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The bare truth about flat feet

Nurturing

FLAT OUT Suspected flat feet often have more to do with high rigid arches and collapsed ankles.

Health

Andrew O'Brien

Flat feet. Once upon a time that was a diagnosis that would have kept you out of the army and had surgeons and orthotists rubbing their hands together. Children were put in corrective shoes and millions have been sold supportive running shoes on the premise that having a flat foot was almost as bad as the curse of ’51.
But the worm is turning. Interestingly, you are now just as likely to be barred from joining the defence forces for having a high, rigid arch in the foot as for having a flat foot. And if you were to travel to Kenya, home of the greatest distance runners, or the Pacific Islands of Fiji and Samoa, home of some of the most naturally gifted rugby players, you would find whole populations of people with flat feet.
I remember being on placement as a student in a hospital in Sydney and seeing a giant of a Fijian man with knee pain and the flattest feet I had ever seen. I suggested to my supervisor that maybe he needed some orthotic insoles to correct his feet and resolve the knee pain. ‘Forget his feet, he’s Fijian’ was the reply. It seemed there was one rule for naturally athletic people, and another for the rest of us.
So why do so many of us panic – parents especially – about flat feet? First, let’s clear something up: very few people have truly flat feet, and the majority of them are from places like Kenya and Fiji, where they don’t tend to wear supportive (or any!) shoes. In fact a true flat foot should really be called a natural foot.
The majority of people who present to physiotherapists and podiatrists have high rigid arches, and collapsed ankles. When analysed on a plantar pressure plate (a scanner that analyses where your feet carry the weight) we are more likely to see a lack of connection between the ball of the foot and heel, and very little pressure coming through the toes. So despite appearing flat to the naked eye, there is no pressure on the middle of the foot. The significance of this cannot be understated when it comes to running sports.
Flat feet and running
When running with good technique, 17 percent of the impact is absorbed by the foot in a movement known as pronation – a compression of the arch. A runner with a rigid arch loses this shock absorption, and the force is shifted either to the inside of the ankle as it collapses inwards, or further up the leg to the calf or knee.
Prescription orthotics, off-the-shelf insoles and motion-control running shoes all aim to correct this visible fault, but they fail to address the faulty movement pattern, muscular weaknesses and mal-adaptions that allow it to occur.
Anyone with suspected flat feet, adults and children alike, would benefit from spending time in bare feet to allow the muscles of the ankle to strengthen.
Think about it, if you dislocate your shoulder you only wear the sling until the pain settles, then start work on rebuilding the muscles. Why should the foot be any different? Taking your shoes off will also remove the compressive force applied by most shoes, allowing the toes and forefoot to splay.

Push and wiggle
By way of exercise – try this right now – stand in your bare feet and try to push your big toe into the ground, while keeping the other toes relaxed. The bones of the big toe are four times the density of the other toes, and this is where your weight should be all the time. If you can push down with the big toe, try keeping it down and wiggling the others. A coordination test to frustrate the life out of you, but an excellent exercise.
And if the curse has been lifted on flat feet, who knows what might happen on the third weekend in September?

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.