When a foot is flat, it means that the natural arches have fallen. Flat feet are less shock-absorbent and make for a less stable base involving everything above the foot (i.e. knees, hips, and spine). Feet are the body’s foundation. Flat feet can cause serious problems all the way up the kinetic chain to the neck and head!
When a foot loses its arch and becomes flat, it can cause the ankle to roll in toward the midline. This movement pattern of allowing the foot and ankle to roll in is called pronation. Because pronation shifts the body out of its natural alignment, people may experience aches and pains in the foot, knee, hip, back and/or neck. Flat feet can also lead to injury and problems like shin splints, Achilles tendonitis, and plantar fasciitis. People with flat feet or pronation are 50% more likely than those without to have low back pain.
Biomechanical problems also exist when one arch is lower than the other, creating asymmetry, as in the picture below. The pelvis and hip will drop slightly as the leg’s support structure (the foot) drops. The body may lean slightly to that side. The muscles and tendons must now work harder, yet less efficiently to make up for the imbalance.
In the picture above we see a person from the backside. The picture on the right shows a normal person with good foot structure and arches that are the same on both feet.
The picture on the left demonstrates a person who has a flat foot on the left. As seen in this picture, the loss of the arch on this foot causes the ankle to roll in (pronate) which in effect causes the left knee to torque inward now making this leg shorter and causing the left hip to drop lower than the right. In an attempt to keep the body standing erect the shoulder on the left side now has to rise up to prevent the rest of the spine from leaning to the left! One can now see how these alignment changes will cause all of the muscles in the entire body to compensate and leave one prone to more injuries.
A good analogy to think about is your car. Imagine the 2 left tires are set to 20 PSI and the 2 right tires are set to 40 PSI. The entire car will now pull to the left because of the deflated tires and the driver will now have to use more muscular force pulling the steering wheel to the right in an attempt to keep the car straight. This is exactly how the body is working when one foot pronates or is more flat than the other foot. Symmetry is vital.
It is estimated that about 33% of the American population over the age of 21 may suffer from unilateral pronation or flat feet! Are you one of them?
The most common causes of flat feet are the following: congenital birth abnormality (genetics), traumatic injury, stress over time (due to weight, improper foot wear, everyday activity like standing, running, etc.), nerve problems, post-pregnancy, aging, diabetes, and health conditions such as rheumatoid arthritis.
The connective tissue (plantar fascia) on the underside of the foot is critical to maintain the foot’s healthy arched type. Injury and certain health conditions can cause the fascia to stretch out and flatten, but so can every day, ongoing stressors like walking and standing. In fact, repetitive, low impact force overtime can be just as devastating as a sudden, high impact force like injury. Once the fascia stretches out it is unable to “spring back” and create an arch. With the foot structure flattened, the body’s very foundation is in trouble.
Prevention is Key! Now that you have the knowledge and basic understanding of the foot and how it functions, preventing weakness of the plantar fascia is vital if possible (i.e. no genetic factors involved).
One of the best ways to prevent a loss of your arch is to walk around bare foot as much as possible. By doing this you are forcing the foot muscles to work hard to stabilize the foot, in essence working out this muscle to keep it strong and maintain a proper arch.
Secondly, proper foot wear is vital. Flip flops wreak havoc on the arch by causing the toes to claw up and prevents muscle contraction at the moment of foot impact. These should be avoided at all costs! Most foot wear is subjective with regards to comfort and the occasion, but when choosing any type of foot wear you want as little heel drop as possible. Heel drop is the difference from the height of the back of the sneaker to the front. The higher the back of the foot off the ground, the shorter your muscles in the foot and ankle become therefore weakening these muscles.
Lastly, foot and ankle mobility is of the utmost importance when trying to prevent injury and maintain proper foot structure. Simple movements involving calf stretches, ankle rolls, and using a tennis ball (or something similar) to roll up and down the arch of the foot. These movements should be done daily and can easily be completed while working at the desk or sitting on your couch!
If you are already experiencing foot pains the previously mentioned recommendations may not be suitable as they are meant for those with normal arches in both feet. If you are not sure, or you are already experiencing foot, ankle, knee, hip, or spinal pains, have your feet evaluated and see if this could be a cause.
In next month’s blog, we will be covering specific pain syndromes involving the foot and ankle, how they can be managed, and what one should do to prevent these issues from getting worse.
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