From the Guidelines
Treatment for flat feet typically involves a combination of supportive footwear, orthotic inserts, and exercises. The goal of treatment is to reduce symptoms and improve quality of life, rather than solely focusing on correcting the flat foot deformity. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include open-backed shoes, orthoses, accommodative padding, NSAID therapy, and physical therapy.
Some key considerations for treatment include:
- Wearing shoes with good arch support and a firm heel counter to reduce stress on the foot
- Using custom or over-the-counter orthotic inserts to distribute pressure evenly across the foot and provide arch support
- Performing exercises to strengthen foot muscles, such as toe curls, heel raises, and arch lifts
- Using over-the-counter NSAIDs like ibuprofen or naproxen for temporary pain relief
- Considering physical therapy for persistent cases, focusing on strengthening the tibialis posterior muscle and improving foot mechanics
It's essential to note that most flat feet don't require surgery, but in severe cases causing significant pain or disability, procedures to create an arch or repair tendons might be considered 1. The treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, rather than solely focusing on correcting the flat foot deformity.
In terms of specific treatment protocols, the American College of Foot and Ankle Surgeons recommends continuing initial treatments if symptoms improve, and considering other diagnoses and referral to a podiatric foot and ankle surgeon if symptoms do not improve within six to eight weeks 1. Additionally, immobilization casts or fixed-ankle walker-type devices may be added to the treatment plan, and bursa injection may be considered in some cases.
From the Research
Treatment Options for Flat Feet
- Non-surgical interventions, such as orthoses, physical therapy, and anti-inflammatory medications, can be effective in treating flat feet 2, 3, 4, 5
- Custom-made orthoses have been shown to reduce pain intensity and disability in children with flat feet 2
- Bracing, including the use of foot orthoses, can be beneficial in treating adult-acquired flatfoot deformity 3, 4, 5
- Exercise, either alone or combined with foot orthoses, can reduce pain levels in adults with flat feet 5
Effectiveness of Treatment
- A systematic review of non-surgical interventions for pediatric flat feet found that the evidence was limited, but suggested that custom-made orthoses and supportive shoes may be effective in reducing pain and disability 2
- A retrospective cohort study of nonoperative care for adult-acquired flatfoot deformity found that 87.5% of patients achieved successful treatment with bracing, physical therapy, and anti-inflammatory medications 3
- A network meta-analysis of foot orthoses and exercises for adult flatfoot found that both interventions can reduce pain, but do not affect navicular drop (foot posture) 5
Considerations for Treatment
- The use of foot orthoses should be considered on a case-by-case basis, taking into account factors such as age, flexibility, and symptoms 6
- Customized foot orthoses may be reserved for children with foot pain and arthritis, or for unusual morphology or unresponsive cases 6
- Surgery is rarely indicated for pediatric flat foot, unless it is rigid or has failed thorough conservative management 6