Have you ever seen a bridge collapse? One of those old-style bridges with stone arches and fancy carvings along the side? As the structure starts to fail, the entire thing begins to come apart, piece by piece. Granted, your body does not start coming completely apart when the arches of your foot start to collapse, but you may experience some painful symptoms. What is happening? Basically, fallen arches refers to a flattening of the feet that takes place in adulthood. Although there may be other causes, this flattening usually occurs when the tendon (posterior tibial tendon) and ligaments that hold the arch in place gradually stretch. As we get older and our cumulative use of these tendons and ligaments increases, they lose their ability to maintain that nice arch shape, and may even begin to tear. This stretching or tearing may also be the result of an injury, obesity, or a genetic predisposition for flat feet. Could it be normal? Fallen arches shouldn't (if possible) be confused with feet that are normally flat. Arch height varies a lot from individual to individual. If you have fairly flat feet, but notice that an arch appears when you stand on your tiptoes (flexible flatfoot), and if you don't experience any pain with your flat feet, you're more likely to be okay. However, if your feet still fail to arch when up on your toes, if your feet lose an arch you used to have, or if you experience any painful symptoms, you probably ought to see a podiatrist. What would you feel or see? Fallen arches may induce pain in the heel, the inside of the arch, the ankle, and may even extend up the body into the leg (shin splints), knee, lower back and hip. You may also experience inflammation (swelling, redness, heat and pain) along the inside of the ankle (along the posterior tibial tendon). Additionally, you may notice some changes in the way your foot looks. Your ankle may begin to turn inward (pronate), causing the bottom of your heel to tilt outward. Other secondary symptoms may also show up as the condition progresses, such as hammertoes or bunions. You may also want to check your footprint after you step out of the shower. (It helps if you pretend you're in a mystery novel, and you're leaving wet, footprinty clues that will help crack the case.) Normally, you can see a clear imprint of the front of your foot (the ball and the toes) the heel, and the outside edge of your foot. There should be a gap (i.e. no footprinting) along the inside where your arches are. If your foot is flat, it'll probably leave an imprint of the full bottom of your foot—no gap to be had. Your shoes may also be affected: because the ankle tilts somewhat with this condition, the heel of your shoes may become more worn on one side than another. What will your podiatrist do? If you notice that your feet are flat, but you're not really experiencing any pain, then you're probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it's better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that's certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor's own in-person examination. Treatment of flat feet really depends on how far the damage has progressed. Conservative treatments often include immobilization (often by cast or brace) to reduce inflammation. Your doctor may also recommend physical therapy and anti-inflammatory medication (like ibuprofen) to get your inflamed tendon to calm down a bit. Orthotics can also offer significant relief. If these treatments fail to significantly improve symptoms, then surgery may be your best option to get the structure of your body back where it needs to be. Your podiatrist can discuss surgical options with you in greater depth.
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