The Center for Podiatric Care and Sports Medicine

Flat Feet: How Serious Are They for Foot Health?

Posted by on Wednesday, October 9th, 2013


It is estimated that 20-30% of the general population has a condition known as “flat feet,” “pes planus,” or “fallen arches.” You can tell just by looking — if your foot rests completely flat on the ground, with no arch space in between the heel and ball of the foot. Stepping a wet foot onto a piece of paper will also reveal a larger, fatter footprint.

flat foot
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Yet, is a flat arch a real cause for concern that can lead to debilitating pain and other issues in the future… or is it just part of what makes one person different from another? The Center for Podiatric Care and Sports Medicine in NYC weighs in.

What Causes Pes Planus?

A flat arch is a normal finding in children, since it could take until age 7-10 for an arch to fully form. Children who run around barefoot all the time or who are overweight / obese are more likely to have flat arches as adults. There is also a genetic component that leads fallen arches to run in families. Particularly strong foot muscles in athletes can cause the surrounding tendons to stretch out flat. Occasionally, arches will fall as the result of rheumatoid arthritis or another neuromuscular condition.

Are Fallen Arches A Problem?

“Very flat feet feet can lead to serious tendon problems over time,” says Dr. Nadia Levy, adding that “orthotics work great to prevent a problem before it occurs.”

“Many people have ‘flat feet,’ but that doesn’t  mean they are symptomatic or that they have limited function,” adds Dr. Ryan Minara. However, he does see some people with debilitating pain whose flattened arches are to blame. “Sometimes flat feet can lead to joint pain elsewhere in the body, including the ankles, knees, hips, and back,” he says.

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During a visit to a podiatrist, a physical exam will test the strength of the muscles and tendons of the legs and feet. The shoes will also be checked for abnormal wear patterns. X-rays may be done in patients who exhibit symptoms of chronic pain.

How To Treat Flat Feet

“Flat feet issues may be resolved with external support like custom foot orthoses,” says Dr. Minara, “or internal support with surgical correction.” He says the most common symptoms include pain, swelling, and back pain. Most acute cases are treated with rest, ice, anti-inflammatory medication, and orthoses. Chronic symptoms can be relieved with physical therapy, stretching exercises, or wearing a cast to correct the deformity.

orthotics for flat feet
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Stubborn cases of rigid pes planus (in about 2-3% of sufferers) may require surgery. In a procedure called an osteotomy, doctors will extract hipbone marrow and soak a bone graft from a cadaver in the marrow so the body will accept it. From there, the graft is wedged in the ankle to change the shape of the foot and ease pressure. The heel is sliced off, moved over a few millimeters and anchored back down with screws to create an arch. Any calf muscle or tendon deformities from years of walking with an unnatural gait can also be addressed by slicing a release.

Needless to say, it’s an expensive surgery, not to mention, a painful and lengthy recovery. As one NY Times writer described it, “… I was punching the air blindly and biting the cushions on my couch. I couldn’t get the pills down my throat fast enough.” After five days on painkillers and two weeks of rest, most people can resume some semblance of a normal life. Yet, it will be another four weeks in a non-weight-bearing cast and ten weeks before physical therapy may begin. By four months, most people are recuperated fairly well, but it could take up to a year to bounce back to completely pain-free living.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.