Collapsed or Fallen Arches (Flat Feet)

A fallen or collapsed arch is more than the typical flat foot; the arch is often getting worse over months or years. Although flat feet can be present from birth, many develop over time due to wear and tear on the tendons and ligaments that support the arch. For some people, flat feet are painless and require no treatment. But a collapsing arch is almost always a problem. If you experience pain or limited mobility, it’s important to get evaluated by a specialist.

What Causes Fallen Arches?

The tendons in the foot and lower leg create tension that forms a natural arch. Although some people have higher or lower arches than average, anyone can be affected by a collapsing arch. Different people experience collapsing arches for different reasons. Common causes include:

• Genetics
• Injury or trauma to the foot or ankle
• Posterior tibial tendon dysfunction (PTTD)
• Obesity
• Aging
• Rheumatoid arthritis

What Are the Symptoms?

For some people with flat feet, there are no symptoms, and they can function without any issues. But for many, fallen arches cause painful and debilitating symptoms, including:

• Pain in the arch or heel
• Swelling along the inside of the ankle
• Foot fatigue
• Difficulty standing on tiptoe
• Pain that worsens with activity
• Uneven wear on shoes
• Toe drift (the front part of the foot/toes point outward)

How Are Fallen Arches Diagnosed?

Flat feet are fairly common, so you might not know if fallen arches are the cause of your foot pain. An orthopedic specialist can provide a diagnosis using:

• A physical exam of your feet while standing and walking
• A review of your symptoms and medical history, including any injuries
• Imaging tests, such as X-rays, MRI, or CT scans

How Are Fallen Arches Treated?

Nonsurgical Treatments

Nonsurgical treatments are usually the first step and are effective for many people. These may include:

• Anti-inflammatory medications to reduce pain and swelling
• Arch supports or custom orthotics
• Lifestyle changes, such as weight loss
• Physical therapy to strengthen supporting muscles and improve mobility
• Supportive footwear

Surgical Treatments

Surgery may be recommended for individuals who do not respond to nonsurgical treatments and continue to experience significant pain or mobility limitations.

Several procedures can address this condition, depending on the severity and cause. These include:

• Tendon transfer or repair: Reinforces or replaces damaged tendons
• Spring ligament reconstruction: Our surgeons are creating novel techniques for reconstructing the arch ligaments (spring ligament)
• Osteotomy: Realigns bones to restore the arch
• Fusion: Permanently joins bones together to provide stability
• Lateral column lengthening: Adds bone to the outside of the foot to correct alignment

These procedures may be combined to address the multiple underlying causes.

What Are the Risks?

Any surgery carries some risk of complications, including:

• Infection
• Nerve damage
• Blood clots
• Ongoing pain or stiffness
• Need for additional surgery

What Is Recovery Like?

Recovery will take up to a year, and must start slowly to avoid damaging the affected area.

• First 6 weeks: No weight-bearing activity; you will wear a cast or boot
• 6–12 weeks: Gradual weight-bearing with physical therapy
• 3–6 months: Strength training and return to normal footwear
• 6–12 months: Full return to activities and sports

What Is the Outlook for Fallen Arches Surgery?

With proper care, surgery can significantly improve foot function and reduce pain. Most patients experience improved mobility and stability, especially when combined with rehabilitation.