Flat Feet

Low arched, or flat feet, are a common type of foot structure. Most flat feet are pronated which is a foot in poor functional position. Close examination of this type of foot in a weight-bearing position shows:

• turning out of the heel bone away from the centre of the body
  
• inward rotation of the leg
  
• bulging of the inner aspect of the ankle
  
• shifting of the forefoot outward from the heel
  
  
  • Not all pronated feet appear flat, especially when off a weight-bearing position. Conversely, some flat-appearing feet are not pronated. It is the pronated foot which is troublesome.

Causes
Flat feet may be apparent from birth or may develop over time. The foot structure may be a consequence of:

abnormalities in the shape and alignment of bones;


excessive elasticity or laxity of the ligaments holding bones together; or
an imbalance in the muscles acting on the foot.


If any of these factors are present, other symptoms may develop as well. Flat pronated feet may run in families. The genetics of this condition are not simple, so if you have flat feet, it is not inevitable that your children will get them as well. Some forms of congenial flat feet are severe and require corrective casting or surgery during infancy. Fortunately, these cases are rare. More commonly, flat feet become apparent in later childhood.

Consequences
Posture - Position and alignment of the foot, leg, pelvis, and spine are all related. Flat feet predispose people to problems of the ankle, knee, hip and lower back due to a poor posture.

Arthritis and Deformity - The long-term consequences of strain on the pronated foot may include arthritis, bunions, heel spurs, hammer toes, and other deformities.
Fatigue and Strain - The pronated foot does not function efficiently to propel the body forward. As a result, the joints go through an excessive range of motion with undue strain on the soft tissues binding the bones together. This creates an unstable foot and the sensation of "tired" feet, arch discomfort, pain in the heel or pain in the ball of the foot.

Leg Discomfort - The large muscles of the lower leg have tendons which help move the foot. The instability characteristic of the pronated foot may cause these muscles to overwork and create sore and aching legs. Shin splints is a condition well known to runners and is often the result of pronated feet. In some individuals, discomfort may be present in the entire leg and lower back.

Treatment
Treatment starts with a proper evaluation of the underlying cause of the conditions to diagnose the appropriate correction. Your podiatrist may recommend functional orthotics, or special supports to compensate for mechanical faults, to allow your feet to function with improved efficiency. Orthotics relieve stress from compromised joints, ligaments and muscles, diminishing deforming forces acting on the foot.

Author: Neil Humble , DPM


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