Flat Feet - Facts and Treatment

Flat feet (also known as fallen arches or pes planus) occurs when the long arch on the inside of your foot collapses, causing the entire sole to make contact with the ground when standing.

The Role of the Foot Arch
The arch of the foot is a remarkable structure, essential for efficient movement and stability. Its primary roles include:

• Shock Absorption: Acting as a natural spring to cushion the impact forces generated during activities like walking, running, and jumping, thereby protecting the body.
• Energy Transfer: Transforming the foot from a flexible structure into a rigid lever for propulsion, providing a crucial rebound motion during movement.
• Stability and Balance: Providing a stable base for standing posture, which helps maintain proper alignment and balance throughout the body.
• Adaptation: Offering flexibility that allows the foot to adapt to various uneven surfaces.

There’s a simple at-home test you can use to get an initial idea of your arch shape:
1. Wet your feet thoroughly.
2. Step onto a piece of paper, cardboard, or a concrete floor.
3. Examine the footprint.

Interpreting Your Footprint
* Normal Arch: The print will show the ball of your foot, the heel, and a narrow band connecting them on the outside edge.
* Flat Foot (Fallen Arch): The entire sole of your foot will leave a complete print, showing no inner gap where the arch should be.

Types of Flat Feet
It’s important to distinguish between the two main categories:
* Flexible Flat Foot: The arch is visible when you are sitting or standing on your toes, but disappears when you stand normally.
* Rigid Flat Foot: The arch is absent (flat) whether you are standing or not.

For many people, being flat-footed causes few, if any, symptoms. However, when flat feet lead to biomechanical issues, they can cause problems extending far beyond the foot itself.

Common Symptoms
If your flat feet are symptomatic, you may experience:
* Pain in the foot and ankle.
* Pain in the knee, hip, or lower back, caused by altered alignment.
* Difficulty or discomfort during normal activities, such as standing or walking long distances.

Long-Term Considerations (The ‘Kinetic Chain’ Effect)
The arch’s collapse can alter the forces transmitted throughout the body, affecting the entire kinetic chain—the interconnected system of joints, muscles, and bones from your feet up to your spine.

This may lead to:
* Altered Limb Biomechanics: Changes in the way you walk and run.
* Malalignment Issues: Such as internal rotation of the hip and leg, and potentially pelvic tilting.
* Increased Risk of Pain: Foot, knee, and hip pain as an individual grows or places greater demand on their body.

The stability and function of the longitudinal arch are fundamental to athletic performance. When this function is compromised, it can reduce overall movement efficiency and increase the risk of injury.

Impact on Gait and Movement
In a flat foot, the foot may spend too much time in the flexible, shock-absorbing phase and too little time in the rigid phase necessary for powerful propulsion. This inefficiency can compromise performance by:
* Decreasing Propulsive Force: The ‘spring’ mechanism is reduced, leading to less powerful push-off.
* Reducing Energy Transfer: Movement becomes less economical and requires more effort.
* Compromising Forward Momentum: Movement patterns are altered, affecting speed and endurance.

Effects on Sports Performance
Flat feet can compromise the quality of movement in sports that demand high levels of control and explosive power, specifically those requiring:
* Quick changes of direction (agility).
* Effective jumping and landing mechanics.
* High levels of balance and stability.

At ESIC, we focus on a logical and evidence-based treatment strategy. Treatment aims to reduce pain, improve function, and enhance stability.

We find that treatment is most successful when the flat foot is flexible (not rigid), and a comprehensive plan typically includes:
* Orthotics: Custom or off-the-shelf insoles to provide external arch support, improve foot alignment, and optimise force distribution.
* Mobility and Flexibility Exercises: To address any restricted movement in the ankle or foot.
* Strength and Conditioning: Targeted exercises to strengthen weakened foot and ankle muscles, helping to support the arch internally.
* Proper Shoe Selection: Guidance on footwear that provides the necessary support for your specific foot type and activity level.

While many individuals with flat feet live pain-free, when they cause biomechanical dysfunction or pain, seeking professional assessment can significantly improve your daily life and athletic performance.