Have you ever been told by a healthcare professional that your feet are flat or collapsing? Have you ever experienced ankle or foot pain? Have you been prescribed orthotics for your shoes? If you’ve answered yes to any of these questions, then this blog is exactly what you need!
Clients are often diagnosed with flat feet or collapsing feet as an explanation for their lower body pain. But what do these diagnoses actually mean, and how do we fix this?
Well, let’s start with some basic anatomy to understand what is happening at the foot.
If we look at the image below, we can see that there are 3 different arches in our feet. The medial longitudinal arch refers to the arch running along the inside of your foot, while the lateral longitudinal arch is the arch running along the outside of your foot. Finally, there is an arch across the ball of your foot that is termed the transverse arch.
Today, we will focus on the medial longitudinal arch, as that is the most common problem area associated with flat or collapsed feet. Throughout the general population there is a good amount of variation in medial longitudinal arch height. As you can see in the image below, individuals can often be categorized into having a normal arch, a high arch, or a flat/reduced arch.
Both high arches and reduced/flat arches have been associated with lower body injuries. The medial arch of the foot is very important for efficiently carrying the weight of our bodies. The arch acts as a spring to absorb shock as we perform weight-bearing activities such as walking, running, or jumping.
Furthermore, the arch also helps with transferring energy so that we may rebound off the ground efficiently.
One way to think about this is if we compare the medial arch of the foot to a trampoline. A high arch may be like a trampoline that is too firm, while a reduced or flat arch may be like a trampoline that is worn out and too soft. With a trampoline that is too firm, we may feel more pressure in our joints if we jump on it. A firm trampoline will not absorb shock very well, and so our bodies will have to absorb the force generated from jumping. On the other hand, a trampoline that is worn out will be difficult to jump on because it is absorbing all of the energy from our jump. Thus, someone with a high arch may develop lower body pain or discomfort because their medial foot arch is not absorbing enough shock when they walk, run, or jump. Instead, other parts of their foot may have to do this.
The increased pressure in other parts of the foot that were not designed for shock absorption may lead to pain. On the other hand, someone with a reduced or flat arch may start to experience pain because the arch is absorbing too much shock and collapsing.
When the arch of the foot is absorbing too much force, it may lead to pain in the bones, joints, ligaments, or muscles that support the arch.
Functional vs Structural Flat Feet
Arch variation is often simply a result of structural differences between people. In essence, some individuals’ feet will naturally be shaped with a smaller or larger arch. That being said, some individuals may have a foot collapse that leads to a smaller arch only when weight-bearing. In this case, there is a functional problem rather than a structural problem. These individuals often have difficulty activating the muscles in their feet and ankles, which leads to a collapsed foot. We can see this in the image below.
If we look at the person’s feet in the image above, we can see some subtle but important differences. The first major difference I will point out is how their ankles are positioned. The ankle on the left is poking inwards, while the ankle on the right seems to be in a neutral position. Next, we can see that the medial arch of the foot on the left looks smaller than that of the foot on the right. Finally, we can see that the foot on the left is slightly rotated out. This picture is a great example of what a functional flat foot or foot collapse looks like. The foot on the right clearly looks strong and stable, while the foot on the left looks like the muscles are not really supporting it.
What should I do if I have flat or high arches?
Research has found that for individuals with foot collapse (a decrease in medial arch height when weight bearing only), wearing a customized orthotic can help improve pain/comfort and physical functioning.
Furthermore, research has found that the short foot exercise can be helpful in improving both medial arch height, as well as foot posture and functional movements, such as a deep squat.
The image below demonstrates how to complete the short foot exercise.
In order to complete this exercise, we need to contract the muscles of our feet to create a dome. As our muscles contract, we should feel the medial arch of our foot lift up slightly. During the exercise, try to keep your big toe in contact with the ground the whole time and don’t let it curl up! Don’t worry if you aren’t getting a huge lift right away. This exercise will take time to master, and the movement will be small. Start out trying holds for 5-10 seconds while sitting down. As you get better at the exercise, progress to performing it while standing, and then eventually while balancing on one foot!
Another exercise that I often recommend for clients to help improve their foot posture is ankle pronation and supination. We won’t go into the details of what exactly those words mean, but instead we will use them to refer to rocking our ankles inward and outward. We can see this in the image below.
If we look at the image above, we can see the person’s ankle is rocking inwards (pronation) and outwards (supination), while passing a neutral position in between. This exercise can help us learn how to access the different positions of our ankles, as well as how to find our neutral ankle posture. While performing the exercise, try to figure out how your ankles are normally postured. Constantly having your ankles more pronated or supinated may contribute to pain and discomfort. Try to keep your big toe in contact with the ground the whole time you are doing the exercise.
As mentioned previously, some people will have naturally high or flat arches. If this is you, don’t worry too much about it! That being said, if you are experiencing pain or discomfort, it is important to always see a healthcare professional, such as a physiotherapist so that you may be correctly diagnosed and treated. In the meantime, these exercises may be helpful!
Still not sure what to expect with your pain and posture? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.