigning of bone, tendon transfers, tendon lengthening and bone fusion.

Biomechanical Examinations

Biomechanics is the study of the movement of parts of our body. Biomechanical analysis or examination is an important tool that helps determine the cause of injuries and ways to prevent them. It plays an important role in sports medicine, where physiotherapists analyze various sports to determine safe and effective techniques.

Biomechanical examination involves three general aspects:

  • Subjective or qualitative method: Gait or movement of a patient or athlete during a specific sports activity is observed for gross abnormalities. This assesses an athlete’s skill or quality of a performer. Every movement of the athlete is closely and repeatedly observed on the whole and with regard to individual movements that a particular sport requires.
  • Objective or quantitative method: Specific performance goals are set and numerical variables assigned to each, and the athlete is evaluated based on these values.
  • Predictive analysis: Computer simulation using a computer model of an athlete helps ascertain the outcomes of alterations to a particular sports technique in order to perfect the technique. This helps in enhancing performance.

From this analysis, biomechanical flaws that predispose you to injury can be detected and further information will be provided about why you have pain, why you have developed an injury and how it can be prevented in future. This information guides you and your doctor in identifying a clinical diagnosis, management and injury prevention.

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