What causes them?
Many people do not develop arches on the soles of their feet and are therefore said to have “flat feet”. This flattened arch foot shape is also common in the child and adolescent and often resolves with time and after skeletal maturity.
A rare cause of a painful flatfoot particularly in the adolescent is the failure of bones in the back of the foot to separate during growth (tarsal coalition). Surgery to separate or stabilize them is occasionally recommended depending on the symptoms.
When is treatment necessary?
As long as this causes no pain or other problems treatment is usually not necessary. Foot supports (insoles or orthotics to elevate the arch) are helpful in patients with discomfort or pain, particularly if this has developed as a result of weakness or injury of the tibialis posterior tendon behind the inner ankle or hind foot. This is not uncommon in the middle-aged patient with painful flat feet and can be related to fashionable footwear with high heels.
What role does surgery play?
Occasionally, symptoms can be more severe and surgery to repair or replace the damaged tendon (transfer) with or without a realignment procedure of the heel bone (osteotomy) becomes necessary. This has the advantage to preserve movement in the hind foot joints, but if these are damaged due to a longstanding loss of shape in the foot, a stiffening operation (fusion or arthrodesis) of one or several joints to restore and maintain foot shape and function may be the best way forward.