When you hear the phrase “flat feet,” you might remember it from a scene in the Barbie movie a few years back, where characters treated it like an all-out disaster. And for the millions of people who experience adult acquired flatfoot, the reality can feel surprisingly similar to those dramatic reactions. This condition affects daily activities, causes discomfort, and often leaves people wondering what went wrong.
The good news? What medical professionals once called "flat foot syndrome" is now better understood and more effectively treated. Today, Certified Pedorthists and podiatrists commonly refer to this condition as progressive collapsing foot deformity (PCFD). This updated terminology reflects our improved understanding of how the condition develops and progresses.
And fortunately, unlike Barbie's harrowing experience in the movie, PCFD is highly treatable—often without surgery—when identified and managed early.
What is PCFD?
Progressive collapsing foot deformity involves multiple structures in your feet working in ways they shouldn't. When you bear weight on your feet, the normal arch structure is compressed or "collapsed," creating the flattened appearance that gives flatfoot its name.
This collapsing arch process typically begins with dysfunction of the posterior tibial tendon, which is why PCFD closely relates to posterior tibial tendon dysfunction (PTTD). The posterior tibial tendon runs along the inside of your ankle and foot, playing a crucial role in maintaining your arch structure while bearing weight on your feet.
When this tendon becomes weakened, inflamed, or damaged, it can no longer properly support your foot arch. Over time, the arch gradually flattens, and other supporting structures—including ligaments, muscles, and bones—begin to compensate. This compensation leads to the progressive nature of the condition, where symptoms typically worsen without proper treatment.
What causes flat feet?
Several risk factors contribute to the development of PCFD, making some individuals more susceptible to this progressive condition than others.
Injury and trauma
Direct injuries to the foot or ankle can damage the posterior tibial tendon or other supporting structures. A single traumatic event, such as a fall or sports injury, may initiate the process. However, repetitive microtrauma from activities that place excessive stress on the tendon is more likely and equally problematic.
Arthritis and joint degeneration
Both rheumatoid arthritis and osteoarthritis can affect the joints and soft tissues in your feet. As joint surfaces wear down and inflammation becomes chronic, the arch-supporting structures gradually weaken.
Genetic predisposition
Your genes influence the strength and structure of your tendons, ligaments, and bone architecture. Some people inherit a particular foot anatomy that places additional stress on the posterior tibial tendon or have naturally weaker connective tissues. Having a family history of flat feet increases your risk of developing the condition.
Posterior tibial tendon inflammation
Chronic inflammation of the posterior tibial tendon can occur without an obvious injury or arthritis diagnosis. This inflammation may result from overuse, biomechanical imbalances, or underlying inflammatory conditions. As inflammation persists, the tendon weakens and loses its ability to support the arch effectively.
Age-related changes
The natural aging process affects soft tissues throughout the body, including tendons and ligaments. As we age, these structures become less elastic and more prone to injury. The cumulative effects of years of weight-bearing activity can gradually wear down the posterior tibial tendon's supportive capacity.
Hormonal factors
Hormonal changes can also affect connective tissue strength. Conditions that alter hormone levels may influence tendon health and/or increase susceptibility to PCFD.
Can you treat flat feet?
In most cases, the progression of PCFD means that early intervention typically yields better outcomes than waiting until the condition worsens. Fortunately, you have several options for this early intervention based on your preference and budget.
Custom orthotics
Orthotics represent a simple, accessible, and effective first-line treatment for PCFD. Custom-made orthotic devices provide targeted support to your whole foot, helping to control the progression of collapsing foot deformity based on your unique foot anatomy. These devices work by redistributing pressure across your foot and providing support to compensate for weakened internal structures.
The beauty of orthotic treatment lies in its simple integration into daily life. Orthotics literally slip into your existing footwear, allowing you to maintain your normal activities while receiving therapeutic benefits with every step. Biocorrect’s custom orthotics are designed to be comfortable and durable for many years of daily use.
Physical therapy and therapeutic strengthening
Physical therapy is accessible in a different and complementary way to custom orthotics. You can see a physical therapist in most states without needing a doctor's referral and start receiving clinical guidance immediately.
During physical therapy treatment, you’ll learn to strengthen the muscles that support your arch and improve overall foot biomechanics. Specific exercises target the posterior tibial muscle and other supporting structures, helping to slow or halt the progression of PCFD. Stretching exercises for the Achilles tendon and calf muscles can also reduce strain on the posterior tibial tendon.
Medical braces and supportive devices
In some cases, medical professionals may recommend specialized braces or supportive devices. These range from simple arch supports to more complex ankle-foot orthoses (AFOs) that provide additional stability and control.
Surgical intervention
When conservative treatments fail to provide adequate relief or when the condition has progressed significantly, surgical options may be considered. Surgical procedures for PCFD vary depending on the severity and specific structures involved. Options range from tendon repair and transfer procedures to joint fusion in advanced cases.
No matter when you discover your flat foot condition, seeking treatment sooner rather than later is your key to getting good results and the potential for a simple solution.
Orthotics for flat feet
If you're experiencing symptoms of flatfoot or have been diagnosed with PCFD, the first step toward treatment is to see a specialist like a podiatrist or our Certified Pedorthists. During an evaluation, we’ll let you know whether orthotics are a good treatment option for your condition and recommend next steps accordingly.
Biocorrect is your source for custom orthotics in West Michigan and throughout the country. No matter where you live, our mobile app transforms your smartphone into a sophisticated 3D scanner, making the fabrication process that much quicker with the ability to send instant, high-quality scans straight to our lab in Grand Rapids.
