Flat Feet… When Should I Get A Foot Check?

Are Flat Feet Really A Problem?

Flat feet are often confused with pronated feet. Foot pronation is the type of motion which can be observed when you see feet “rolling in” in relation to the leg. Pronation of the foot is normal to a certain degree but there are times when this type of motion may be excessive and, when significant, can contribute to forces causing pain in the feet and legs.

This is where it gets a little confusing…

An excessively pronated foot can give the appearance of a flat foot where there appears to be a reduction or loss of arch height. A true flat foot where the arch is very low may be quite normal but a severely pronated foot or hypermobile foot can cause significant problems in the feet legs and overall posture.

True flat feet are quite rare. Flat feet in their true sense will be well aligned in relation to the leg and the foot arch will appear extremely low. Excessive pronation, which is what can be seen in the above image, is estimated to be present in almost half the population with approximately 10% of the population displaying general hypermobility in conjunction with excessively pronated feet. Hypermobility and excessively pronated feet are two problems podiatrists encounter frequently and these two issues together can contribute to many overuse foot and leg injuries.

Most feet when observed in a seated or non-weight bearing position have an arch. It is only when standing or weight-bearing that the feet collapse. This simple test can be used to determine whether or not you have true flat feet or simply pronated (aka “rolled-in”) feet.

So when feet pronate or “roll-in” excessively, they appear to be flattened through the arch and are therefore often mistakenly termed “flat feet”.

What are the symptoms of flat feet?

True flat feet won’t cause a problem but flattened feet secondary to foot pronation can contribute to a variety of overuse injuries, sports injury, foot problems, aching legs and postural complaints.

Symptoms can occur in a range of areas including the:

• Feet (e.g. bunions, hammer toes, calluses and corns)
• Heels (e.g. heel spurs, plantar fasciitis, achilles tendonitis, achilles tendinopathy)
• Ankles (e.g. ankle instability, deltoid ligament strain, sinus tarsi syndrome)
• Shins (e.g. shin splints, posterior tibial tendonitis)
• Knees (e.g. Patellofemoral syndrome, chondromalacia or cartilage damage beneath the kneecap)
• Thighs (e.g. Iliotibial band syndrome)
• Hips (e.g. greater trochanter bursitis or inflammation near the hip joint)
• Lower back & Spine (e.g. Sciatica, pelvic instability)

“Growing Pains” in children may also be the result of hypermobility or feet that roll in too far.

Excessive pronation or hypermobility tends to contribute to alot more problems when the degree of foot pronation is significantly different between the left and right side.

What causes flat feet?

There are many causes of abnormal pronation which gives rise to the appearance of flat feet. The most common being:

• Hereditary bony conditions within the foot that distort normal walking patterns. (e.g. rearfoot varus of the heel bone)
• Abnormal muscle length or muscle tone. (e.g. tight calf muscles can cause pronation as a compensatory mechanism)
• Abnormal leg rotations (e.g. bow legs or knock knees can be functional or structural altering forces through the feet)
• Poor pelvic alignment causing leg length differences
• Spinal conditions (e.g. scoliosis)
• Hypermobility or ligamentous laxity can cause feet to appear flat.
• Muscle spasticity (e.g. cerebral palsy)

Once your Podiatrist determines the cause of your excessive pronation, appropriate treatment options can then be discussed.

How are flat feet diagnosed?

Your history is considered and your podiatrist will normally carry out a full biomechanical assessment. This will involve examination of:

1. The range of motion in the joints of your feet and legs;
2. The muscles in your feet and legs to check for any strength or flexibility deficits; and
3. Your walking pattern or a gait analysis.

Once your podiatrist has completed their examination, an appropriate treatment plan can be recommended.

How are flat feet treated?

If you have flat feet without excessive pronation, you should not experience painful symptoms. In this situation, your feet should be well aligned in relation to the leg and you will be much less likely to experience overuse injuries.

If your podiatrist performs a detailed assessment of your feet, legs, gait and posture and determines your foot alignment is contributing to any pathological forces, treatment may include:

• Stretching exercises. Some people with flatfeet also have a shortened calf muscle. Exercises to stretch this tendon may help.
• Specific strengthening exercises. A weak tibialis posterior muscle can contribute to arch collapse.
• Supportive footwear may be needed if current shoes are inadequate.
• Training advice may also assist
• Orthotics may be necessary. Foot orthotics are specially designed arch supports to help restore normal symmetry and function especially when hypermobile joints are evident. The type of orthotic you require will normally be determined following a thorough analysis of your feet, legs and gait.
• Different conditions will require integrated therapy with other health professionals especially in the case of a scoliosis. Your podiatrist will discuss this with you when necessary and refer you to the appropriate healthcare professionals if required.

Surgery
Surgery isn’t normally performed solely to correct flatfeet. However, symptoms or problems associated with flat feet may need surgery if conservative treatment fails to provide adequate relief.

Where Can I Get Help for Flat Feet?