Flat Feet

Sinead Brogan is a Chartered Physiotherapist and runs FlexPhysio Physiotherapy Clinic at Whelehans Pharmacy, Pearse St, Mullingar. To book an appointment or ask a question call Sinead at 083 1722171 

During childhood, usually between the ages of 3 and 10, we develop a space on the inner side of our feet where the bottom of the foot is off the ground. These are referred to as the "arches" of our foot. The height of this arch varies. People with a low arch or who have no arch are classified as having flat feet. Sometimes this is referred to as having "fallen arches" though this term is misleading as most with “fallen arches” actually have a low arch.

Causes

Flat feet can run in families, and both feet are usually affected. Occasionally, flat feet are due to a problem in the way the foot forms in the womb. For example, a joint may be misformed or two or more bones may fuse together. In these situations, the feet are stiff and flat and the problem is usually noticeable during childhood.

Another form of the problem is when the foot has a tendency to roll inwards too much while standing or walking. This can be due to weak ligaments in the heel joint or at the base of the big toe which can cause excessive rolling in of the foot. "Pronation" of the foot is another term for rolling of the foot thus an "over-pronated foot" is a term for excessive rolling of the feet.  Regular rolling in of the middle of the foot causes the heel and the front of the foot to point outwards more than usual. People with these problems can tend to have weak joints in other areas of their body too. A common method of telling if you have developed over-pronated feet is to stand up on your tippy-toes, or by pushing your big toe up as far as it can go. If an arch appears, the foot is sufficiently flexible and there are no issues.

While over-pronated feet usually develop in childhood, there are times when flat feet develop when the person gets older. Flat feet may develop due to a ruptured tendon (a ruptured tibialis posterior tendon which is rare), tear of the spring ligament (also rare), arthritis, nerve damage due to diabetes, or injury which leads to stiffness and distortion of the joints of the feet. Conditions of the nervous system or muscles including cerebral palsy, spina bifida or muscular dystrophy can cause flat feet as they can cause muscle weakness or lack of movement in the muscles. These conditions lead to the feet becoming stiff which get worse as the condition develops.

Other contributing factors can include shoes which limit toe movement such as high heels (walking barefoot may have a protective effect). Tight achilles tendon or calf muscles can also make a person more prone to flat feet. Obesity also can contribute to flat feet.

Are flat feet hereditary?

It is reckoned that about 20% of the population suffer from flat feet but only a small proportion of these are born with flat feet. Some cases of flat feet are hereditary. Flat feet that run in families are due to feet being shaped in an abnormal way or over-pronation feet in those with lax joints.

When is treatment needed?

Most flat feet do not cause any problem so no treatment is needed. Reasons to look for treatment include:

• Pain (not eased by any type of foot wear). Flat feet do not usually cause pain, but can put strain on muscles and ligaments (connect two bones together at a joint). This can use leg pain when walking. Pain from flat feet can occur in a number of areas including inside the ankle, at arch of the foot, the outer-side of the foot, calf, knee, hip or back.

• Wearing out shoes quickly
• Feet appear to be getting flatter
• Feet tire easily
• Swelling on the inside bottom of feet
• Feet are stiff
• Lack of feeling in the feet or weakness

There is some evidence that flat feet can contribute to osteoarthritis of the feet and that flat feet can reduce the shock absorbing qualities of the feet leading to back problems and back pain.

Treatment

No treatment is required if flat feet do not cause problems. Well-fitted shoes, especially extra-broad fitting types of shoes can help. For people suffering from over-pronated feet, a special insole, which prevents feet rolling over too much, can ease the problems. These specialised insoles can be advised on by a chiropodist or a physiotherapist who are specialists in assessing for and measuring the specialist insoles. These insoles are also called orthotics and are available in pharmacies. If pain occurs, rest, ice and over-the-counter non-steroidal anti-inflammatories, or NSAIDS (eg. ibuprofen) can give relief; however painkillers should only be a temporary solution; the cause of the problem should be identified and corrected.
Children with an abnormal foot that has not developed properly may require an operation to straighten the foot or to separate bones that have fused. Luckily operations are rarely needed as these are rare causes of flat feet in children. Most children with flat feet have a mobile form of flat feet which generally does not need treatment, or if treatment is needed due to pain or excessive wear of shoes, an insole is often sufficient to rectify the problem.

Flat feet that develop due to a disorder of the nervous system may require specialised insoles, shoes or braces to support feet or legs.  In some of these cases, an operation will be required to straighten the feet. Flat feet due to ruptured tendons or arthritis may need to be treated with pain-killers and an insole initially. Again, an operation may be required to straighten the foot in these cases.

Other actions that can help include wearing footwear with lower heels and wide toes, losing weight if appropriate and doing appropriate exercises that strengthen muscles in the feet which can include walking barefoot, exercises called toe curls (flexing the toes) and heel raises (standing on tiptoes).

Heel cord stretching exercises

These stretch and lengthen the achilles tendon and posterior calf muscles. Your physiotherapist is best for advising on appropriate exercises.

How to do:

Stand facing a wall with your hands on the wall at about eye level. Put the leg needing stretching about a step behind the other leg. Keeping the back heel on the floor, bend the front knee until you can feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times. You should aim to do this exercise 3 to 4 times a day.

Children

As noted earlier, most cases of flat feet in children do not need treatment. In the past, it was thought that flat feet in children required treatment with specialised shoes, insoles or callipers to prevent problems as they grew into an adult. This is now recognised as being incorrect and these treatments are ineffective. It is now recognised that children treated in this way will end up the same as similar children who are not treated. Additionally, children often refuse to wear the shoes, insoles or callipers. No evidence show that treating flat feet in childhood prevent problems in later life and most of these children do not develop problems when they reach adulthood even if left untreated. The only reason to seek treatment for a child's feet would be if they cause pain or their shoes wear out excessively. In these cases, a specialised insoles measured professionally by a chiropodist or physiotherapist will help.

Physiotherapy service in Whelehans

Chartered Physiotherapist Sinead Brogan MISCP runs FlexPhysio Physiotherapy Service in the therapy rooms at Whelehans Pharmacy in Mullingar. Sinead has an Honours Physiotherapy degree and has experience  working in Midland Regional Hospital Mullingar and private practice in New Zealand, Australia and Ireland, treating a wide variety of musculoskeletal issues including acute and chronic sports injuries, repetitive strain and postural problems, spinal dysfunctions and pregnancy related issues. Sinead has also completed a Masters in Neuromuscular Physiotherapy in UCD. Sinead is interested in sports injuries, having worked with many Gaelic and rugby teams providing pitch-side cover. Sinead is a Stott Pilates instructor and teaches pre and post-partum pregnancy, beginners and intermediate Pilate’s classes. She is also a Trigger Point Dry Needling practitioner and uses this technique with great results.  Reduced physiotherapy rates for over 60’s and affiliated sport clubs. Contact Sinead at 083 1722171 or flexphysiomullingar@gmail.com.

FlexPhysio Physiotherapy service at Whelehans Pharmacy, 38 Pearse St, Mullingar (Opposite the Greville Arms Hotel). Book by calling Sinead at 083 1722171