Flat foot

A normal foot does not touch the floor with its inner side and shows an inner arch. A flat foot is characterized by a progressive collapse of this medial longitudinal arch. The forefoot sometimes seems to turn outside.

Flat feet can be accompanied by pain and sometimes a swollen ankle. The pain normally starts on the inner side of the ankle but with time migrates to the outer side. Very often patients realize that their shoes are worn out more on the inner than on the outer side. A flat foot most often becomes symptomatic in adults and rarely causes foot pain in children or teenagers.

The reason for a flatfoot is not fully examined but seems to be a combination of hereditary factors, a diseased tendon (tibialis posterior tendon) and wrong footwear. The tibialis posterior tendon is the main active stabilizer of the longitudinal arch of the foot. If its function weakens the longitudinal arch begins to break down.

During my examination of your foot I will find out what degree of flat foot you are suffering from. I will advise you to do an x-ray of your foot to quantify the deformity of the foot. Depending on the degree of the flat foot and foot pain, an individualized therapy is established.

Therapy of a flatfoot begins with conservative measures such as insoles and physiotherapy, where the muscles of the leg can be strengthened.

If conservative measures are not successful a surgical treatment of the flat foot deformity is recommended. Surgical treatment of flat foot includes realignment procedures such as foot bone osteotomies and tendon transfers or in more advanced stages arthrodesis of selected joints.

Flatfoot Treatment: Orthotics or Surgery?

If we observe people walking, we will very often see the foot buckling inwards. Pronation, or the inward motion of the ankle and outward motion of the rest of the bones in the foot, is normal to the foot. Commonly known as “flatfoot,” hyperpronation is characterized by excessive pronation and causes an imbalance in the distribution of body weight. Hyperpronation can be accompanied by pain and swelling in the foot or ankle and, in time, can cause further damage to joints, ligaments, and even the bones of the foot.

In most people, a slight flatfoot deformity is very common and usually absolutely harmless. Particularly in children, flat feet are not considered a pathological deformity.

Conservative Hyperpronation Treatment

Early hyperpronation or beginning flexible flatfoot can effectively be treated with insoles and physiotherapy. Podologic insoles can be used to treat hyperpronation at its early onset, in the treatment of beginning flexible flatfoot deformity. Podologic insoles correct the deformity by stimulating the muscles. With the help of physiotherapy and the insoles, the foot and lower leg muscles are strengthened, which enables them to absorb the load of the body when walking. Exercises during physiotherapy are designed to focus on and strengthen the muscles that stabilize the longitudinal arch of the foot, thus stabilizing the position of the foot.


In an advanced stage of flatfoot deformity, a significant lowering of the longitudinal arch of the foot can be observed. Unlike hyperpronation, or beginning flexible flatfoot, the individual may no longer raise the longitudinal arch of the foot with the help of their own muscle force. At this advanced stage, the flatfoot usually causes significant swelling and pain in the ankle area.

In the acute stage, insoles provide pain relieve and more comfort. However, long term, corrective foot surgery may be needed. During an operation, the axis of the rear foot is corrected. The result is an almost normal appearance of the foot.

The results of a surgical intervention are promising, as the deformity is corrected and the function of the foot restored.