Flat feet and other support problems

What flat feet are

Flat feet means the arches of the foot are lowered. The foot absorbs shock less well, the load is spread unevenly, and the work is passed on to the joints above: the ankle, knees and pelvis.

In Natalia Romanchuk’s view, flat feet are above all a muscle problem. When the muscles that hold the arches weaken, the arches gradually drop. So the main way to work with flat feet is to strengthen the foot and restore how it functions.

Types of flat feet

Longitudinal flat foot is a lowering of the inner arch. The foot lengthens, its inner edge almost touches the floor, and the heel may tilt outwards.

Transverse flat foot is a flattening of the transverse arch. The forefoot widens, calluses appear under the ball of the foot, and the big toe may drift, forming a bunion. The two types are often combined.

Flat feet are also divided into flexible and rigid. With a flexible flat foot, the arch appears when you stand on your toes or sit, and disappears under load. With a rigid one, the arch does not appear in any position. A rigid flat foot is a clear reason to see a doctor.

There are other support problems too, such as an unusually high arch (cavus foot) or valgus foot position in children, when the heels tilt outwards and the foot rolls inwards.

Flat feet in children: they won’t grow out of it

In small children the foot looks flat: the arch is still forming, and there is a fat pad on the sole. This is normal for their age. But by 5–6 years old the arch should usually be visible.

If the foot stays flat after that age, waiting does not help: a child will not simply grow out of flat feet. Left alone, they usually become more fixed. So preventive foot work can confidently start from 5–6 years old, and earlier when there are health problems and a medical reason.

Many children find it hard to practise regularly on their own. So it is best if an adult — a parent or a specially trained person — keeps an eye on their technique.

How to tell normal from abnormal

You can make a few simple observations at home. Wet your feet and stand on a sheet of paper or dark tiles: if the print almost fully covers the inner part of the foot, the arch is lowered. Look at the feet from behind: normally the heel is almost vertical. Stand on your toes: with a flexible flat foot the arch will appear.

These checks are only a rough guide. The exact degree of flat feet is determined by a doctor after an examination and, if needed, further tests.

Insoles and exercise

A common myth is that insoles cure flat feet. An insole supports the foot and can reduce the load, but it does not train the muscles. Natalia believes an insole only shifts support in a certain direction, while the muscles do not get any stronger.

If a doctor has prescribed insoles, wear them as advised. But the muscles need work alongside them: without it, the support will not become stronger.

Why flat feet develop

There are usually several causes that add up. In Natalia’s experience the main one is weakness of the muscles that hold the arches. Other factors join it:

• an inactive lifestyle and little walking on varied surfaces;
• long hours of standing at work;
• extra weight that constantly loads the arches;
• tight shoes, high heels or, on the contrary, shoes with no support at all;
• foot and ankle injuries;
• pregnancy: ligaments become softer during this time while weight increases;
• inherited weakness of connective tissue.

What happens if you do nothing

Flat feet rarely cause trouble on day one. More often it starts with legs that tire quickly, then calluses, foot pain by evening, and the big toe may begin to drift. Because the foot absorbs shock less well, the knees, hips and back take more of the load.

Natalia sees this as the main purpose of the course: to pay attention to the feet in time and avoid later injuries and joint damage. The earlier the work begins, the easier it is.

Transverse flat foot and bunions

When the transverse arch flattens, the metatarsal bones fan out and the forefoot becomes wider. The big toe gradually drifts towards the other toes, and a bony bump appears at its base. Shoes start to press, and redness and calluses appear.

In the early stages, strengthening the muscles that hold the transverse arch and the big toe helps, along with shoes that have a wide toe box. If the deformity is already marked, growing quickly or painful, see an orthopaedic specialist.

When to see a doctor

See a doctor (an orthopaedic specialist) if your foot hurts, if the flat foot is rigid or on one side only, if it appeared after an injury or is quickly getting worse, and if a child complains of pain and tiredness in their legs. Read more in “When you need a doctor”.