Flat Feet (pes Planus)

An abnormal gait (walking in a way that puts pressure on the heel) can cause pain. Continually doing high-impact exercise like running, jogging, and jumping, especially on hard surfaces, commonly causes heel pain. Wearing ill-fitting or unsupportive shoes can also cause heel pain or make it worse.
One of the most likely causes of pain on the bottom of your heel is plantar fasciitis. This condition develops when inflammation affects the plantar fascia, a piece of connective tissue that runs under your foot.

• What causes it?

  Flat feet means the arch of the foot is lower than normal — in some cases, the entire sole contacts the floor when standing. Some people are born with flat feet; others develop them over time as the arch gradually collapses.

  Adult-acquired flatfoot most often results from dysfunction or tearing of the posterior tibial tendon — the tendon that runs along the inside of the ankle and supports the arch. Obesity, diabetes, high blood pressure, and previous ankle injuries are risk factors. Flatfoot can cause pain in the arch, heel, ankle, knee, or even the lower back due to the altered mechanics of walking.

• How do I know if i have it?

  Your doctor will observe your foot from behind while you stand — a collapsed arch causes the heel to tilt outward (valgus alignment) and the forefoot to point outward. A single-leg heel rise test checks whether the posterior tibial tendon is functioning properly.

  Weight-bearing X-rays show the alignment of the foot and ankle bones and measure the degree of deformity. MRI is ordered when posterior tibial tendon tear or rupture is suspected, or when surgical planning is needed.

• How is it treated?

  Mild to moderate flat feet: custom orthotics with arch support to correct alignment, supportive footwear, calf stretching, and physical therapy targeting the posterior tibial tendon.

  Corticosteroid injections are used cautiously, as injection near the posterior tibial tendon carries a risk of tendon rupture.

  For progressive or severe flatfoot that doesn't respond to conservative care, surgery addresses the specific structural cause — this may involve tendon repair or transfer, bone cuts to realign the heel (calcaneal osteotomy), or joint fusion, depending on the stage of deformity.

  MLS laser therapy can be used to treat posterior tibial tendon pain and inflammation.