Flat feet & high arches. Malalignment of the foot
Flat feet and high arches are often free of symptoms.
The terms flat feet and high arches initially describe the outer appearance of the foot without attaching any significance to it. Feet come in a large variety of shapes and sizes. A foot that appears to be "flat" or "arched" is very often free of symptoms. The flattening of the feet is also a normal developmental phase in children´s feet.
Further tests, diagnostics or medical treatment are always indicated, when malpositioning is extremely pronounced, new, has gotten worse or has started to cause symptoms.
Symptoms & causes for flat feet & high arches..
Definition. What are flat feet & high arches?
A flat foot (pes planus) can encompass a fallen longitudinal arch of the foot, the inward tilting of the heel and the inward tilting of the forefoot. The entire sole of the foot is more or less in contact with the ground and is the reason why the footprint covers a large area (see figure).
High arches (pes cavus) can encompass a high instep and a raised longitudinal arch as well as an outward tilting of the heel. People with high arches tend to twist their ankles more often. In extreme cases, the midfoot is twisted so that the patient can only walk on the outer edge of the foot. Only the outer edge of the foot is seen in the footprint (see figure).
Symptoms. What are signs of flat feet & high arches?
Possible problems with flat feet and high arches.
Most mild cases of flat feet or high arches are free of symptoms and do not require further treatment. When patients have flat feet, increasing pain on the inner side of the ankle can indicate an overloading of the tibialis posterior tendon. More pain can develop in this region if the the heel tilts inwards even more. When patients have high arches, pain dominates the outer edge of the foot. Patients report twisting their ankles more often and having more calluses on the skin on the edge of the foot.
Causes. How do flat feet develop?
Children up to 8 years of age.
Flat feet are a normal and temporary phase of children´s foot development. They are particularly noticeable at 4 years of age, with the foot later becoming more upright. There are two reasons why children develop flat feet. Firstly, there is more fat underneath children´s soles than adult´s soles and the foot appears to be flat. Secondly, the muscles that lift up the arch are not as well developed. Children´s flat feet are a natural component of foot development and do not require treatment. The use of arch supports is pointless, as is wearing shoes with prominent insoles. The ideal children shoe should not affect the development of the child´s foot negatively, as far as is possible. It is not likely that shoes are able to positively influence the development of the foot. Flat feet in children is very rarely the result of bone malpositioning. Further diagnostic tests are indicated when the arch does not develop by the age of 6 or when malpositioning is extremely pronounced.
Youths and young adults.
The most common causes for flat feet at this age are lax capsules and ligaments. This type of flat foot is usually not clinically significant. If the foot is stiff, abnormal connections between the individual small bones of the foot (tarsal coalition) may be causing the flat foot. Malpositioning of individual bones rarely causes flat feet.
From 40 years of age onwards.
If flat feet develop after the of age of 40 or a minor case of flat feet clearly worsens, this indicates that functional disorders in the tibialis posterior tendon may be present. This tendon normally lifts up the longitudinal arch and ensures stable ground contact. Problems here are mostly caused be degenerative changes in the tendon.
Causes. How do high arches develop?
How do high arches develop?
A number of neurological disorders can cause high arches to develop over the course of our life (e.g., Charcot-Marie-Tooth disease, Friedrich´s ataxia). The position of the small bones of the foot is abnormal in most patients with high arches. More pressure is placed on the outer edge of the foot when walking, and the outer ligaments and tendons are placed under more stress. This can promote the degeneration of these structures as the years go by.
Diagnostics & Therapy
Depending on the nature and degree of discomfort occurring flatfoot and cavus be treated conservatively or surgically.
Experts for foot disorders: Specialised clinics and hospitals for diagnostics, treatment and therapy of flat feet & high arches at a glance.