It is universally known that flat feet get a bad rap for causing discomfort and pain. Although this is generally true, flat feet are extremely common and there are entire populations of people around the world with flat feet who have no problem walking or standing. Within our population in the western world, shoe-wearing is common and feet do not get used to functioning flat-footed as well as in other parts of the world where shoes are not worn much from an early age. In essence, while flat feet cause their fair share of foot problems, it is quite normal to have them, and under other biological circumstances, flat feet would not be a problem. It would seem that the combination of our use of footwear (albeit necessary in modern life), a relatively sedentary lifestyle, and the hard surfaces we must walk on lead to problems associated with flat feet.
Flat feet are often the result of your own genetics inherited from your family. Flattening is a normal part of the foot’s gait cycle, and in fact, this is how much of the shock forces created by walking are dispersed by the body. However, in some people, the foot flattens out too much. This changes the way certain muscles in the foot and leg have to work, causing numerous changes to the feet over time. These changes can include chronic ligament and tendon strain, as well as the development of deformities that are based on structural imbalance such as bunions and hammertoes. Some people can live their entire lives without having any problems, while others may have pain from childhood.
Due to the added demand on the muscles of the feet and legs, people with flat feet fatigue more easily, with leg pain or cramping after activity. The vast majority of the time, general discomfort or even pain is felt on the soles of the feet, mainly in the arches. Severely crushed feet can cause hip, knee or back pain, as the stress borne by the foot is ultimately transferred to the joint ligaments further up the leg. In the most severe cases, early arthritis can develop in various joints in the feet. As noted above, people with flat feet can develop bunions and hammertoes over time, and are more susceptible to heel and arch injuries. The most common condition I see in my office related to flat feet is plantar fasciitis, which involves damage to the plantar fascia, a ligament that attaches to the heel and runs along the arch. Often misconstrued as being caused by a heel spur (which can be present but almost never causes pain), plantar fasciitis is almost always directly related to arch stress caused by flat feet and has little to do with the heel. per se. High arches can cause plantar fasciitis, but for entirely different reasons.
Many people have flat feet but assume that their foot has a normal arch, since they can see an arch when they sit and examine their feet. The foot naturally curves inward in an arched position while sitting, even in people with flat feet, which is misleading to think that the arch is higher. Flat feet should be assessed when you are standing and placing your body weight on your feet. Sometimes the flattening is not obvious, but it still affects the function of the foot. X-rays taken while standing on your feet provide the best understanding of the true structure of the foot, as the bones show obvious changes in position that are not always seen outside of the body.
There are numerous ways to treat flat feet. Some are more effective than others. Prescription shoe inserts are effective for the vast majority of people with flat feet. Many people start with over-the-counter inserts to increase arch support. For people with more than a slight amount of flattening, this may not be enough support. Most over-the-counter inserts rely on padding to push up the arch and decrease its flattening. The padded material will compress significantly when the weight of the body is applied to it, reducing the level of support. Some over-the-counter insole designs are made of a plastic or composite material that offers more support, but is not well tolerated, as it does not conform to a person’s specific foot and can cause further irritation.
To really support the arch to the maximum degree, one must wear inserts not just made from a mold of their foot, but from a mold made while the foot is held in a specific position that eliminates flattening. These types of inserts are called orthotics and are used medically across the country to stabilize flat feet. When made correctly, orthoses will eliminate excessive flattening. If it is made from a mold in which only the shape of the foot has been captured but no adjustments have been made to correct for flattening, the insert will simply reflect the flat foot and be much less effective. This is sometimes seen when orthotics are manufactured by people who have little training in foot mechanics. There are also many cases now where retail stores have gotten into the ‘orthopedic craze’ and offer inserts that claim to be orthopedic. In reality, many of these inserts are simply over-the-counter devices that are taken off the shelf using rudimentary measurements that these stores claim is a custom process. Don’t be fooled by these lesser devices and pay large sums of money unnecessarily.
True orthotics are a prescription product that require a detailed examination of the foot by a foot specialist (usually a podiatrist), along with a written prescription plan, and a modification specific to a person’s foot (many angles and adjustments). they go into the orthotic manufacturing process beyond simply obtaining a mold of the foot to be condition specific). Treatment with prescription orthotics is generally successful in controlling many symptoms associated with flat feet and the conditions that are due to flat feet, as long as the foot is still flexible. If the flat foot is stiff or rigid, orthotics will not help. Orthotics realign the foot to allow it to function properly and, over time, will help prevent further progression of associated problems, such as bunions and hammertoes, and conditions related to foot strain, such as tendinitis and plantar fasciitis. .
However, orthotics will not cure these conditions if they have fully developed, as the deformities require surgery to correct and inflammation from foot stress requires medication and rest. Orthotic devices function as long-term maintenance devices for more serious conditions, and most importantly, they eliminate the fatigue associated with flat feet. Properly supported shoes are also a must in this equation, as without stiffer-soled shoes with more support, orthotics have to fight with the shoe to function properly, reducing their effectiveness.
Unfortunately, severe cases of flat feet where there is a severe deformity, or where the foot is fixed in a flat position, require surgery to reshape the foot into a more functional shape. In these cases, orthopedic and supportive shoes are insufficient to stabilize the foot. Even leg braces are often not enough to control the abnormal forces acting on the foot in these cases. Reconstruction is often the only answer in these relatively rare situations. There are a multitude of different types of procedures to correct flat feet, each addressing a specific component of flat feet to provide the most effective relief. Since the flat foot deformity involves many directions of movement, surgical correction of the deformity must take all of these into account and be planned based on the specific mechanics of abnormal foot movement. Recovery from these procedures generally involves a period of non-weight bearing and can take several months depending on the complexity of the reconstruction. This surgery is performed by podiatrists and some trained foot and ankle orthopedic surgeons and can be quite successful in many cases.
As you can see, many factors go into identifying and treating flat feet. Usually only a simple prescription coin in shoes is needed to counteract the foot’s tendency to collapse the arch, helping to prevent many of the foot problems associated with flat feet. Surgery is necessary in advanced cases, which is usually very successful. Although many people with flat feet do not have problems, it is simply a matter of time before they eventually develop as our western feet are not well conditioned to function with flat feet in general.
