Flatfeet – When is Treatment Necessary?

By Michael Gillman MD

Restore Orthopedics and Spine Center, Orange County

Symptoms Associated with Flatfeet include:

Believe it or not, a majority of children aged 1-5 have flatfeet.  About 95% of the time we “grow out” of our flatfeet by the time we are adults.

Orthotic treatment vs an evaluation by a trained orthopedic specialist:

In some cases flatfeet can be treated with simple over the counter orthotics or a custom orthotics. However, most studies do not show any benefit to special shoes, insoles/orthotics or splints as a way to prevent adult flatfeet. An orthopedic evaluation can be more cost effective in flatfeet cases where a proper diagnosis is essential for determining the correct treatment. It is important to be checked if you have a painful flatfoot, even as a child.

As a general rule, flatfeet that don’t hurt should not be a concern.  Flatfeet that do hurt should be evaluated by a specialist to prevent further injury and/or longer-term bigger problems from developing.

Conditions associated with Flatfeet pain:

Tarsal coalition

This is a bony bar or bridge that connects two bones and does not allow for normal motion in the ankle and foot.  To prevent long-term problems if there is a tarsal coalition found on x-ray or MRI we treat these with surgery.

Accessory navicular

This is an extra bone in the foot.  It is found in about 7-19% of people.  In most cases, it is not painful and may unite or fuse as we become adults.  If it is painful, we usually treat with shoe supports or braces as a first step.  When not effective, we remove the extra bone which almost always cures the problem.

Posterior tibial tendon problems

These can be found in children but are much more common in adults.  They can occur from an injury but more commonly just happen.  Treatment is usually successful without surgery.  Medication, physical therapy, orthotics and/or braces usually are effective.  In about 1/3 of patients with acute injuries or in chronic cases, we perform a surgery — most often to realign the bones and to transfer and repair a tendon.  In severe cases, sometimes a fusion of three joints (triple arthrodesis) is performed to take care of the problem.


Dr. Gillman is an orthopedic surgeon and 3rd generation physician. He received B.S. with honors and M.S. degrees from Stanford University and his Medical Degree with AOA honors from Case Western Reserve University.  He completed residency at Tufts University affiliated hospitals, ankle and foot fellowship at Baylor College of Medicine and received a Health Care Executive degree from UC Irvine.  He has practiced in Orange County since 1999. He is an early adopter of ambulatory knee replacement teaching other surgeons in the technique.  In addition, he has developed a method for patient-specific hip replacement with issued patents and testing validated by academic orthopedic surgeons in the U.S. and London.  In his free time he enjoys recreational sports, spending time with his wife Rebecca and three sons.  He currently serves on the Board of Tarbut V’Torah Community.

If you would like to find out more about Flatfeet treatment please call for an appointment with Dr. Gillman at 714.598.1745

Restore Orthopedics and Spine Center

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