“When is surgery needed for flat feet?”

Surgery is rarely indicated for flat feet. Most flat feet do not cause pain and therefore there is no need for surgical correction. In the rare event that the flat foot is painful, additional evaluation is necessary including MRI and CAT scan of the foot and surgery would be considered if conservative management fails including physical therapy, orthotics, medications and lotions and acupuncture and the pain remains disabling. In that case you should consult an experienced foot and ankle surgeon.

Surgery for flat feet is very complex depending on the cause of the flat foot. Some flat feet are from arthritis, some are from tendon and ligament instability and some are combinations of arthritis and soft tissue problems. The big question is how much trouble are you having? Can you navigate the steps? Do you have knee pain? Can you wear shoes without pain? What has been done nonoperatively? I always state that the full recovery from flat foot surgery is one year until we see maximal improvement. I would recommend an evaluation from a board-certified orthopedic surgeon with subspecialty training in foot and ankle disorders.

Thanks for sharing your MSK issue. Thanks for allowing me to give you my thoughts, tips and suggestions regarding this issue.

There are many types of flat foot. If there is no pain, then there is nothing to do. Having varying degrees of flat feet is normal. Some arches are higher than others. There are some foot strengthening exercises that can help strengthen the arch on the inside aspect of your foot. It has been shown that inserts do not help increase the size of an arch, unless your bones are still growing. I have relatively flat feet, and like to think it offers me some more balance since there is more surface area contacting the ground when I stand. If you can, do a two-legged or one-legged heel raise, and your arch forms, then you do have functioning tendons (the ropes connecting the muscles to the bones). This is a good exercise when done in a controlled fashion. One can strengthen the foot by ‘gripping’ a piece of paper that is on the floor or on a rug, by bending the toes (as if you are grasping a piece of paper with your hand), and then holding and releasing 5-10 times 2-3 times a day. If there is no pain, I would encourage you to embrace your feet for how they look, and trust them to carry you around for many years (as long as you keep them flexible, mobile and strong).

David T. Neuman, MD FAAOS

Almost never. Many people have flat feet and are normal. Pull up your toes. Do you get an arch back? If you get pain from the plantar fascia pulling tight try some orthotics. I like Superfeet, the green colored ones

When you have symptoms of pain and tendon issues. Mostly this condition can be treated with orthotics.

Robert D. Swift, DO, FAOAO

Flat foot surgery is needed when conservative care measures have failed and a patient is symptomatic and the condition is limiting activity. Initially flatfoot is treated with orthotics and if other pathology is present that can be addressed as well with the proper treatment. I would recommend seeing a Foot and Ankle specialist to help guide the treatment.