Can my feet become flat over time? Understanding adult-acquired flatfoot

According to UCLA Health, one of the most obvious signs of an aging foot is a change in its size and shape over time. This natural wear and tear can lead many to wonder: Can my feet become flat over time? It's a common concern, and the answer lies in the slow degeneration of the foot's supportive structures.

Quick Summary

Yes, feet can become flat over time, a progressive condition known as adult-acquired flatfoot deformity. It is caused by the weakening or dysfunction of the posterior tibial tendon, often accelerated by factors like aging, obesity, and injury. This collapse can cause significant pain and affect overall body alignment, but various treatment options are available.

Key Points

• Adult-Acquired Flatfoot: Yes, your feet can become flat over time due to the gradual weakening of supportive ligaments and tendons, a condition known as adult-acquired flatfoot deformity (AAFD).

• Posterior Tibial Tendon: The primary culprit is often the dysfunction of the posterior tibial tendon (PTT), which becomes stretched or torn and can no longer support the arch effectively.

• Common Risk Factors: Key risk factors include aging, obesity, diabetes, rheumatoid arthritis, and foot/ankle injuries that increase strain on the feet.

• Beyond Foot Pain: Flat feet can impact your entire body's alignment, leading to pain in the ankles, knees, hips, and lower back as your body compensates for the arch collapse.

• Treatment and Prevention: Management options range from conservative measures like orthotics, supportive shoes, and physical therapy to surgical intervention in severe, progressive cases.

• Don't Ignore Symptoms: Pay attention to persistent pain, swelling, or changes in your foot shape. Early diagnosis and treatment are crucial for managing symptoms and preventing further complications.

The Anatomy of an Aging Foot

Your foot is a complex structure of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. The foot's arches are key for weight distribution, balance, and shock absorption. However, over decades of supporting your body, these tissues endure significant stress. As we age, ligaments and tendons can lose their elasticity and strength, leading to a gradual 'falling' or collapsing of the arch. This process, also called 'pes planus' or fallen arches, can lead to a variety of uncomfortable symptoms.

The Primary Cause: Posterior Tibial Tendon Dysfunction

The most common cause of adult-acquired flatfoot is the weakening or failure of the posterior tibial tendon (PTT). This vital tendon runs from a muscle in your calf, down the inside of your ankle, and attaches to bones in the midfoot, helping to hold up your arch. When this tendon becomes overused, strained, inflamed, or torn, it can no longer provide adequate support, causing the arch to slowly collapse over time. The failure of the PTT creates a biomechanical chain reaction, leading to misalignment of the foot and ankle and altering your entire gait.

Major Risk Factors for Fallen Arches

While aging is the central factor, several conditions can increase your risk of developing adult-acquired flatfoot or accelerate its progression. Being aware of these can help you take preventative action:

• Age: The natural wear and tear on supportive tissues increases with age. PTTD is particularly common in women over 40.
• Obesity: Excess weight puts increased pressure on the foot's tendons and ligaments, causing them to stretch and weaken more quickly.
• Diabetes: Nerve damage (neuropathy) and compromised circulation associated with diabetes can weaken bones and ligaments, potentially leading to arch collapse, a severe condition known as Charcot foot.
• Rheumatoid Arthritis: This autoimmune disorder can attack the joints and supporting ligaments in the foot, causing inflammation, pain, and deformity.
• Foot and Ankle Injuries: Trauma, such as a fracture or severe sprain, can damage the ligaments and tendons that hold the foot's structure together, resulting in a sudden or progressive arch collapse.
• High-Impact Activities: Sports or occupations that place repetitive, high stress on the feet can contribute to overuse and tendon damage over time.

The Progression of Flatfoot

Adult-acquired flatfoot typically develops in stages, with symptoms worsening over time if left untreated.

1. Early Stage: Pain and swelling along the inner ankle, where the posterior tibial tendon is located. This pain may increase with activity.
2. Mid-Stage: As the tendon continues to fail, the arch collapses further. The foot begins to turn outwards, and the heel shifts out of alignment. Pain may become more widespread, radiating to the outside of the ankle.
3. Late Stage: Severe deformity may occur, with significant pain and stiffness in the midfoot due to arthritis setting in. This stage can dramatically affect mobility and require more invasive treatments.

Diagnosis and Treatment Options

It is important to see a healthcare professional, like a podiatrist or orthopedist, if you suspect your arches are falling, especially if accompanied by pain. Diagnosis typically involves a physical exam, a gait assessment, and imaging like X-rays or MRI to evaluate the extent of the damage.

Depending on the severity, treatment can include:

1. Supportive Footwear: Wearing shoes with strong arch support can help stabilize the foot and reduce strain.
2. Orthotic Devices: Custom-made or over-the-counter arch supports can realign the foot and provide crucial support to the weakened tendon.
3. Physical Therapy: Targeted stretches for tight calf muscles and exercises to strengthen the foot's muscles can improve stability and reduce stress on the arch.
4. Medication and R.I.C.E.: Anti-inflammatory drugs, rest, ice, compression, and elevation can help manage pain and swelling in early stages.
5. Surgery: For severe cases where non-surgical treatments fail, surgical intervention may be necessary to repair the tendon or realign foot bones.

Flexible vs. Rigid Flatfoot: A Comparison

Feature	Flexible Flatfoot	Rigid Flatfoot
Appearance	Arch is visible when sitting but disappears when standing.	No arch is present whether standing or sitting.
Flexibility	Foot and arch are flexible and move normally.	Foot is stiff and inflexible.
Development	Often starts in childhood and can worsen with age.	Typically appears in adulthood, often after trauma or with conditions like severe arthritis.
Treatment Focus	Management with orthotics, physical therapy.	Addressing the underlying cause, potentially requiring surgery.

Practical Steps for Healthy Feet

• Maintain a Healthy Weight: Reducing excess weight significantly decreases the load on your feet's supportive structures.
• Choose Supportive Shoes: Opt for footwear with good arch support and a firm heel counter to provide stability. Avoid consistently wearing flat-soled shoes or high heels.
• Stretch and Exercise: Incorporate simple exercises, like calf stretches and towel curls, into your daily routine to maintain foot flexibility and strength.
• Listen to Your Body: Pay attention to persistent foot, ankle, or knee pain. Early intervention is key to preventing the condition from worsening.
• Consider Orthotics: If you notice your arches are changing or experience pain, supportive inserts can provide immediate relief and long-term stability.

Conclusion: Proactive Care for Healthy Feet

The answer to can my feet become flat over time? is a definitive yes, but it doesn't have to lead to chronic pain and mobility issues. The gradual weakening of tendons and ligaments is a natural part of aging, but a proactive approach is your best defense. By understanding the causes, recognizing the symptoms early, and adopting management strategies like supportive footwear and physical therapy, you can help your feet continue to support you comfortably for years to come. Foot health is a critical component of overall senior well-being and mobility, so don't hesitate to consult a professional if you have concerns. Learn more about flatfeet from the Mayo Clinic

Frequently Asked Questions

What is adult-acquired flatfoot?

Adult-acquired flatfoot is a condition where the arch of the foot gradually collapses over time, often due to the weakening or failure of the posterior tibial tendon. It's different from being born with flat feet.

Can flat feet cause other health problems?

Yes, fallen arches can disrupt the alignment of your body, leading to increased strain and potential pain in your ankles, knees, hips, and lower back.

What is the role of the posterior tibial tendon?

The posterior tibial tendon is a crucial structure that helps hold up the arch of the foot and provides support while walking. Its dysfunction is the most common cause of adult-acquired flatfoot.

Are older adults more likely to get flat feet?

Yes, age is a significant risk factor. The tissues that support the arch lose elasticity and strength over many years of use, increasing the likelihood of arch collapse.

Can losing weight help with flat feet?

Yes, reducing excess body weight can significantly decrease the stress placed on your foot's arches, helping to prevent or slow the progression of flat feet.

Is surgery necessary for adult flatfoot?

In many cases, non-surgical treatments like orthotics, physical therapy, and supportive footwear are effective. Surgery is typically reserved for severe cases where conservative methods have failed.

How can I tell if my arches have fallen?

A simple 'wet foot' test can help. If you wet your feet and step onto a flat surface, a fallen arch will leave a complete footprint of your sole, with no curve on the inner edge. A medical evaluation provides a definitive diagnosis.