Flat feet (pes planus) describes a foot in which the medial longitudinal arch is reduced or absent -- the inner edge of the foot contacts or nearly contacts the ground during standing and walking. It is extremely common (10-20% of adults have some degree of flat foot) and in most people causes no symptoms or walking limitation. This article focuses on symptomatic pes planus and the specific conditions where a walking cane becomes a relevant mobility consideration.
When Flat Feet Cause Walking Problems
Asymptomatic flat feet in an otherwise healthy adult rarely require anything beyond appropriate footwear. A cane becomes relevant in three situations:
- Adult-acquired flatfoot deformity (AAFD): Progressive collapse of the medial arch in adulthood, most commonly caused by tibialis posterior tendon dysfunction (TPTD). The tibialis posterior muscle actively supports the arch; when its tendon is damaged or degenerates, the arch collapses progressively, causing medial ankle pain, deformity, and eventually a stiff rigid flatfoot that severely impairs walking
- Pes planus in the context of inflammatory arthritis: Flat feet in RA or spondyloarthritis are more symptomatic because the synovial inflammation also affects the talonavicular and subtalar joints, removing the stabilising joint structures
- Rigid flatfoot from tarsal coalition: Fusion (bony or cartilaginous) between tarsal bones creates a rigid flatfoot that is painful on uneven terrain and during prolonged walking
Adult-Acquired Flatfoot Deformity (AAFD) and Walking
AAFD has a staged progression:
- Stage 1: Tibialis posterior tendinitis, pain on walking but no deformity. Conservative management (physiotherapy, orthotics, anti-inflammatory treatment)
- Stage 2: Tendon elongation, beginning of arch collapse. Flexible flatfoot deformity. Orthotics and walking support become important
- Stage 3: Fixed flatfoot deformity. Significantly impaired walking, severe pain. Surgical consideration
- Stage 4: Ankle joint involvement, valgus tilt
A walking cane in AAFD reduces the total load on the medial column of the foot (the navicular, medial cuneiform, first metatarsal chain that bears the arch load), providing pain relief and potentially slowing progression by reducing the mechanical stress on the already-failing tibialis posterior tendon.
Tip Selection for Flat Foot Gait
AAFD causes medial foot overpronation and an inward roll of the ankle (valgus hindfoot). This means the cane tip is placed on a foot that is rolling inward during stance, creating lateral forces on the cane. The Steady Tip (28mm contact patch) tolerates the variable tip placement angle better than a small ferrule, and provides consistent traction even when the placement is slightly angled from the foot pronation.
Pes Planus Type and Cane Role
| Type | Walking Impact | Cane Role |
|---|---|---|
| AAFD stage 1-2 (flexible) | Medial arch pain; fatigue | Load reduction during longer walks; orthotics primary |
| AAFD stage 3 (rigid) | Severe pain, significant limitation | Essential support; surgical review |
| Tarsal coalition | Rigid flatfoot, uneven terrain pain | Balance and terrain support |
| Inflammatory arthritis flat foot | Pain from joint and tendon inflammation | As for RA/spondyloarthritis; orthotics + cane |
Explore the DaiWalk cane collection or use the rubber tip size finder. Related: Walking Cane for Plantar Fasciitis | Walking Cane for Rheumatoid Arthritis
