If you wake up with tight, painful ankles or feet, that's a sign that your arches are falling -- and you may have flat feet.
Fallen arches, which are typically related to overuse, are a major cause of flat feet among adults, which can lead to back pain and other issues if left untreated. With a few expert-approved strategies, you can halt your fallen arches in their tracks -- and relieve that pain and swelling, too.
In many cases, fallen arches happen when a tendon in your foot weakens, making it unable to support the arch, Dr. MaCalus V. Hogan, chair of orthopedic surgery and chief of foot and ankle surgery at the University of Pittsburgh Medical Center, tells TODAY.com.
"As the arch starts to collapse, (patients) develop pain and discomfort in that area," he says. "And in some scenarios, they can develop arthritis over time as related to that." To treat severe cases or torn ligaments, patients often require surgery.
But not everyone with fallen arches needs surgery, Dr. Maryann P. Hartzell, medical director at the Temple university School of Podiatric Medicine, tells TODAY.com. In the earlier stages, even if you have pain, swelling and tightness due to fallen arches, "there are things that you can do to limit the progression," Hartzell says.
Fallen arches are a common cause of flat feet in adulthood. This occurs when a specific tendon in the foot, the posterior tibial tendon, degenerates and becomes weaker over time, often due to overuse, Hogan explains.
Normally, this tendon runs from the inside of your leg down into your foot and supports the foot's arch, Hogan explains. But when the tendon weakens, that allows the arch of the foot to gradually collapse.
The tendon also can become inflamed, causing a painful condition called posterior tibial tendonitis or posterior tibial tendon dysfunction, according to the Cleveland Clinic.
Some people have childhood foot conditions that predispose them to develop flat feet, Hogan explains. In other cases, genetics might play a role. Additionally, having tight heel cords -- essentially, a tight Achilles tendon, Hogan says -- can also make fallen arches more likely.
The relaxation of ligaments that happens during pregnancy can also affect the ligaments in your feet, Hartzell adds, causing the arches to fall.
In other cases, people can develop flat feet due to trauma or an injury, Hartzell says. For instance, someone may make a jump from a height and tear the ligament when they land incorrectly. "Their foot can collapse, and that requires surgical intervention to reconstruct," Hartzell explains. If a fallen arch is due to an injury, it may only affect one foot, Hartzell says.
When your arches begin to fall due to posterior tibial tendonitis, you may not see it happen. But you're likely to notice a few telltale signs as your feet flatten:
The most obvious and common symptom is pain, the experts say.
Patients may describe it as a dull ache or sharp pain, Hogan explains. The pain "starts around the ankle and the inside of the foot, but then (they feel) the pain going up the inside of their leg, almost shooting toward their knee," he says. "That's inflammation of the muscle and tendon that supports the arch."
Patients also frequently report feelings of tightness when they first get out of bed, Hogan says. "It can be difficult to take the first couple of steps in the morning," he adds.
If you feel pain in your feet, it's a good idea to get checked out by your doctor or a specialist, Hartzell says. "Feet aren't supposed to hurt," she adds.
Pain that feels like posterior tibial tendonitis might also be due to a tear in the tendon, Hartzell says, a condition that requires surgery to correct. So it's important to get a prompt and accurate diagnosis before trying to treat your issue at home.
Additionally, if left without treatment, fallen arches may lead to arthritis in the area, Hogan says. If the tendon has been weakened over the years, that causes the joints to wear in an abnormal way, he explains. That leads to progressive arthritis that needs to be treated with injected medications or surgery.
Even if you don't require surgery, your fallen arches might be contributing to pain elsewhere in your body, Hartzwell says, especially the lower back. "If your feet hurt, everything hurts," she says.
Treating flat feet typically begins with conservative measures, the experts say. The goal is not necessarily to rebuild your arch, but rather to limit the progression of the falling, ease your symptoms and strengthen the surrounding muscles.
That might include:
However, when it comes to wearing over-the-counter orthotic inserts, Hartzell cautions that "you have to have the right ones."
Many of the options you'll find are actually too soft to be helpful for those with fallen arches, she says. "If you can flatten that orthotic down with your finger, it's not doing anything for you," Hartzell says. Instead, look for a pair that's firm but with a layer of softer material on top to make them comfortable to wear for longer periods of time, she advises.
And if you don't have luck with over-the-counter options, a podiatrist can make custom orthotic inserts for you. However, those tend to be expensive, Hartzell says, often in the $400 to $600 range, while over-the-counter options are typically available for around $40.
And when you're looking at buying supportive footwear, "a stiffer sole is better," Hogan says. "You don't want a shoe that bends a lot from front to back. If it bends like a piece of paper, then it probably is not giving you much support for your arch," he adds. He also recommends visiting a running store to get a foot analysis and shoe suggestions from the experts there.
If conservative measures aren't enough to ease your symptoms, Hogan says, you may need to undergo imaging tests to look for more serious issues, like a tear or arthritis. And if those issues are present, you may require surgery.