Flat Feet Overview

By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S. 

The arch of a person’s foot is the main supporting structure of the body.  It is composed of bones that are connected by ligaments.  If the ligaments are strong, the integrity of the arch remains intact.  Ligaments that are loose or weak allow the arch to flatten.  When this occurs, muscles try ineffectively to hold up the arch.  Pain in the foot, legs, ankle and back often develops.


  • Loose ligaments in the arch.
  • Trauma to tendons or bone abnormalities cause the foot to flatten. 
  • Tight calf muscles can severely aggravate the condition. 
  • Arthritis in the foot or ankle (rheumatoid, psoriatic).


  • Pain usually in the arch, ankles and legs aggravated by standing and walking. 
  • Cramping in the legs at night.
  • Premature fatigue during any type of activity. 
  • In children, a general lack of interest in participating in sports.


  • Flat arch when standing or the foot excessively points to the outside. 
  • The foot points excessively to the outside during gait.
  • Usually associated with knock-knees and abnormal shoe wear. 
  • Bulging of the bones on the inside of the ankle and foot are usually seen. 
  • Abnormal shoe wear.


  • Hammertoes, heel spurs and bunions are often associated with flatfeet as a person ages. 
  • Back and knee problems are seen, especially in children and men. 
  • Inactivity causing weight gain and poor cardiovascular fitness. 
  • Arthritis in the foot, ankle, knees, hips and back.


  • Identifying the area of pain and underlying cause. 
  • Proper shoe gear and custom molded orthotics to support the foot and the entire extremity. 
  • Physical therapy to improve flexibility, strength, balance and coordination.
  • Stretching of the calf muscles in a cast to diminish excessive strain on the arch and improve flexibility.
  • Surgery to correct the deformity and return the child or adult to full function.

Pre and Post op pictures status post subtalar implant flatfoot correction