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Cologne Foot and Ankle Surgery Center | Flatfoot

Center of Expertise

... it is better to carry out a comprehensive diagnosis, than to operate prematurely!



Flatfoot is an pathological deformation of the foot bone, in which the arch of the foot has collapsed and the entire sole of the foot sits against the floor, even without applying pressure. As the foot cannot cushion steps when walking, each step is painful.
Causes of flatfoot are, for example, weak tendons or obesity. Other causes may be injury, rheumatoid arthritis and neuromuscular diseases.


Pain normally develops in the instep, at the point at which shoelaces are tied, and/or in the ankle, where the main tendon supporting the foot is located. Pains related to the condition can occur in the ankle region, in the calves, hips or in the small of the back, due to the improper alignment of the feet.

The pain is normally caused by increased pressure on the tendon in the rear shin muscle, the main tendon which supports the instep and which aligns the foot below the leg. Problems with this tendon normally occur in stages and start with the inflammation of the tendon itself. Over time, the tendon weakens and become over-wound, or ‘lacerated’. Scar tissue, which is much weaker than the normal tendon, and much more easily injured, replaces the healthy tissue.

Once this has happened, increased pressure is placed on the small muscles and ligaments which support the foot bone, and other muscles are called upon to support the instep. This causes swelling, pain and ultimately arthritis in the ankle joints.

If symptoms go untreated, the tendon can rip and the foot can twist under the leg, leading to stiff and painful ankle joints. The Achilles’ tendon and calf muscles often lose their flexibility and become rigid over time, placing yet more pressure on the instep.

Conservative Therapy

If flatfoot causes little plain, the best solution is to try a better shoe, that has a good insole. A slightly raised heal can be helpful. This allows the foot to shift weight forwards, reducing pressure on the Achilles’ tendon. In addition, this helps to flex the instep further upwards, reducing pressure on the rear shin tendon. If these simple measures do not help, but the foot is still flexible, a special insole (‘orthosis’) can provide relief. This helps to realign the foot and ankle joint and to reduce pressure on the tendon in the rear shin muscle.

Surgical Therapy

The aim is to realign the foot and restore its normal function. Depending on the extent of the condition, a variety of procedures are available. In infantile flatfoot, a mini titanium implant is inserted during a small surgical procedure. The implant can remain for life.

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