Mount Elizabeth Novena Specialist Centre
(65) 6684 5828
(65) 6684 5829
Parkway East Medical Centre
(65) 6348 2605
(65) 6348 2606
Connexion Farrer Park Medical Centre (Opens on 1 March 2020)
(65) 6738 2628
(65) 6738 2629
1. What are flatfeet?

Flatfeet is when the feet has an arch that is lower than usual. The condition occurs when the arches on the inside of your feet are collapsed and flattened, causing the entire soles of your feet to touch the floor at a standing position.

2. Is flatfeet normal?

Flatfeet is mostly a common and painless condition and can occur when the arches remain undeveloped from childhood.  Flatfeet is regarded as normal in infants and toddlers as the ligaments holding the joints in the foot together are still loose.  For children by the age of 2 or 3, the tissues tend to tighten and form an arch.  Most people have normal arches by the time they reach adulthood.  However, for some people, the arch may never form and symptoms develop.

3. Problems from flatfeet?

The main problems with flatfeet are due to the misalignment of the feet and the lower limb. Some of the clinical problems are:

  • Bunions
  • Over-pronation
  • Heel pain (plantar fasciitis)
  • Hammer toes
  • Plantar pain over the sole of the feet (Metatarsalgia)
  • Aching feet & difficulty with running or sports
  • Anterior knee pain (pain in the front of the knee)
  • Hip & back pain
4. How do I tell if I have flatfeet?

Age group is an important consideration in the approach to flatfeet. Factors that can contribute to the problems are obesity, diabetes, certain types of arthritis and athletic over use.  Painless flexible flatfeet are most common amongst children. As such, children may experience some dull aching pain over the foot or calf during or after bouts of rigorous sports activities.

In some rare cases, children with an aching flatfoot may have an underlying condition such as tarsal coalition (fused bone) or an unstable OS Navicular (unfused bone on the inside of the foot) and need further investigation.


In the slightly older age group, the most common cause of adult flatfoot deformity is a tendon dysfunction of the posterior tibial tendon. This tendon sometimes gets damaged from overuse or degeneration. Patients have pain and swelling on the inside of the foot. There is a gradual loss of the arch, weakness and inability to stand on tip toes.  This condition is called Adult Acquired Flatfoot Deformity.


5. Do I need to see a specialist?

Assessment by a trained specialist is important to differentiate the physiological flatfeet from the pathological flatfeet.

In the early stages of flatfeet, patients benefit the most from Achilles stretching exercises, tendon strengthening exercises, customized insoles and footwear modification.

6. Is flatfeet surgery necessary?

Not all flatfeet cases need surgery. Many cases of symptomatic flatfeet do well with insoles and footwear modification. The aim is to avoid tendon or bone degeneration and give the patients the quality of life that they want. So that they are not overly reliant on insoles and can walk bare feet without pain. Importantly, patients are also not restricted to any particular type of shoe that can accommodate an insole.

7. Is minimally invasive flatfoot surgery for me?

There is minimally invasive procedure to correct the misalignment of the feet. It is called EOTTS (Extraosseous Tarsal Tunnel Stabilization). A titanium stent is placed into the natural space between the ankle and heel bones to realign and stabilize the foot instantly. This is done through a very small cut on the outer area of the foot. This is long term solution to prevent degenerative problems from setting in. After the procedure, the patient is able to walk immediately and natural joint movement is preserved.

8. Is EOTTS enough?

In almost 90% of paediatric cases and early adult flatfoot cases, the EOTTS procedure alone is sufficient to restore alignment of the foot and prevent long term tendon damage in a flatfoot.

If the flatfeet is more severe or not flexible, then the titanium stent alone will not be sufficient to address the problem and you may require additional procedures. The surgery depends on the diagnosis, aimed at surgically correcting the shape and function of the foot.  So that tendon and bone degeneration do not occur.

Some of the surgical procedures include:

  • Removal of the accessory ossicle (OS Navicular)
  • Repairing of the tibialis posterior tendon
  • Repairing of the spring ligament
  • Bone realignment procedures
  • Heel cord lengthening
  • Fusion of foot joints

Your foot & ankle specialist surgeon will evaluate and discuss the surgical options in detail with you after an assessment.

ask our orthopaedic surgeon

If you would like to find out more details about bunion, please use the enquiry form below to ask our orthopaedic surgeon, Dr K Kannan. You may attach medical reports on the enquiry form as well.

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