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Flatfoot fundamentals

The arch in your foot supports you when you stand or walk. The absence of an arch is known as flatfoot. In flexible flatfoot, the arch can be seen when the foot is not bearing any weight. In rigid flatfoot, the arch is not present, whether bearing weight or not.

All children are born with flat feet. After the age of three, children begin to develop an arch. However, rarely, rigid flatfoot can be identified at birth and may be able to be treated earlier. Painless, flexible flatfeet usually do not lead to any problems in adulthood.

What causes flatfoot?

Flexible flatfoot is caused by lax ligaments in the foot, resulting in a flattened arch. The condition is heredity. It can be seen among people with Down’s Syndrome. Rigid flatfoot is caused by abnormal foot development, either due to genetics or another condition, such as cerebral palsy. Adult onset flatfoot can also be caused by a bone fracture or dislocation, a torn or stretched tendon, or arthritis. Rigid flatfoot can develop among adults 40 years of age and older who are sedentary and overweight. At times, an adult can recall an injury, but more often the flatfoot is a gradual development.

Flexible flatfoot is typically not painful, though some people may experience pain after playing sports. Rigid flatfoot can cause foot pain during everyday activities.


See your doctor if:

  • Your feet tire easily or become painful after standing.
  • It’s difficult to move your heel or stand on your toes.
  • Your feet hurt while playing sports.
  • You have rheumatoid arthritis, or any other systemic illness which is contributing to your foot problem.

How is this treated?

Children usually outgrow flexible flatfoot as their foot ligaments develop. Rigid flatfoot may require surgery.

If your flatfoot condition is bothersome, consider the following treatment options:

  • Purchase better-fitting shoes.
  • Use shoe inserts, such as arch supports. These can be obtained over-the-counter, or you may require custom-made inserts with a prescription from your doctor.
  • Take nonsteroidal anti-inflammatory drugs to relieve pain.
  • Rest the foot and apply ice to the painful area.
  • Follow a physical therapy regimen prescribed by your doctor.
  • Undergo surgery if conservative treatments fail.

Surgical procedures to correct flatfoot include:

  • Repairing a stretched or torn tendon.
  • Fusing one or more of the bones in the foot or ankle together.
  • Cutting and reshaping a bone to correct alignment.
  • Using a piece of one tendon to lengthen or replace another.

What are the risks of treatment?

Risks include nerve injury, infection, and stiffness of the joints, and onset of a new callus in a different area of the foot.

How do I prepare for surgery?

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
    • Main Campus: 216.444.0281
    • Beachwood: 216.839.3500
    • Strongsville: 440.878.3400
    • Marymount: 216.518.3200
  • Refrain from eating or drinking anything after midnight the night before surgery.

Are there exercises I can start now prior to surgery?

In preparation of any foot surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin on the morning of surgery.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens after surgery?

It is not unusual to experience numbness, tingling, and burning sensations in your foot or ankle. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problem, your cast or surgical dressing may be too tight, and you may need to call your doctor. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your doctor.

Your doctor will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery.

If you are wearing a cast, do not put anything in the cast and keep the cast clean and dry. If you are itching beneath the cast, take Benadryl and blow cool air down the cast with a hair dryer.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

Depending on the type of surgery performed, recovery typically takes 3 months to 6 months with the foot in a cast initially, and then a removable cast boot.

Rehab after surgery?

Foot and ankle surgery rehabilitation can be done at home, or, may require formal physical therapy. Depending on the procedure, physical therapy is often necessary to strengthen the muscles that have weakened while in a cast. Also, you doctor may prescribe orthotics even after a successful surgery.

How can I manage at home during recovery from the procedure?

After the first 48 hours of foot elevation, you can usually gradually return to most activities. However, the use of crutches or a walker will be required. At some point, your physician will allow you to wean off the crutches/walker to more "normal" activities. Typically, the dressing placed at the time of surgery is left intact until your first postoperative visit. The surgical dressing cannot get wet. Therefore, baths are encouraged. If one chooses to shower, then an "over-the-cast" bag is necessary.

How frequently should I schedule follow up appointments with my doctor following surgery?

Follow-up visits are scheduled by your surgeon.

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