The answer to whether foot arches fall with age is yes, they often do. The foot contains three arches, but the medial longitudinal arch, along the inner side, is primarily responsible for supporting the body’s weight and acting as a dynamic shock absorber. This structure allows the foot to adapt to uneven terrain and efficiently distribute forces during movement. When this arch begins to flatten over time, it is a progressive process that alters the entire biomechanics of the lower limb.
Confirming the Phenomenon of Arch Collapse
The medical term for this age-related arch flattening is Acquired Adult Flatfoot Deformity (AAFD). This condition is distinct from a flexible flatfoot, which is often present since childhood and typically causes no symptoms. AAFD is a painful and progressive change that develops after skeletal maturity, characterized by the gradual collapse of a previously normal arch.
The condition is most frequently diagnosed in adults, with the average onset occurring around age 60. Females are statistically more likely to develop AAFD than males. The deformity is progressive, meaning a flexible flatfoot can eventually become a rigid flatfoot fixed in a flattened position. Recognizing this change early is important because the foot’s structure becomes increasingly difficult to correct as the condition advances.
Structural Changes That Lead to Fallen Arches
The main structural reason the arch collapses with age is the deterioration of the Posterior Tibial Tendon (PTT), known as Posterior Tibial Tendon Dysfunction (PTTD). The PTT is the primary dynamic stabilizer of the medial arch, running from a muscle deep in the calf, behind the ankle bone, and attaching to bones in the midfoot. Its role is to actively lift the arch and invert the foot during walking, preventing the foot from rolling inward.
Over decades, cumulative stress, overuse, and chronic inflammation weaken the PTT, causing it to stretch, degenerate, and lose its mechanical integrity. As the dynamic support fails, the arch begins to sag, placing strain on the foot’s passive stabilizers. The most affected static structure is the spring ligament, a thick band of connective tissue supporting the head of the talus bone, the keystone of the arch.
The failure of the PTT and the stretching of the spring ligament create a cycle of collapse. This loss of support allows the bones of the hindfoot to shift out of alignment. Excess body weight, a pre-existing mildly pronated foot, and inflammatory diseases accelerate this process by placing excessive load on these supporting structures. As a secondary change, the specialized fat padding under the heel, which functions as a shock absorber, can also atrophy with age, reducing the foot’s overall cushioning capacity.
Secondary Effects on Gait and Joint Alignment
The physical consequence of a fallen arch is excessive foot pronation, where the ankle rolls inward and the heel bone shifts outward (hindfoot valgus). This misalignment creates a ripple effect, forcing compensatory changes in the joints higher up the leg, known as kinetic chain disruption. The inward roll of the foot causes the lower leg and thigh to rotate internally.
This rotation increases stress on the knee joint, often leading to issues like patellar maltracking, where the kneecap does not glide smoothly. The misalignment continues upward, causing the hip to rotate and the pelvis to tilt forward. This pelvic imbalance strains the muscles and joints of the lower back, often manifesting as chronic low back pain.
The foot’s compromised ability to absorb shock means that impact forces are transferred directly up the leg and into the spine. Pain is initially felt along the inner ankle where the PTT is inflamed, but it often shifts to the outside of the ankle as the deformity progresses. This lateral pain occurs because the shifted bones begin to pinch against each other, leading to bony impingement and arthritis in the foot joints.
Management Strategies and Treatment Options
Treatment for AAFD typically begins with conservative measures, especially in the early stages where the foot remains flexible. Supportive footwear is a foundational element of care, often combined with custom orthotics designed to support the collapsed arch and control excessive pronation. Over-the-counter insoles offer basic cushioning but cannot correct the specific biomechanical flaws present in a foot with AAFD.
Custom orthotics are medical-grade devices crafted from a mold or three-dimensional scan of the patient’s foot. They allow for a precise, rigid correction that offloads the damaged PTT and spring ligament. Physical therapy is another crucial step, focusing on exercises to strengthen the weakened PTT and surrounding muscles. Key movements include banded foot inversion and single-leg heel raises performed with conscious control to prevent the arch from collapsing.
Surgical intervention is reserved for cases where conservative care fails to relieve pain or when the deformity is severe and progressive. For a flexible flatfoot, surgery involves reconstructing the arch by transferring a healthy tendon, such as the flexor digitorum longus, to substitute for the failed PTT. This procedure is often combined with a medial displacement calcaneal osteotomy, which involves cutting and repositioning the heel bone to realign the hindfoot. In advanced stages where the foot has become rigid and arthritic, the treatment involves fusing the hindfoot joints together to stabilize the foot and eliminate painful motion.