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Flat feet, also called pes planus or fallen arches, is the condition in humans in which arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. In some individuals (an estimated 20-30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally). Horses can also develop flat feet.
Flat Feet in Children
The appearance of flat feet is normal and common in infants, partly due to "baby fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Training of the feet, especially by foot gymnastics and going barefoot on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years.
Recent medical research indicates that arch support inserts and certain heel cups, inserted into a growing child's shoes, can facilitate the proper development of the longitudinal arch, by holding the foot in the correct neutral position while it is growing. There is little debate, however, that going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitis. One medical study in India, with a large sample size of children who had grown up wearing shoes and others going barefoot, found that the longitudinal arches of the barefooters were generally stronger and higher as a group.
Flat Feet in Adults
Flat feet can also develop as an adult ("adult acquired flatfoot") due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics, or as part of the normal aging process. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin (elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
If a youth or adult appears flatfooted while standing in a full weight-bearing position, but an arch appears when the person dorsiflexes (stands on tip-toe or pulls the toes back with the rest of the foot flat on the floor), this condition is called flexible flatfoot. Muscular training of the feet, while generally helpful, will usually not result in increased arch height in adults, because the muscles in the human foot are so short that exercise will generally not make much difference, regardless of the variety or amount of exercise. However, as long as the foot is still growing, there is still a possibility that a lasting arch can be created.
Treatment
Most flexible flat feet are asymptomatic, not painful; in these cases there is no real cause for concern. Rigid flatfoot, a condition where the sole of the foot is rigidly flat even when a person is not standing, can be legitimate cause for concern, however. Other flatfoot-related conditions, such as various forms of tarsal coalition (two or more bones in the midfoot or hindfoot abnormally joined) or an accessory navicular (extra bone on the side of the foot) should be treated promptly, usually by the very early teen years, before a child's bone structure firms up permanently as a young adult. Both tarsal coalition and an accessory navicular can be confirmed by x-ray.
Treatment of flat feet may also be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the back. Treatment may include using arch supports/orthotics, foot gymnastics or other exercises as recommended by a podiatrist or other physician. Surgery, while a last resort, can provide lasting relief, and even create an arch where none existed before.
Attitudes
Although frequently a cause of worry by anxious parents, who think the appearance of a flat foot is not "normal" in their developing child, a flat foot is well within the normal range of foot types. Any child who complains of foot pain should have his or her feet examined. Some argue, however, that rather than focusing on trying to get an arch to develop in the child's foot, it is far better encourage a healthy self-acceptance of being flatfooted, since a flat foot is still considered by some to be less than ideal. Functionally, one study showed the complete opposite: soldiers with a flexible flatfoot condition were actually less prone to injury than soldiers with a very high arch--because the flat, more pronating foot is more able to accommodate repeated or unusual pressure than a high arch, which is inherently a poor shock absorber. The high-arched soldiers had an appreciably higher incidence of stress fractures as a result of their inflexibly high arches.
As an example of the kind of attitude adjustment that may be more helpful than surgery, one flatfooter was quoted some years ago as feeling more "grounded", saying "I like the thought of having my entire sole making contact with the ground--it means there's more of me in contact with Mother Earth--plus, I just like the way it feels."
Many of the fastest runners--including Olympic record-setters--have had totally flat feet with no arch at all. The choice of proper footwear, including stability or motion-control shoes, can be helpful, but other flatfooted Olympians have run the course barefooted. In fact, having a flat foot can result in somewhat less-efficient movement--which makes these Olympians' accomplishments all the more noteworthy.
References
MedlinePlus: Pes planus
"Flat feet"