Flat feet can cause chronic muscle strain.

©iStockphoto.com/Heiko Potthoff

It is often assumed that flat feet mean a life sentence of pain from the waist down. In this article we will discuss some of the common contributors to flat feet and whether they are the cause of discomfort or the result of poor conditioning. 

Every day people all over the world are born with flat feet. Many are extremely active, running, playing soccer and doing heavy labor. This begs the question, how are some individuals with flat feet perfectly fine, even when active, and others get a lifetime of foot and leg pain? First we must look at how a normal foot works as opposed to a troubled one.     

During walking, the foot normally flattens out slightly so that it can absorb force and help accommodate the surface. A flattened or pronated foot is a flexible foot. The alignment of the bones essentially unlocks the foot. Reversely, when a foot has a higher arch or is in a supinated position, it is locked and rigid. It does not absorb force well nor does it mold to the ground as a pronated foot does.

Since a flat foot is structurally looser, it can be prone to chronic muscle strain as the muscles attempt to keep the foot in a stable position. For people who have always had flat feet, their muscles have likely adapted pretty well to their normal activity level. However, when the demand on the muscles increases, as with an increase or change in activity intensity or duration, pain may result. Decreased stability of a flat foot naturally increases the movement of the medial (inside) part of the foot.

When the foot flattens excessively it can trigger an inward rotation in the lower leg bone, the tibia, causing the knees to point toward each other. Of course the upper leg bone will likely follow along, causing increased or altered movement at the hip. So, ultimately excessive or increased movement of the foot into a flattened position can cause pain all the way up the leg to the hip and lower back.

Patients need to determine whether the feet (or sometimes just one foot) is flat due to its own problem or whether something else is going on. Since the foot can cause rotational issues all the way up the leg, the same rotations at the hip can cause the foot to flatten. It is extremely important to know if the foot is causing the problem or if the foot is the result of a problem further up the leg. Through thorough analysis, perhaps including gait analysis, a physical therapist or other health professional should be able to determine this answer for you. 

Treatment

This leads us to treatment for flat feet. Feet that are flat because of a structural problem, or gradually loosening ligaments or tendons can be helped through shoe orthotics. Start with a firm, over-the-counter insert. They usually cost less than $40 per pair. If needed, you can get custom orthotics from a physician, podiatrist, orthotist or physical therapist. These can cost hundreds of dollars but are usually made with more durable materials. 

If flat feet are acquired (have not always been flat), you should start by trying to determine what is causing this change. It is quite common for flat feet to be caused by excessive muscle stiffness in the calf muscles or weakness in the hips. If the foot is being forced flat or allowed to become flat because of muscle stiffness or weakness further up the leg, those areas need to be addressed first. It is quite possible that pain in the foot or lower leg from increased flattening could be resolved by doing selected exercises or stretching the calves as well as possibly trying an orthotic or shoe insole. Remember, if an insole is placed in one shoe, be sure to put one in the other as well to maintain balance. 

The bottom line for treating flat feet is, you have to get to the cause of the problem first then treat it according to the cause, not according to the appearance of the foot. Just because your feet are flat, does not mean that they are the cause of your discomfort. Likewise, flat feet may be caused by problems at the other end of the leg.