Fix Flat Feet!

One of the most common faulty movement patterns we deal with as athletes is overpronation, aka a collapsing arch in our foot. A solid arch must be able to maintain solid integrity during your day-to-day activities and stand up to environmental demands. Flat feet, or overpronators, are not uncommon. In fact, nearly a quarter of the population deals with it. Most of the time having flat feet doesn’t cause any significant problems, however in some causes it can not only lead to foot and ankle pain, but cause issues up the chain and contribute to knee pain, hip pain, and even lower back problems. If you have flat feet or dealing with pain associated with collapsing arches, read on.

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​Flat feet are actually normal in infants and toddlers, however, during childhood, most people develop an arch. Some do not. Research published in the Journal of Bone and Joint Surgery found that kids who wore shoes were three times more likely to develop flat feet than those who spent most of the time bearfoot. This link is tied directly with development of the strength of the muscles within your foot. Shoes act as an external support, causing the foot intrinsics to not need to work as hard.  While you can be born with flat feet, more often than not it’s acquired through the years. It’s estimated that about 20% of adults deal with it.

However, if you’ve noticed your once-sturdy arches have started flattening over time, you might be in for more pain. More often than not, this is caused by chronic stretching, tearing, and weakening of the posterior tibial tendon—the tendon most responsible for supporting the arch. If you do nothing, adult-acquired flatfoot tends to get progressively worse and worse. You may not feel much pain now, but the likelihood is high that it may be coming in your near future..

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The influence of shoes and flat feet

The foot/ankle complex needs to serve as a rigid lever for weight bearing and propulsion during movement, and at the same time, be a flexible structure to adapt to altering surface areas.  In addition, the foot/ankle complex works to support body weight, provide proprioceptive feedback (awareness of where your body is in space), and absorb shock. This flexibility is needed to allow the foot to conform to varying surfaces, especially when walking barefoot. When adding shoes to the equation, these natural mechanics can be altered. A shoe that is to stiff and doesn’t bend much can provide too much support and potentially weaken the arch muscles over time. Everyone’s specific circumstances are different depending on the integrity of your arches and what forces you subject them too, causing everyone’s footwear needs to vary from one person to the next.

Most traditional shoes, including athletic shoes, are over-supportive, increasing the potential for weakness over time. If you have decent arches and you wear supportive shoes, you could be putting yourself at risk for developing foot weakness and poor arch strength, simply because your arch muscles don’t need to do anything. On the flip side, if you have severely collapsing arches, and you pop on minimalist shoes, you may be in trouble. These athletes may benefit from a more supportive footwear to provide some temporary relief. The word temporary is in there for a reason. This can be a double edged sword, since adding external stability (the stiff shoe) to your foot will cause the muscles to weaken even further over time, because they simply have to work less. So as a general guideline, if you have normal or high arches, you likely need more flexible, minimalist shoes. However if you have flat feet, you likely could benefit from more supportive shoes to help relieve some pain while you get them stronger. However, in either circumstance you need solid arch strength, which we’ll dive into deeper in these next few paragraphs.

In addition to most traditional shoes being more rigid, many also have a raised heel relative to the toes (and even worse with women’s high heels are men’s work/business shoes). This places the foot in a relative position of plantarflexion — the ankle pointed down — position. Over time, this can cause the upward motion, dorsiflexion, to become stiff, causing restrictions in the ankle joint and calf muscles and achilles tendon. Lack of ankle dorsiflexion is one of the leading causes of excessive stress on the arch and other regions around the foot and ankle. Especially if you engage in activities that require a lot of it – think squatting, running, etc – you could be in a lot of trouble.

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Spending more time outside your shoes helps not only maintain adequate dorsiflexion but helps to strengthen the arch muscles. But before you throw away all your shoes I should mention that the role shoes play in flat feet and overpronation still is not entirely clear. There are likely many other contributing factors such as genetics, weight, hip strength, and other environmental factors that play a role. So let’s dig in a bit further.

The Effect of Body Weight and Flat Feet

The basic structure of the foot is formed by the shape of the bones, connected by ligaments, and supported by muscles forming a bridge. The bones wedge together in a way to provide a firm foundation from the forces coming down from above. The ligaments provide resistance to these bones separating. The muscles that connect in and around the foot have the ability to lock and unlock the bridge. For instance when we want to push off we need our foot to be locked for propulsion and when we land we need our foot to unlock to absorb impact and conform to the ground.

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The connection between arch (bridge)  integrity and weight is straight forward. The more weight we carry, the stronger the bridge needs to be, and the harder the arch needs to work to support its shape. The ligaments and muscles then need to be stronger to hold firm, however, because of the amount of time we spend in shoes, and the subsequent hip weakness that occurs in overweight individuals, this rarely happens. So, to not beat around the bush anymore, if you’ve got a dad bod or you’ve been carrying excess weight, consider working on losing some lbs.

The Effect of Hip Strength and Flat Feet

The body moves and functions as one big machine, on big unit. If one part isn’t pulling its weight, others will suffer the consequences. There is clear evidence that hip weakness can lead to a host of problems, including excessive pronation. Hip weakness, particularly with your glute max and glute med (your booty muscles) lead to poor movement patterns and poor control of what’s happening downstream. For you science nerds out there, it essentially causes femoral internal rotation, leading to genu valgus, and further causing that inward collapse of the arch!What About Orthotics?
Overall, I am not a big advocate of orthotics, however, they can be helpful in certain situations and more severe cases. Using an artificial arch support can prevent the arch from excessive collapsing and significantly reduce pain. As we mentioned previously, however, this can further weaken the arch over time, and potentially lead to more frustrating and involved issues down the road. I would recommend to only go to an orthotic as a last resort, not as your first option. And if you do, make sure you continue to work on strengthening the arch muscles and spend time barefoot within tolerance. 

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The Takeaway

Our constant use of over-supportive footwear, poor hip strength, extra lbs, and other environmental factors can lead to the development of painful flat feet. The bottom line is that 9 times out of 10 this is a strengthening issue (check out my youtube channel and instagram for arch exercises), nothing more. If you want to reduce the pains associated with an excessively collapsing arch, you must take an active, not passive approach (i.e. ice, stretching, massage, estim, laser, etc. etc.) in your treatment. We, at The Charlotte Athlete, help athletes and active individuals dealing with flat feet and collapsing arches all the time. If this is you, and your foot pain is affecting your workouts or your day to day life, shoot me an e-mail at [email protected], and we’ll help get you rolling down the right path!

THanks for reading,
​Dr. Andrew

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