Flat feet start a chain reaction of injury, and how orthotics can help

The shape and structure of the foot and whether the foot has an arch that offers support determines flat feet and the resulting problems

Foot health is often overlooked by chiropractors and medical doctors and is important for a variety of reasons, and flat feet can cause a chain reaction of injury resulting in back pain, leg pain, and even reaching up to the neck due to the loss of shock absorption to cause tightness and discomfort.

Healthy feet properly support the body while standing and walking. Additionally, a National Foot Health Assessment found that individuals who self-reported having “excellent” or “very good” foot health also tended to be more physically active. This provides them with benefits which include easier weight management, reduced risk of disease, and even better emotional health.

Looking after your foot’s health can be even more important if other diseases are present. Diabetes is one to consider, with the American Diabetes Association explaining that neuropathy in the foot can occur with this particular condition, making it easier to injure the foot due to a loss of feeling, and poor blood flow causing even more potential issues in this lower extremity.

Another factor to consider with regard to healthy feet is the shape and structure of the actual foot; specifically, whether the foot has an arch that offers the patient a proper level of support and function. If it doesn’t, if the foot is too flat, it can set off a chain reaction of injury.

The consequences of poor arches

While not having an adequate arch can present issues for the feet specifically, oftentimes resulting in pain because body weight is not evenly distributed in the lower body, the impact can create issues in other areas of the body as well.

For example, in 2013, Arthritis Care & Research published an article noting that participants with a flat (planus) structure tended to experience more pain in the ankles and knees due to “altered lower extremity functional alignment…and muscle activation patterns.” This structure also caused an excessive anterior pelvic tilt.

Other studies have made a connection between flat feet and low-back pain, with one such piece of research finding that 45.07% of the participants with chronic low-back pain had a flat right foot and 49.29% had a flat left foot.

Causes of flat feet

The Cleveland Clinic reports that everyone is born with flat feet as the arch does not begin to develop until around the age of three. And if flatfoot continues to exist beyond that age, it can either be flexible flatfoot — meaning that the arch appears when sitting or standing on tiptoe but disappears when standing — or rigid flatfoot, which is more permanent in nature.

The American Academy of Orthopaedic Surgeons adds that some people can develop a condition called “adult acquired flatfoot.” Causes of adult acquired flatfoot include injury to the ligaments in the foot, posterior tibial tendon dysfunction (PTTD), arthritis, and diabetic collapse.

Tips for identifying flat feet

The first step in helping patients with flat feet is to identify whether it exists. This process is primarily visual as the patient’s entire foot will be touching the floor when he or she stands. If it is difficult to tell, you can also do what is called a “wet test.”

A wet test involves getting the patient’s feet wet and having him or her stand on a surface that leaves a clear imprint of the foot, such as a piece of colored paper or cardboard. The flatter the feet, the more the footprint will be filled in. The Mayo Clinic offers an easy-to-use graphic that helps better identify the type of foot arch based on the imprint.

The wear patterns on patients’ shoes are also a good indicator of whether the feet are flat. With flat feet specifically, the bottom of the shoe tends to be worn more on the inside due to pronation of the feet.

It can also be helpful to ask the patient about symptoms commonly associated with flat feet. Among them are pain in the arch of the foot, as well as pain in the calf, knee, hip, or lower back. The patient may experience stiffness in their feet as well.

Treatment with custom orthotics

Research has found that treating flat feet with custom orthotics is often beneficial. For instance, one study published in the Journal of Physical Therapy Science noted that use of orthotic insoles when flexible flatfoot is present offered significant improvements in the plantar pressure of the flatfoot. Further, these orthotics are especially beneficial when walking down stairs, even when the individuals had “normal” feet.

Another study, this one published in the journal Medicine, focused solely on the effect of customized arch support insoles for children with flexible flatfoot. Fifty-two children were included and, when compared with a control, those treated with insoles showed significant improvement in pain, physical health, mobility, stair ascent time, and physical function.