Not All Flat Feet Are the Same

Adult flat feet — or more precisely, adult acquired flatfoot deformity (AAFD) — encompasses a broad spectrum from the flexible flat foot that causes no problems to the progressive rigid deformity that results in disability. The approach to treatment must match the specific type, severity, and symptoms of the individual patient’s flatfoot. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate adult flatfoot with a systematic approach that identifies the stage of deformity and directs appropriate intervention.

Flexible vs. Rigid Flatfoot

The critical initial distinction is between flexible and rigid flatfoot. Flexible flatfoot: the arch collapses when weight-bearing but reconstitutes when non-weight-bearing or when the great toe is dorsiflexed (the Jack’s test or Hubscher maneuver). This type is often asymptomatic or managed conservatively. Rigid flatfoot: the foot remains flat regardless of weight-bearing status — the joints have lost motion from arthritis, tarsal coalition, or long-standing deformity. Rigid flatfoot cannot be corrected with orthotics and often requires surgical consideration if symptomatic.

The Posterior Tibial Tendon: The Arch’s Key Stabilizer

Adult acquired flatfoot most commonly develops from posterior tibial tendon dysfunction (PTTD) — progressive failure of the primary dynamic arch support tendon. Stages: I (tendinopathy, no deformity), II (flexible flatfoot deformity, single-heel-rise test weakness), III (rigid flatfoot with subtalar arthritis), IV (ankle involvement with valgus tilt). Treatment is stage-dependent: Stage I (activity modification, orthotics, physical therapy), Stage II (orthotics, bracing, or surgery for reconstruction), Stage III-IV (surgical fusion of involved joints).

When Conservative Treatment Is Enough

Asymptomatic flexible flat feet — even significant ones — that don’t cause pain, affect activity, or show progression on serial X-rays don’t require treatment. Treatment is indicated for: pain with daily activities or exercise, progressive deformity on X-ray, inability to wear standard footwear comfortably, or impaired function. Conservative options: custom orthotics with appropriate posting and arch support (the most evidence-supported non-surgical intervention), Arizona AFO (ankle foot orthosis) for more advanced deformity, physical therapy targeting posterior tibial tendon strengthening and calf flexibility. Contact Balance Foot & Ankle at (810) 206-1402 for evaluation to determine whether and how your flat feet should be treated.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.