What exactly is a Flatfoot? Are there different types?


If you do a Google Search on “Flatfeet”, you will be supplied with a staggering number of hits; 40,900,000 to be exact (as of 19 August 09).  Let’s take a look at this foot structure that obviously affects many people.

What exactly is a flatfoot?

A flatfoot, or Pes Planus, is a term given to a foot that has lost its arch and is flat.

There are two distinct types of flatfeet


The structural flatfoot – the arch of your foot is always flat.  That is, your foot is flat when you are sitting, standing or walking (See Photo A below).


Photo A - Structural flatfoot. The arch of the foot is always flat.

The flexible flatfoot – the arch of your foot is flat only when weight is put on the entire foot (such as standing with weight on entire foot), but intact when weight is taken off the heels (such as standing with weight only on the toes) (See Animation B below).

Animation B - Flexible flatfoot. Standing, weight on toes, the arch is intact.  Standing, weight on heel, the arch is collapsed.

It’s pretty easy to see if you have a structural flatfoot.  But how do you determine if you have a flexible flatfoot?  Take this Footprint Test:

When you get out of a swimming pool, look at your footprint on the concrete.  The front of the foot (the ball) should join the heel by a strip.  Ideally, this strip should be about ½ the width of the ball of the foot. If your foot is flat, then the strip is the same width as the ball of the foot, creating a footprint that looks like a stretched out pancake. (Hence the expression, “flat as a pancake’) (See Foot Imprint below).   However, when you sit down and take weight off your feet, your foot will have an arch.


Foot Imprint made by a flexible flatfoot

The structural flatfoot is like a level foundation of a building.  It is very stable and solid and generally requires no treatment.  In this article, I am going to talk about the flexible flatfoot, which is not stable and so can lead to problems in the body including chronic muscle and joint pain. 

What causes the flexible flatfoot?

The flexible flatfoot is not a 'cause' in of itself.  It is merely a symptom of an underlying cause. The most frequent common causes cited in the literature for flexible flatfeet are: 
  • Weakening of the tendons in the foot (e.g., Posterior tibial tendonitis[1], Ehlers-Danlos syndrome[2])
  • Weakening of the muscles in the foot (e.g., Myasthenia Gravis, Muscular Dystropy)
  • Nerve Injures (e.g., Multiple Sclerosis)
  • Injury to the foot
In 2002, I described another common cause of the flexible flatfoot, which was previously unknown.  It is an embryological foot structure in which the heel bone is twisted inward (See Photo C below).


Photo C (right foot) -
the heel bone is twisted inward


When weight is applied to this foot structure, gravity forces the heel bone to twist outward until the entire bottom surface of the heel bone rests on the ground.  This outward twist of the heel bone causes the inner arch of the foot to flatten.

I termed this embryological foot structure, which I discovered, the PreClinical Clubfoot Deformity.

  • PreClinical – A word that I have coined to mean a precursor or milder form of a condition.
  • Clubfoot – A congenital malformation in which the entire foot is structurally twisted inwards.
  • Deformity – A misshapen alteration of the natural form.
In 2002, I published a paper in the Journal of Bodyworks and Movement Therapy, entitled Medial Column Foot Systems. In Innovative Tool for Improving Posture, describing this foot structure. 


For information on using arch supports to treat flatfeet
, go to: Flexible Flatfeet are Weakened by Arch Supports


To learn the difference between the Rothbarts Foot and the PreClinical Clubfoot Deformity, go to: What is the difference between the Rothbarts Foot and the PreClinical Clubfoot Deformity?

For information on the difference between a PreClinical Clubfoot Deformity and a Clubfoot
Deformity, go to:
  Clubfoot vs. PreClinical Clubfoot Deformity. A Technical Presentation.


References

[1] Kulowski J. Tendovaginitis (tenosynovitis): general discussion and report of one case involving the posterior tibial tendon. Missouri State Med Assoc. 1936;33:135-7.
[2] Ehlers-Danlos Syndrome. A connective tissue disorder. Wikipedia

Rothbart BA 2009.  What exactly is a Flatfoot? Are there different types?  Podiatry Review, Vol 66(6):4-6.



Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot
and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain


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