“Fallen arches,” medically known as pes planus, describe a condition where the medial longitudinal arch of the foot collapses, causing the entire sole to make contact with or nearly touch the ground. This loss of the arch can occur from birth or develop later in life due to injury, disease, or wear and tear. Whether fallen arches can be corrected depends on the underlying cause and the foot’s structural flexibility. For most people, the goal is managing symptoms and improving function through non-surgical methods. Severe or structurally compromised cases may require surgical intervention.
Classifying Flat Foot Structure
Determining the type of flat foot dictates the treatment path. The two classifications are flexible flat foot and rigid flat foot. The flexible flat foot is the most common variety, characterized by an arch that disappears when standing but reappears when the foot is non-weight bearing, such as when sitting or standing on the toes. This type is often asymptomatic, but pain is generally treatable with conservative methods.
The rigid flat foot is a more serious structural problem where the arch remains collapsed even when the person is not standing. This can be caused by conditions like arthritis, bone irregularities, or the abnormal joining of bones, known as tarsal coalition. Rigid flat feet are more likely to cause persistent pain and mobility problems. A simple heel raise test, where the patient stands on their toes, helps differentiate the two types: arch formation suggests a flexible foot, while a persistent flat appearance points to a rigid one.
Conservative Treatment Options
For symptomatic flexible flat feet, treatment focuses on reducing pain and providing support, rather than physically restoring the arch structure. Custom or over-the-counter orthotic devices are a primary intervention, offering arch support to redistribute pressure and control excessive inward rolling of the foot (overpronation). While orthotics will not “cure” flat feet, they are effective at alleviating symptoms and improving comfort during daily activities.
Physical therapy targets the muscles and tendons that support the arch. Exercises strengthen the intrinsic foot muscles and the posterior tibial tendon, a major dynamic stabilizer of the arch. Stretching exercises address tightness in the Achilles tendon and calf muscles, as posterior chain tightness can contribute to arch collapse. Maintaining a healthy body weight also reduces stress on the feet and can slow the progression of arch collapse.
When Surgery Is Necessary
Surgery is reserved for fallen arches when conservative treatments fail to relieve persistent pain or functional limitations. It is also considered for rigid flat foot caused by congenital abnormalities or severe, progressive deformity. The goal of surgery is restoring the foot’s alignment and stability to improve function and alleviate chronic discomfort.
The specific procedure depends on the underlying cause but often involves a combination of techniques. These may include osteotomies, where bones are cut and realigned, or soft tissue procedures such as tendon transfers to replace a damaged tendon, like the posterior tibial tendon. For severe or rigid deformities, joint fusion (arthrodesis) may be performed to stabilize the foot, resulting in a stiffer foot. Patients must be prepared for a recovery period lasting six to twelve months, with physical therapy being essential for an optimal outcome.
Long-Term Management and Expectations
For most adults with fallen arches, the long-term expectation is successful symptom management and improved functional ability, not complete anatomical restoration of the arch. “Correction” means achieving a pain-free, stable foot that allows a return to normal activities. This often requires a commitment to ongoing care, even after initial treatment.
Individuals who respond well to conservative treatment need to continue using custom orthotics and performing regular strengthening exercises to maintain comfort and support. Following successful surgery, patients can expect significant pain reduction and enhanced mobility. Long-term maintenance still involves wearing supportive footwear, adhering to a physical therapy regimen, and managing body weight to protect the reconstructed foot structure.