Bilateral pes planus, commonly known as flat feet, is a condition where the arches on the inside of both feet flatten, causing the entire sole to make contact with the ground when standing. This anatomical variation can be present from birth or develop over time. While many individuals with flat feet experience no symptoms, for others, it can lead to discomfort and affect daily activities.
Understanding Bilateral Pes Planus
Bilateral pes planus refers specifically to the flattening of arches in both feet. This condition exists primarily in two forms: flexible and rigid. Flexible flatfoot is the more common type, where an arch is visible when the foot is not bearing weight, but disappears upon standing. This type often develops in childhood, with most children forming arches by around age 10. In contrast, rigid flatfoot means the arch remains flattened regardless of whether the foot is bearing weight. Rigid flatfoot is less common and often indicates a structural issue.
Genetic predisposition plays a role, as some families naturally have flatter arches. Developmental factors, such as incomplete arch formation during childhood, can lead to flexible flat feet persisting into adulthood. Acquired flatfoot, often called “fallen arches,” can result from conditions like posterior tibial tendon dysfunction, where this important tendon weakens and can no longer support the arch. Injuries, such as foot bone fractures or ligament trauma, can also lead to acquired flatfoot. Underlying medical conditions like arthritis, diabetes, and certain neurological problems (e.g., cerebral palsy or spina bifida) may contribute. Obesity and pregnancy, due to increased weight and ligament laxity, are additional factors that can influence arch collapse.
Recognizing the Signs
Individuals with bilateral pes planus may experience various symptoms, though some have no noticeable discomfort. A common indicator is pain in the foot, occurring in the arch, heel, or ankle. This pain often results from strained muscles and connective tissues in the midfoot, heel, lower leg, knee, hip, and even the back, as the body compensates for altered foot mechanics.
Fatigue in the feet or legs, especially after walking or standing for extended periods, is a frequent complaint. Lack of proper arch support can lead to increased stress on various parts of the lower body. Changes in gait or walking patterns are common, with the foot often rolling inward excessively (overpronation). Swelling along the inside of the ankle may signal underlying tendon damage or inflammation. Difficulty performing certain physical activities, such as running or standing on tiptoes, can also be a symptom.
Diagnostic Methods and Management Options
Diagnosing bilateral pes planus typically involves a comprehensive physical examination. The provider observes the foot’s shape, position, movement, and how the individual stands and walks. Differentiating between flexible and rigid flatfoot involves observing the arch when not bearing weight versus its disappearance when standing. Gait analysis, which studies walking patterns, can assess the condition and its impact on movement. Imaging techniques, such as X-rays, are often used to confirm the diagnosis, evaluate bone alignment, and identify structural abnormalities. In some cases, MRI or CT scans may provide a more detailed view of soft tissues or complex bone structures.
Management of bilateral pes planus largely focuses on conservative treatments, especially when symptoms are present. Orthotic devices, such as custom-made insoles or arch supports, are frequently recommended to provide support, redistribute pressure, and improve foot mechanics.
Physical therapy plays a significant role, involving exercises that strengthen foot, ankle, and leg muscles, and stretches to improve flexibility, particularly for tight calf muscles or the Achilles tendon. Lifestyle adjustments, including wearing supportive footwear with adequate arch support and cushioning, are important.
For some individuals, pain relievers like NSAIDs may manage discomfort and reduce inflammation. Surgical intervention is generally a last resort, reserved for severe cases where conservative treatments fail to provide relief from persistent pain or significant functional limitations. Procedures can involve realigning bones, repairing or reconstructing tendons and ligaments, or fusing joints to restore arch stability.