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Are Your Arches Falling?

By Erin Buenger, DPT

Is there such a thing?  Yes!

“Falling” or “fallen” arches is another term for Adult Acquired Flatfoot Deformity (AAFD).  This three dimensional foot and ankle pathology can affect anyone during the normal aging process and can affect those with pes cavus (a high arched or supinated foot), neutral (normal) arches or those with pes planus (flat feet — yes, they can get flatter!)

Typically, you can see this change around age 30 or older.   Our arches will all flatten or fall a little over time, just as our skin develops wrinkles and becomes less elastic. Variables that may contribute to AAFD or fallen arches include rheumatoid arthritis, neuropathy or decreased sensation, diabetes, weight gain including pregnancy, non-supportive footwear, excess impact activities and injuries to the soft tissues or bones of the foot and/or ankle.

What exactly is a normal arch?  As a quick test, stand up without shoes or socks.  The inside region of the middle part of the foot should not touch the floor; the foot should maintain an arch upwards.  You can also have someone take a picture of your foot in this position from behind and count how many toes you can see in the photo.  With a flat foot, the foot is more likely to be pointed outward with visibility of more than the fourth and fifth toes.

Other issues that can occur with the development of flat foot include bunions, other toe deformities such as hammertoes, heel spurs, plantar fasciitis, posterior tibialis dysfunction and Achilles or calf dysfunction.  Posterior tibialis tendon pathology is a commonly blamed source, estimated to be responsible for approximately 80% of cases of AAFD.  This tendon runs through the arch and is responsible for holding it up (like a sling) when weight-bearing.  Common symptoms include pain on the inside of the ankle and worsening symptoms with increased standing or weight-bearing activities.

Even if you are asymptomatic, addressing this postural issue as soon as possible will benefit you.  During an examination, your doctor or physical therapist will assess your posture, gait pattern, arch structure, strength, flexibility and shoes.  If indicated, your physician will order imaging to rule out other injury or fracture.  More conservative management includes rest, bracing, icing, physical therapy, massage therapy, orthotic prescription, shoe wear modification, anti-inflammatories and potentially weight loss.  A study published in the Journal of Foot and Ankle Surgery in 2011 (Nielsen MD, et al) showed that over a 27 month period, conservative treatment was 87.5% successful for treatment of AAFD.

Surgical options include reconstruction to tighten or lift the flat arch and is classically minimally invasive.  The procedure requires tendon re-routing, ligament repairs, and bone cutting or fusion.  You can expect significant short-term activity restrictions and rehabilitation for a few months post-op.  Your surgeon may also require weight loss prior to surgery.   The prior study by Nielsen MD, et al, found that overall 78.12% of the patients with AAFD were obese.

If you are concerned that your arches are falling, call to schedule a consultation or evaluation with one of our physical therapists.  Your insurance may now allow you to see a physical therapist without a physician’s referral.  Conservative management, including manual interventions, strengthening, shoe wear education and modalities can be very successful in managing flat feet.

Fun fact:  Babies are born without a normal arch structure and it doesn’t progress to full development until around ages 7-10! 


Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58-64. DOI: 10.1302/2058-5241.1.000015.