Arch Conditions: Flat Feet and Cavus Foot

What are flat feet? 

Flat foot is a common condition that can be congenital (you're born with it) or can develop over time. Most people who have flat feet have no symptoms and their feet function normally. But in others, it causes pain and discomfort.

Adult acquired flatfoot (flexible flat foot) 

Adult-acquired flat foot is (as the name implies) acquired over time. Often, there’s no arch when the person walks, but there is an arch when they sit or stand on their tiptoes.

Risk factors for adult-acquired flat foot include:

• Poster tibial tendon dysfunction: Damage to the posterior tibial tendon, which is the main tendon supporting the arch of the foot, can lead to flat foot. With a tear in the tendon caused by many years of abnormal strain, the foot’s arch will begin to collapse as the posterior tibial tendon weakens and unravels.
• Tight Achilles tendon and/or calf muscle: The tight muscles and tendons bring the heel off the ground too early with each step.
• Overpronation: If your foot rolls inward as you walk, you’re putting strain on the muscles, tendons, and ligaments that support your arches.
• Rheumatoid arthritis: RA is an autoimmune condition that can destroy tendons in the foot, which can cause flat feet.
• Other contributing causes of flat foot include obesity, hypertension, and diabetes mellitus.

Pediatric flatfoot

As a baby grows, the tendons in their feet strengthen, helping to form a normal arch in the foot. But in some children, an arch never develops properly, which can cause various problems.

Some children with flat feet experience foot pain or discomfort during exercise and may start to withdraw from sports and other physical activities. In some cases, the fallen arch can cause the knee and leg to rotate inward, which can cause foot, back, and knee problems.

It’s important to seek medical advice to avoid any further pain or future foot problems. Children can suffer from both flexible and rigid flat feet conditions. 

Tarsal coalition 

Tarsal coalition, also known as rigid fixed flatfoot, is a type of flat feet in which the foot is permanently fixed in a flat position. This can happen when two bones in the rear of the foot are fused together from birth, rendering the joints of the hindfoot and foot, in general, less mobile.

Although most people with fixed flatfoot are born with the condition, usually symptoms won’t manifest until the foot bones start to mature, around puberty (ages 9-15).

What are the symptoms of flat feet?

While the most obvious symptom of flat feet is noticeably flat feet, there are many other side effects that can alert us that your flat feet need to be evaluated by our professionals. Some of these include:

• Pain in the lower back
• Aching pain in the arch, heel, ankle, or lower leg
• Shin splints (pain running up the shin bone, especially when weight-bearing)
• Ankle rolling inward
• Foot and leg fatigue after a few hours of standing or walking
• “Toe-drift,” a condition in which the toes gradually begin to point outward. This tendency can cause bunions and hammertoes in some patients.

How is flatfeet diagnosed? 

The podiatrists at University Foot and Ankle Institute are experts in a wide range of foot and ankle problems—including flat feet. 

The first step of diagnosis is a close physical examination of your feet and how your foot moves and changes shape while sitting, standing, or taking steps. An X-ray can help us understand the severity of the condition. We may also order an MRI to get a look at your tendons and ligaments—especially if we suspect a tear.

How is flatfoot treated? 

Treatment for flat feet usually only requires support and pain management. At UFAI, we always start with the most conservative, least-invasive option where possible. 

We have many possible treatment options for relieving your flat feet.

What are conservative treatments for flat feet? 

Most cases of flatfoot deformity can be treated conservatively. There are several non-surgical options that you can use to relieve your discomfort, including:

• Supportive shoes with firm soles.
• Orthotic inserts
• Custom bracing
• Modify painful activities
• Nonsteroidal anti-inflammatory (NSAID) painkillers
• Lose excessive weight
• Physical therapy

Regenerative treatments for flatfoot 

Restorative medicine options have improved our current treatments for flat feet and dramatically decreased the need for surgery.

Restorative medicine is the ability to increase the body’s own capability for healing damaged tendons or ligaments. Some restorative treatment options include platelet-rich plasma, amniotic stem cell injections, and bone marrow stem cell therapy.

Surgery to treat flatfoot 

In severe cases, conservative treatments cannot target the underlying issue causing your discomfort. In these cases, our specialists may recommend flatfoot reconstruction surgery. 

We have several surgical techniques to choose from and will custom-tailor your treatment plan to your individual needs. The best option will depend on the cause and severity of your flat foot.

What is a cavus foot? 

A cavus foot is the opposite of flatfeet. A cavus foot has a very high arch. It is often present at birth, although it can develop at any age. It can affect one or both feet. The high-arched foot places an excessive amount of weight on the ball and heel of the foot when walking or standing.

Diagnosing cavus foot includes a review of the patient’s family history along with a physical examination. Our foot and ankle surgeon examines the foot and tests your muscle strength. We’ll also observe your walking pattern and coordination and study the pattern of wear on your shoes.

X-rays are sometimes ordered to assess the condition further. In addition, our specialist may refer the patient to a neurologist for a complete evaluation if a neurological condition appears to be present.

What are the symptoms of cavus foot? 

To begin with, the arch of the foot will appear higher than usual. While not everyone with a high-arched foot has symptoms, over time, your metatarsals (the long bones between your ankle and toes) can start to shift, causing you to become symptomatic. In addition, one or more of the following symptoms may occur:

• Hammertoes
• Claw toes
• Callus formation on the ball, heel, or along the outer edge of the foot
• Plantar fasciitis
• Foot instability as your ankle tends to roll outward (known as supination, a foot posture that predisposes you to ankle sprains)
• Knee, hip, and lower back pain can result from your body’s effort to compensate for the muscle imbalance in your midfoot
• Foot pain
• Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step.

In severe cases, cavus foot deformity can lead to ankle arthritis, frequent tripping and falling due to ankle instability, stress fractures around the ankle, shin splints, or Achilles tendon pain.

What are common causes of cavus foot? 

More often than not, a cavus foot is an inherited structural problem that has no link to any medical condition. However, in some patients, cavus foot can be due to neuromuscular diseases that cause muscle contractures that draw the ball of the foot closer to the heel.

Neurologic conditions that can cause cavus foot deformity include Charcot-Marie-Tooth disease (CMT), cerebral palsy, clubfoot, post-stroke paralysis, spina bifida, muscular dystrophy, spinal cord tumors, and, rarely, poliomyelitis. 

Cavus feet caused by neurological disorders tend to get worse faster. As such, they require more monitoring and proactive treatment to prevent progressive foot deformity.

In some cases, cavus is due to a tendon tear of the peroneal tendon, resulting in cavus deformity.

What are the treatment options for cavus foot?

The treatment of cavus foot has a lot to do with the cause and severity of the condition.

Conservative treatment options include:

• Modifying your shoe choices: Shoes with thick flexible soles, wide heels no more than 2 inches high, wide toe boxes, and shoelaces that can be loosened to accommodate a high arch all help mitigate pain. In addition, high-topped shoes or ankle boots can provide extra hindfoot support.
• Custom orthotics and shoe inserts: These custom-made orthotic devices are placed inside your shoe to provide cushioned arch support while also correcting your foot position.
• Ankle braces: Braces may be prescribed to provide stability and prevent excessive supination (ankle rolling out).
• Physical therapy: Physical therapists can teach you how to stretch your plantar fascia and Achilles tendons as well as strengthen the muscles and ligaments of your foot and ankle. Strengthening these muscles and ligaments can provide extra support and strength to your foot and arch.
• Surgery: Foot surgery is not uncommon and is an option when other treatments aren’t successful. For surgery for cavus foot, our surgeon will realign the foot to restore function and muscle balance. Surgical procedures can include a combination of soft-tissue releases, tendon transfers, and osteotomies.

Why UFAI is the best choice for your foot care 

Our nationally recognized surgeons have decades of combined experience and have helped develop the techniques used in the surgical correction of flat feet and cavus foot. With the highest success rates in the country, our specialists work hard to get you back on your feet and back to your life with the least invasive treatment possible.

Our team of podiatrists at UFAI has developed some of the premier surgical and non-surgical treatments for both cavus and flat foot conditions. We have also been at the forefront of conservative work-up options of the foot and conservative non-surgical options for the right patient.

Our combination of groundbreaking clinical research and surgical research makes UFAI the best option for the treatment of flat foot conditions.

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

 

 

 

Flat feet and cavus feet FAQs

What are the best shoes for flat feet? 

When it comes to choosing the best shoes for flat feet, it's important to prioritize comfort and support. That includes:

• Arch Support: Look for shoes that provide good arch support. Inserts or orthotics can also be helpful in providing additional arch support if needed.
• Stability: Shoes with a stable and firm sole can help distribute weight evenly across the foot and reduce overpronation.
• Cushioning: Opt for shoes with ample cushioning, especially in the heel and forefoot areas. This helps absorb shock and reduce discomfort.
• Proper Fit: Always ensure that the shoes fit well and have enough room for your toes. Avoid shoes that are too tight or too loose. 

 

Are flat feet genetic?

Flat feet can be genetic. If you or someone in your family has flat feet, there's a possibility that it's an inherited trait.

 

Can flat feet cause knee pain?

Yes, flat feet can potentially lead to knee pain. When you have flat feet, it can alter the way your feet function while walking or standing, which, in turn, can affect the alignment of your lower limbs, including your knees.

 

Can flat feet cause back pain?

Yes, flat feet can potentially cause back pain by affecting the way you walk and distribute weight while standing.

 

Can flat feet cause shin splints?

Yes, flat feet can be a contribute to shin splints. Several factors can increase the risk of developing shin splints, and flat feet can play a role in this condition for the following reasons: overpronation, poor shock absorption and altered biomechanics. 

 

Can flat feet cause plantar fasciitis?

Yes. When you have flat feet, the arches are unable to provide adequate support which can lead to an increased strain on the plantar fascia. This increased stress can cause micro-tears and inflammation in the plantar fascia, eventually leading to plantar fasciitis.

 

What are the best shoes for high arches?

Here are some key features to look for in shoes for high arches:

• Arch Support: Opt for shoes with good arch support to help distribute your body weight more evenly across your feet. Look for shoes that have built-in arch support or consider using custom orthotic insoles for enhanced support.
• Cushioning: Choose shoes with ample cushioning in the heel and forefoot areas. This cushioning helps absorb shock and reduces the impact on your feet while walking or running.
• Stability: Shoes with good stability features can help prevent excessive rolling of the feet, which is common in individuals with high arches. Look for shoes with a firm heel counter (the back of the shoe) and a secure midfoot fit.
• Neutral or Supination Support: High arches often lead to supination (outward rolling of the feet). Look for neutral or supination-specific shoes designed to counteract this tendency and promote a more natural gait.
• Roomy Toe Box: Ensure that the shoe has enough space in the toe box to allow your toes to move comfortably. Avoid shoes that squeeze or cramp your toes.
• Lightweight Design: Lightweight shoes can reduce the strain on your feet, making them a good choice for high arches, especially for activities like running or walking.
• Proper Sizing: Always choose the right size of shoes that fit your feet comfortably. Shoes that are too tight can exacerbate foot problems.
• Breathability: Look for shoes made from breathable materials to prevent moisture buildup and keep your feet comfortable.

 

Sources: 

Physiotherapy-Treatment, orthopedic physical therapy - pes cavus. Available from: http://www.physiotherapy-treatment.com/pes-cavus.html

Meehan PL. The cavus foot in: Morrisy, RT, (Eds), Lovell and Winter's Pediatric Orthopaedics, J.B. Lippincott, Philadelphia, 1990