I just won an appeal in a case very similar for bilateral pes -planus. My entrance physical the doctor noted feet as normal and near the end of my enlistment a physical therapist noted my feet and prescribed a heel lift and orthotics. I had an comp and pen exam for right knee and was denied because the examiner noted congenital flat feet possibly being the cause of the right knee. That being said I got three independent medical opinions that supported my claim that flat feet were related to my service. In addition to its influence on the medial longitudinal arch, the posterior tibial muscle plantarflexes and inverts the foot. PTTD will cause collapsing of the medial longitudinal arch, subtalar eversion, valgus at the ankle, and forefoot abduction. There will be stretching of the spring and deltoid ligaments as well as the talonavicular capsule. Increasing equinus with progression and the possible development of contractures are also suspected.5 The posterior tibialis initiates inversion and stabilizes the subtalar joint, allowing the gastrocnemius to plantarflex and invert the heel as the patient rises onto his/her toes. Studies analyzing the correlation between flat feet and physical injury in soldiers have been inconclusive, but none suggests that flat feet are an impediment, at least in soldiers who reached the age of military recruitment without prior foot problems. Instead, in this population, there is a suggestion of more injury in high arched feet. A 2005 study of Royal Australian Air Force recruits that tracked the recruits over the course of their basic training found that neither flat feet nor high arched feet had any impact on physical functioning, injury rates or foot health. If anything, there was a tendency for those with flat feet to have fewer injuries. It is critical to understand that the flatfoot itself is never truly the source of pain. It is the secondary effects of the malpositioned foot that result in a pain cascade. Some patients may complain of pain directly under the arch where the bones have collapsed. Painful calluses may develop on the bottom of the foot in areas of increased pressure, and a common site is under the navicular tuberosity. Often, the foot will abut the ankle and cause inflammation on the outer foot within the sinus tarsi. Heel pain may develop and present as plantar fasciitis. Clinical evaluation. Brandt R. Gibson, DPM, MS is a podiatrist with special interest in keeping individuals active through education. He is located in American Fork, Utah. His goal is to educate people and help them "optimize what they were born with." For further educational materials and recommended medical products, visit A free book on foot and ankle health can also be ordered at Also, children who grow up wearing sandals or slippers tend to demonstrate lesser foot arch troubles than those who grow up wearing shoes that are closed at the toes. What Is the Yoga Pose Where You Lie on the Floor & Place Your Right Ankle on Your Left Knee? Flat feet is among the most common foot problems affecting adults, and flat feet are considered normal in toddlers. This health problem occurs when the tendons that bind your foot together become loose. These tendons should tighten as you get older, and they help form your medial longitudinal foot arch. This tendon tightening occurs in most people by the age of three. Wearing a shoe that possesses heel elevation may accelerate your foot deformity if you have equinogenic flat feet. Consider slowly and progressively lowering the back of your heel to help your posterior lower leg structures adjust. Try wearing low-heeled shoes for a while before switching to flats. Rarely, painful flat feet in children may be caused by a condition in which two or more of the bones in the foot grow or fuse together. This condition is called tarsal coalition. Symptoms Children may have foot pain, ankle pain, or lower leg pain. They should be evaluated by a health care provider if this occurs. Symptoms in adults may include tired or achy feet after long periods of standing or playing sports. Exams and Tests Your child's feet will grow and develop the same, whether special shoes, shoe inserts, heel cups, or wedges are used.