Flat Feet

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

During childhood, usually between the ages of 3 and 10, we develop a space (arch) on the inner side of our feet where the bottom of the foot is off the ground. People with a low arch or who have no arch are classified as having flat feet, sometimes referred to as having "fallen arches".

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, in this situation, 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. "Pronation" or "over-pronated foot" is a term for excessive rolling of the feet. 

While over-pronated feet usually develop in childhood it can sometimes develop in adulthood. Flat feet may develop due to a ruptured 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.

 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). 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. Other reasons for seeking treatment include wearing out shoes quickly, feet appear to be getting flatter, feet tire easily, swelling on the inside bottom of feet, feet are stiff and lack of feeling in the feet or weakness.

 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. These insoles are also called orthotics and are available in pharmacies. A more permanent solution is a customized orthotic, whereby an orthotic is specifically designed for your foot. Measurements for this type of insole are taken, by your chartered physiotherapist, from a plaster cast of your foot or by stepping into a foam box. These are then sent on to a lab where the custom insole will be created.

 If pain occurs, rest, ice and over-the-counter non-steroidal anti-inflammatories, or NSAIDS (eg. ibuprofen) can give temporary relief. 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. 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.

Physiotherapy

Whelehans physiotherapy service is with Chartered Physiotherapist Sinead Brogan. Reduced rates for over 60’s and affiliated sport clubs. Book a physiotherapy appointment by calling Sinead at 083 1722171. Sinead can also treat flat feet. Physiotherapists can perform a detailed investigation to assess foot and lower limb function. Specific patient related treatment can then be implemented to accurately treat and manage health and exercise issues pertaining to this condition. This exercise program addresses identified muscle weaknesses and imbalances and is often sufficient to alleviate pain and restore normal function. If the exercise regime or temporary insole or orthotic is not sufficient to relieve the problem, Sinead can measure you for a more permanent customized orthotic (as described above). Our Chiropodist James Pedley can also advise on flat feet in adults and children; to book his clinic for adults or children call 04493 34591 and he also has reduced rates for over 60’s.

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie