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What are flat feet, collapsed arches, fallen arches, over pronation and pes planus?

A Chiropractor’s main speciality is the spine but as you can imagine, the feet, as well as other extremities, all have an effect on what occurs at the spine. Chiropractors therefore have a in-depth knowledge of the extremities to make sure we can determine the exact route of the problem.

To explain how the above titled terms are used medically all you need to remember is that: flat feet (also known as collapsed/fallen arches) is what causes over pronation (the correct term is pes planus). Flat feet, collapsed or fallen arches refer to the arch of the foot whereas overpronation and pes planus refer to how the ankle appears and moves under pressure, therefore occurring as a result of the flat feet.

However, for the sake of simplicity I will only use the term ‘flat feet’ throughout this post.

How did I get flat feet? ‘Flat feet’ can occur for a variety of reasons in the human foot, whether it be aging, a tibialis posterior tendon tear, ligament laxity, genetic, trauma, diabetes or arthritis.

If you have no pathological or traumatic reason for your flat feet and are still wondering why you have developed them, then take into consideration that the human body was not designed to wear soft soled shoes in the first place.

Think about how your body may have adapted over time as a result of having this cushion under the foot preventing the foot from acting how it really should in the natural environment. Changes to the feet can occur as a shoe can dictate the flow of pressure through the foot during the gait cycle.

Also consider how we as humans are now able to stride further whilst running as our heels are protected from the hard ground by the spongy sole of a trainer. The human body usually adapts to changes over thousands of years, not one lifetime!

How do I know if I have got flat feet? There are a few ways to identify if you have flat feet, the first way is to look at how you walk. Does your heel strike the floor initially on the outside of your heel? When your foot leaves the floor, does it leave off the inside of the front of the foot? Does your ankle roll in when you are walking or running? These are all signs that you may be flat-footed. A clear-cut test is to look at the inside arch of your foot, is it touching the floor or is it elevated?

If you are unsure

  1. place the fingertips of one hand, palm up under the arch as far as you can.

  2. Now with your thumb, slide as far up to the foot along the fingers as you can.

  3. Take your fingers out from under the arch once your thumb hits your foot.

If your thumb has not passed the crease of your fingertips then this is a sign that your arch is ok while standing still, if your thumb is past this crease then it is likely you have flat feet.

However! This does not mean they won’t collapse under force! Some people’s arches only collapse when performing a sporting activity. When you consider then amount of force that is distributed into the feet during high impact activities you can understand how this can occur.

To determine if your feet are collapsing during activity I would have to suggest video analysis whilst running or visiting a podiatrist or sports injury chiropractor. A very simple test is to look at the soles of your shoe to see where the wearing occurs, you can then work out how your foot is striking and leaving the floor.

The Common treatment Options The treatment options vary somewhat, If the cause is traumatic (muscle/tendon tear) or as a result of pathology (Arthritis, diabetes etc). Then the correct course of treatment is more likely to be surgical.

If, on the other hand, you have had flat feet all your life or have developed it over time through compensatory changes elsewhere in the body, then there are two options that are likely to be given. Be very aware that fallen arches in children is very common and is usually not a cause for concern as the arches in most occasions will develop as they grow.

The first treatment option for flat feet is retraining the arch in the foot back to full strength by performing an exercise known as the “small foot” exercise. This exercise takes a lot of hard work to perform correctly, it is time-consuming and is not guaranteed to work. Another option, is to perform 'static leans'. These are performed by standing in front of a wall for safety. Lean forward so that you feel the muscles in the arch of your feet engage but not enough that you fall over, try to keep your toes flat, aim for endurance.

A “quick fix temporary solution” is to wear in-soles in your shoes which reintroduce the correct arch to your foot, this allows the rest of the body above to function as it should naturally. You can buy orthotics on the internet, which is the cheapest option (around £20-£30) or you can visit a podiatrist who will make custom fit ones to suit you which costs somewhat more (around £180+ for one pair with discounts on extra pairs). These are good if you are in a lot of pain as they help with the healing process, though however, they are not the permanent solution.

My Recommended Treatment

See a professional, each case is very different and seeing a professional will give you a starting point and an end goal. Without knowing more about your feet, you will never see any change. Sports practitioners are usually good at dealing with these issues, sports podiatrists often work with sports Chiropractors on issues such as this and both are very knowledgeable when it comes to foot issues.

What about Barefoot Running? Barefoot running is great, the only problem is that more and more people are transitioning from normal shoes to a barefoot vibram 5 finger style running shoes too harshly. What is needed is some degree of strengthening before moving onto this style of shoe. You can buy trainers that are transition style trainers to help with this, however at some point you are going to have to wear normal shoes at work. This is where guided foot strengthening exercises come in to play. Your Sports Chiropractor or Sports Podiatrist can help with these.

Conclusion There are a lot of problems that can occur in the lower limbs and back as a direct or indirect result of flat feet. Before buying anything, I would recommend that you see a skilled Sports Chiropractor or Podiatrist to determine the exact cause of the problem. They can determine the problem and suggest a treatment plan that is appropriate to you and your body. Remember, everyone is different.


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