Ask A Doc: Solutions for flat foot pain

by Dr. Peter Stasko, DPM

Dear Doctor,

My feet have been bothering me recently.  I have had foot pain in the arch for the past few months, I did not injure myself. Ever since I was a child, I have always been told that I have “flatfeet’ and that my feet “roll in.” What can I do about this?

Dear Reader,

Thank you for reaching out and asking about this issue. From what you are describing the symptoms that you speak of are very typical of painful flatfoot otherwise known as pes plano valgus deformity. This is characterized by arch pain, usually gradual onset. Oftentimes, patients that I see with this have increased activity recently, or have worn shoes or sandals that do not support their arches. This can occur at any age, adult or child.

As described before, flatfoot is also referred to as pes plano valgus. This deformity is where there is decreased arch height, and sometimes turning out or “abduction” of the foot. The pain you are most likely feeling is a tendonitis at the location of the arch where the tendon inserts. This tendon called the posterior tibial tendon becomes over stretched and stressed, leading to inflammation, and in longer standing cases, tearing. This can lead to dysfunction of the tendon known as posterior tibial tendon dysfunction. This can be progressively painful for the patient.  In many cases, a tight achilles tendon is also present.

There are many treatment options for you, and these yield favorable results. The first thing is that the tendon needs to be calmed down and immobilized. Ice, anti-inflammatories, as well as boot and brace immobilization help with this. Once the tendon is calmed down, then you are progressed to the next phase of treatment. 

It is important to get you back to regular activities, and we do so by progressing you into physical therapy, as well as placing you into custom orthotics (arch supports) to protect your foot and tendon. These are conservative measures that are taken to ensure excellent short term and long term results. 

If conservative measures fail, there are surgical intervention for severe flatfeet that are painful. A full evaluation is done before this including X rays and MRI to properly evaluate the foot position and tendons. 

There are techniques that we use on our practice through smaller incisions to correct a flatfoot using bone grafting materials. There are also tendon procedures that are done in conjunction with these. The goal of surgical intervention is to improve quality of life and restore functionality.  This is done by properly assessing the deformity, and correcting the deformity to ensure the best long term results. 

In conclusion, a painful flatfoot should be seen by the appropriate medical professional for treatment. Thorough evaluation can then be performed, and an appropriate treatment regimen can be started.  Successful treatment occurs when the right steps are followed, and you and your doctor work together to get you pain free. Thank you for reaching out!