Myth: Flat feet cause your pain

The assumption that an individual has “flat feet” and that this is the cause of an array of musculoskeletal issues they may have suffered, is something that has been massively driven by health professionals for decades. Not only does this so-called issue, in isolation, mean very little to most of the population, but those that have imparted this wisdom have often 1)not attempted to specifically assess whether this is the case or 2) not been aware of how this should be measured clinically. Very often the blaming of “flatfeet” as the primary driver of an issue is, in my opinion, a lazy line from the practitioner.

 

In clinic, I often hear the assessment of this issue can be as little as a clinicians visual observation that the client arches are low relative to the ground, literally that can be it. On some occasions the clinician runs their fingers under the clients instep when they are standing and claim the same, and some have even made this assumption when the client is laying on their back…. Unless the patient is weight bearing , ie standing, then no assumption can be made by a practitioner when it comes to your arch height.

Figure 1 The medial aspect of the foot, giving you an idea of where the navicular is (where arch height is measured from) and the Abductor Hallucis and Plantar Aponeurosis (where clinicans often assume arch height from).

 

So how do you know if you have “flat feet”? Firstly, the measuring of this should be done from the distance between the bottom of the navicular and the floor when the client is standing. The navicular is a bone on the inside aspect of the foot and is a bit of a keystone when it comes to foot function. Therefore you may have an apparent “flat foot” when just observed, but the naviculars height could be well within “normal” ranges. The apparent “flatfoot” is frequently due to the mass of soft tissue in the region, like the plantar aponeurosis or abductor hallucis (figure 1). Some people have more than others, and in my experience I’ve noticed if more frequently inAfro-Caribbean populations and those who have a sporting and personal profile that biases speed and high force development.

  

Now a clinically “flat foot” can be acquired, and if clinically relevant, may be something you’d like to affect. However I would argue that the position isn’t the entire issue (if an issue at all), and that the more pressing issue is controlling of movement in that region of the foot.The excessive flattening foot is often referred to as over-pronation (an outdated term which is still frequently used), this describes the flattening of the foot when weight bearing and the clinicians belief that there is too much flattening going on. So what do they prescribe? Often a medial arch supporting orthotic. Which often misses the point. Let’s be clear, you want your foot to flatten as you impact the floor, for a whole host of reasons, so let us not vilify it. But if there is a perceived excessive pronation then perhaps it is time to start looking at the muscles that control pronation of the foot rather than putting something rigid underneath it like a medial arch support. As an improved ability to control this movement will increase the amount of force it can withstand and therefore control the movement of the foot into pronation = less flattening of the foot, and greater efficiency in applying force into the ground.

 

Now this all sounds very simple but the fact is that this is an incredibly complex region of the body and clinicians really do need to know their anatomy and local biomechanics to accurately label someone with something like “flat feet”, whether or not we agree it is a genuine issue in the first place. The point of me highlighting this area is because I’ve often treated people who are resigned to having “flat feet”, that there is nothing they can do about it other than wear the orthotics they received 4 years ago and that this is a barrier to their participation in exercise and performing in the way they’d like. Please do not fear, in the large majority of the time this is not the case and specific strengthening work can work wonders.

 

I’ll cover some more specific things you can do it later posts. However, keep an eye out for Production Education where we will tackle these areas in more depth, and give you practical tools to make the term “flatfeet” a part of your past.

 

Thanks for reading

 

Barry

 

@barry.sigrist