Dr. Sharif’s perspective on Pes Planovalgus foot deformity (flat feet)
“Flat feet, also called pes planus, is a common orthopedic condition in which the inner arch of the foot is low or completely flattened. This condition may lead to pain, fatigue, and deformity in the foot over time. The foot’s primary functions are to support body weight and assist in forward motion. To accomplish this, the foot is composed of multiple small bones connected by ligaments and muscles that form arches to absorb shock and maintain stability.
Flat feet are very common, and not all flat feet need treatment. I focus on treating the patient, not just the shape of the foot. If you have flat feet but no pain, often no treatment is needed. When symptoms do develop, early treatment is important. Supporting the foot with proper shoes, orthotics, and stretching can prevent the condition from getting worse over time. All services that we provide at our Suffolk and Nassau county offices!
Every flatfoot is different, because people develop it for different reasons. That means treatment must be individualized. Not everyone needs aggressive care, and not everyone is a candidate for the same type of treatment. Surgery is reserved for patients who have significant pain, worsening deformity, or limitations in daily life despite trying conservative options. When surgery is needed, it can be very effective in restoring alignment and reducing pain.
My goal is to keep you active, comfortable, and moving well. When possible, I aim to preserve motion and function, especially in younger patients, while always focusing on the most important outcome: relieving pain and improving your quality of life. Call to make an appointment today at any of our Suffolk or Nassau County offices today!”
Dr. Athar’s perspective on Pes Planovalgus foot deformity (flat feet)
“Addressing pes planovalgus, commonly known as a symptomatic flatfoot, is about much more than just the height of your arch. It’s about how your foundation supports your entire body. I recommend moving toward surgery only when the deformity has become progressive. This means your foot is changing shape and the pain is no longer controlled by custom orthotics or supportive bracing. My threshold is reached when you feel a significant loss of function, such as an inability to perform a single-leg heel raise or if you’re experiencing lateral heel pain on the outside of your ankle where the bones are starting to pinch. When we sit down together, I’ll explain that we aren’t just creating an arch; we are realigning your mechanics. I want you to set the direction of this decision. Some patients choose to adapt their lifestyle, while others are ready to structurally fix the underlying mechanical problem to stay active. I will mention that catching this somewhat earlier can be beneficial. Many patients are rightfully terrified of surgery. However, if we can catch a painful flatfoot before it becomes arthritic, we can often reconstruct the foot without fusing joints. This is beneficial in the long term. Alternatively, if we wait till the joints become arthritic, often fusion is your only option. I recommend surgical reconstruction in younger patients who have persevered joints. This is in an effort to give them more time with a foot with somewhat normal mechanics. Once we start fusing foot joints, everything becomes rigid, and certain activities become more difficult.
A successful outcome looks like a foot that is more normally aligned. To me, a good result means you can stand for a full day, walk miles of trail, or simply wear a normal pair of shoes without the persistent, aching fatigue that a collapsed arch causes. A good result means your able to harness the normal biomechanics and natural leverage built into your biology. This will reduce pain, fatiguability, and improve day-to-day function. I was drawn to this specialty because flatfoot reconstruction is the ultimate orthopedic puzzle. It often requires a combination of bone realignment (osteotomies), tendon transfers, and ligament repairs. My fellowship training was focused on joint preserving reconstructions. I aim to realign the foot while keeping your joints mobile, rather than simply fusing them. By using my training to precisely tailor the surgery to your specific deformity, we aren’t just fixing a flat foot; we are building a stable, durable platform that allows you to move through life without constant pain.”
Anatomy and Function of the Arch
The arches of the foot distribute body weight evenly and prevent compression of nerves and blood vessels on the inner side of the foot. The inner arch acts like a bridge, supported by the wedge-shaped bones of the midfoot. The plantar and spring ligaments act as staples holding these bones together, while the plantar fascia and intrinsic muscles function as tie-beams. The posterior tibial tendon, anterior tibial tendon, and deltoid ligament act as dynamic slings maintaining the height and stability of the arch during walking.
Types of Flat Feet
More than two-thirds of adults have flexible flat feet, where the arch collapses only during standing or weight-bearing but reappears when sitting or standing on tiptoes. Flexible flat feet are usually painless and may not require treatment. In contrast, rigid flat feet have a persistently absent arch in both weight-bearing and non–weight-bearing positions and are often associated with structural or neuromuscular abnormalities.
Causes
Flat feet may result from genetic, congenital, or acquired conditions.
Inherited connective tissue disorders such as Ehlers-Danlos syndrome, Marfan syndrome, Down syndrome, tarsal coalition, and congenital vertical talus are common causes. Acquired flatfoot may develop after arthritis (arthrosis), trauma, clubfoot treatment, or Achilles tendon contracture due to conditions like gout or rheumatoid arthritis. Neuromuscular conditions such as cerebral palsy may also cause rigid flatfoot deformities.
Symptoms
Most patients are initially asymptomatic but can develop pain, fatigue, and deformity over time. Common symptoms include:
- Pain and burning sensations in the foot, especially after prolonged standing or walking
- Clumsiness or altered gait, with the patient lifting the entire foot off the ground rather than rolling from heel to toe
- Tightness of the Achilles tendon, worsening deformity
- Development of secondary conditions such as Achilles tendonitis, plantar fasciitis, or bunions
Over time, untreated flat feet can result in joint stiffness and arthritis in the feet.
Diagnosis
Flat feet are normal in children under three years of age, as the arches usually develop by that time. The condition is most often diagnosed in adolescents or young adults. Diagnosis involves a thorough physical examination and evaluation of medical and family history. The foot is examined in both standing and non–weight-bearing positions to assess arch flexibility and Achilles tendon tightness.
Clinical tests are used to evaluate arch height and motion of the upper, mid, and lower foot. X-rays are performed to identify bony abnormalities, while CT scans can reveal fused tarsal bones. MRI may be used to assess tendons, ligaments, and other soft-tissue structures.
Management
Treatment depends on the type of flatfoot and the severity of symptoms.
- Flexible Flatfoot: Most cases are asymptomatic and require no intervention. Physical therapy and exercises that strengthen the foot muscles and stretch the Achilles tendon can help maintain arch integrity. Pain relief may be achieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Arch supports, heel inserts, or custom orthotics can provide additional support and stability. Special braces may help realign the heel in symptomatic cases.
- Exercises: Exercises to strengthen the arch and foot muscles include picking up marbles with the toes, walking barefoot on sand, and toe-walking to stretch and strengthen the calf muscles.
- Surgical Treatment: Surgery is reserved for rigid flatfoot or flexible flatfoot with complications such as persistent pain or progressive deformity. Procedures may include lengthening of the Achilles tendon, cutting and realigning bones (osteotomy), fusing joints to stabilize the foot, or reconstructing tendons to restore arch height.
Prognosis
Most cases of flat feet are painless and do not require treatment. In symptomatic patients, conservative care is usually effective, and surgical correction can significantly relieve pain and restore function. Untreated rigid flatfoot or associated conditions like tarsal coalition may require surgical correction to maintain flexibility and prevent long-term deformity.
Prevention
Most cases of flat feet cannot be prevented, but wearing well-supported footwear and maintaining good strength and flexibility in the lower limbs can help minimize symptoms. Early intervention in children with abnormal gait or pain can prevent future complications.
Research Spotlight
A 2024 systematic review and meta-analysis published in the Journal of Biomechanics examined how foot orthoses (insoles) affect walking mechanics in adults with flexible flat feet.
After analyzing 24 studies, researchers found that orthotic use significantly reduced rearfoot eversion, ankle dorsiflexion, and knee adduction moments—key indicators of improved foot and leg alignment during walking. The review highlighted that studies using the Foot Posture Index (FPI-6) method showed the strongest biomechanical benefits, suggesting this standardized measure should guide future evaluations of flat-foot correction.
Overall, the findings reinforce the role of orthotics in improving lower limb function and gait efficiency in adults with flat feet. (“Study on the biomechanical effects of foot orthoses in adults with flat feet – see PubMed.”)
References / Citations (Optional)
Grear BJ. “Disorders of Tendons and Fascia and Adolescent and Adult Pes Planus.” Campbell’s Operative Orthopaedics. 14th ed. Elsevier; 2021.
Myerson MS, Kadakia AR. “Correction of Flatfoot Deformity in the Adult.” Reconstructive Foot and Ankle Surgery: Management of Complications. 3rd ed. Elsevier; 2019.
Winell JJ, Davidson RS. “The Foot and Toes.” Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020.
Orthobullets Team. “Adult Acquired Flatfoot Deformity.” Orthobullets. Updated October 9, 2025.
