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Flat Feet

The Condition

A decreased medial arch height is commonly referred to as ‘flat foot’ deformity. The change in foot position and arch height in adults is often found to be associated with posterior tibial tendon dysfunction (PTTD). The posterior tibial tendon is a soft tissue structure that helps maintain stability and support to the arch of the foot. The degeneration of this tendon over time leads to a decrease in the arch height and the formation of arthritis. If left untreated, this problem can cause proximal limb pain and lower back pain.

The Treatment

Pain usually prompts patients to seek treatment. Unfortunately, the onset of pain signals the presence of damage to the tendon and surrounding tissue. Early identification of the deformity and the use of custom foot orthotics can be a beneficial prophylactic treatment method.

A thorough physical examination of the foot and ankle should be performed to assess overall muscle strength and function. Plain film radiographs (X-Rays) and magnetic resonance imaging (MRI) can assist in identifying the severity of the condition. In some cases, computer assisted tomography scans (CT) and musculoskeletal ultrasound may also be used to evaluate the integrity of the tendon and bone. Treatments are customized based upon patient needs.

Frequently Asked Questions

The other causes of flat foot deformity include untreated congenital problems, Charcot neuroarthropathy, and trauma.
No. The benefits of the orthotic devices are not permanent. They must be worn over a lifetime to continue to provide structural support to the foot and ankle.
Running shoes made specifically for people that pronate can provide a greater level of support and stability. There are many popular brands that specifically gear their shoes to this condition. It should be noted that these shoes should not be used in place of proper evaluation and management by your podiatrist.
Physical therapy, oral medications, steroid injections, platelet rich plasma prolotherapy, as well as custom foot orthotics and bracing are all potential options.
Prolotherapy, also referred to as regenerative injection therapy, is a non-operative method of treatment that can be used to heal injured tendons, ligaments and joints. Platelet rich plasma is one form of prolotherapy that allows physicians to harvest the natural healing ability of the human body to repair the injured tissues. Platelet cells contain growth factors that promote and direct tissue healing. These cells are obtained from the patient via a simple blood draw and are concentrated using a centrifuge. The platelets and their growth factors are then injected into the injured tissue to promote healing. This method of treatment is commonly used to improve painful conditions of the posterior tibial tendon.
Yes. The arch can be reconstructed and restored. Surgical techniques can give the foot a more normal contour resulting in an improvement or elimination of painful symptoms.
A basic set of guidelines can be used to determine if reconstructive foot surgery is right for you:

  • There are things that you enjoy doing but can not do to your full potential secondary to the pain associated with your flat foot deformity.
  • Pain limits required work duties or actions.
  • Conservative care options have been exhausted with little benefit noted.

Before & After Photos


A Patient’s Guide to Natural Healing: Autologous Conditioned Plasma (ACP)This brochure further explains the platelet rich plasma prolotherapy treatment currently offered at JCMG Podiatry.