The Effects of Having Flat Feet
Every joint in the body has a “neutral” or centralized position. This is the optimal position you want your joint to be in so that the body part could operate smoothly and prevent pain and injury. The “neutral” position of the foot is when there’s an arch on the inside (or medial) part of the foot so that you could feel a space underneath with your fingers. So in order to achieve “neutral”, the weight emphasis of the foot should be placed on the toes (or forefoot), the outside part of the foot, and the heel. If the weight is on the inside part of the foot too, where you feel the entire foot on the floor, you likely have “pes planus”, or flat feet.
Anytime a joint is outside of its “neutral” position, compensations occur up and down the chain. In the case of the foot, this would typically alter the alignment of the leg. If you look at the picture below, instead of the leg being straight up and down, you will see the knees coming inwards which puts increased pressure on the medial part of the knees. This would also alter the hip and pelvic position as well as the low back. Depending on how pronounced the flat feet are, the compensations could differ in severity for each individual. But over a long period of time, these compensations could definitely have its effects. The majority of people who have flat feet come to physical therapy with foot or heel pain, plantar fasciitis, calf tightness and/or cramping, or even pain in their ankle, knee, hip, or back.
So what could be done about it? In many cases it’s a combination of things. You not only have to work on stabilizing the foot properly but the leg should also be in its “neutral” positions and alignment when doing exercises. This often will require cueing by the physical therapist and emphasis on proper activation of muscles (particularly gluteals and quads) and mobility in the ankles (calf/soleus muscles and ankle joint). As mentioned in previous blog posts, another area of focus is the trunk — without the trunk being in its properly stabilized and “neutral” position, it’s difficult for other areas to be in their “neutral” positions too.
One way to check if you have enough mobility in your ankles is in a half kneeling position (as shown in the video below). Come down onto one knee, keep your front foot and heel down on the floor and with your foot a hand’s width away from the wall, come forward with the knee and try to touch the wall. If the knee is able to touch the wall you likely have enough mobility in the ankle but if not, you need to work on calf/soleus stretching and/or ankle joint mobility. The reason this is important is because without this motion, there will likely be a compensation occuring at the foot where no matter how much you work on stabilizing the foot, if you dont have ankle mobility, your foot will always compensate for that with more motion. Hence nullifying some of the foot stability work.
As with other areas of the body, it could be a process in being able to neutralize joint positions and establish proper stability in the foot. So in the meantime, getting a foot orthotic inside your shoe will establish that arch for you (take the insole of your shoe out and put the foot orthotic in). This shouldn’t be a permanent solution (though some people need it for a long period of time), but think of it more as a “crutch”. Crutches are used as assistance until proper function could be restored in the legs. In the same way, an orthotic could be used as assistance while in the process of decreasing pain and restoring proper stability in the foot.
Some people opt for a custom orthotic that is tailored specifically to their feet, which is great. However, unless covered by insurance, this could be an expensive option. A great over-the-counter orthotic is this one by Superfeet. I used to utilize this in the past and have recommended it to many patients. This would help keep your foot in its neutral position.
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