Every foot has its own unique shape, with 26 different bones held together by 33 joints and more than 100 muscles, tendons, and ligaments. Together, they align to form the foot’s arch. Those with a very low arch or no arch at all are said to have flat feet, and for some, this condition can have a painful effect from head to toeTibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. Kohls-Gatzoulis, J., Angel, JC., Singh, D., et al. Royal National Orthopaedic Hospital. BMJ Research Education, 2004 Dec 4;329(7478):1328-33..

Photo by Marissa Angell

Arch Enemy — The Need-to-Know

Flat feet can be hereditary, just like inheriting facial features or eye color. And while most babies are born with flat feet, arches don’t start to form until around age three, so only 1 or 2 out of every 10 children will continue to have flat feet into adulthoodA review of the evidence for non-surgical interventions for flexible pediatric flat feet. Evans, A.M., Rome, K. Department of Podiatry, Auckland University of Technology, Auckland, New Zealand. European Journal of Physical and Rehabilitation Medicine, 2011 Feb 9.. And no need to worry about spending extra money on kids’ shoes, as some research suggests going shoeless during those early years may even be beneficial in foot developmentThe influence of footwear on the prevalence of flat foot. A survey of 2300 children. Rao, U.B, Joseph, B. Department of Orthopedic Surgery, Kasturba Medical College, Karnataka, India. Journal of Bone and Joint Surgery British, 1992 Jul;74(4):525-7..

Aging, injuries, illness, and even pregnancy may cause flat feet to develop by excessively stressing the tendons and ligaments in the footBiomechanics and pathophysiology of flat foot. Van Boerum, D.H, Sangeorzan, B.J. Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA. Foot Ankle Clinics, 2003 Sep;8(3):419-30.. And foot abuse— due to wearing high heels or shoes without proper support— can cause the muscles and tendons to weakenBiomechanics and pathophysiology of flat foot. Van Boerum, D.H, Sangeorzan, B.J. Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA. Foot Ankle Clinics, 2003 Sep;8(3):419-30.. Some people experience no pain, but for others the tendons and ligaments may be noticeably weakened, strained, or damagedNatural gaits of the non-pathological flat foot and high-arched foot. Fan, Y., Fan, Y., Li, Z,, et al. Center for Scientific Research, Guangzhou Institute of Physical Education, Guangzhou, People’s Republic of China. PLoS One, 2011 Mar 18;6(3):e17749.. Flat feet can also cause strain and poor alignment in the ankle, causing the feet rolling inward in a processcalled over-pronation. Other areas of the body may be affected by the pitter patter of over-pronating, like along the shin bone (shin splint), or general aching and fatigue in the leg, lower back, hip, and kneeFoot posture influences the electromyographic activity of selected lower limb muscles during gait. Murley, G.S, Menz, H.B, Landorf, K.B. Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Australia. Journal of Foot and Ankle Research, 2009 Nov 26;2:35..

Foot Loose and Fancy Feet — Your Action Plan

Even though the military no longer automatically bans flat feet from its service, the condition may still warrant expertise from a foot doc.

A trip to the podiatrist is a step in the right direction to get started on the road to treatment. Wearing insoles or changing to shoes with more supportive arches may help alleviate discomfort from flat feetFoot shape and its effect on functioning in Royal Australian Air Force recruits. Part 2: Pilot, randomized, controlled trial of orthotics in recruits with flat feet. Esterman, A, Pilotto, L. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Bedford Park, South Australia. Military Medicine, 2005 Jul;170(7):629-33.. On the flip side, other research indicates barefoot exercising may be effective at strengthening the feet as a type of rehab for weakened arch muscles due to foot abuse over the yearsFoot strike patterns and collision forces in habitually barefoot versus shod runners. Lieberman, D.E, Venkadesan, M., Werbel, WA., et al. Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts. Nature, 2010 Jan 28;463(7280):531-5.Australasian podiatry council conference 2011 melbourne, australia. 26-29 april 2011. Abstracts. Journal of Foot and Ankle Research. 2011;4 Suppl 1:A1-P61. Epub 2011 May 20.. But use caution before switching to a sans shoe option, as barefoot style running takes some getting used to and could actually result in additional injuryBarefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Giuliani J, Masini B, Alitz C, et al. Keller Army Hospital, West Point, New York, USA. Orthopedics, 2011 Jul 7;34(7):e320-3..

Cutting back on activities that cause foot pain can also be effective. And even weight loss can help if the feet are overstressed by too much weight on the archesPlantar pressure differences between obese and non-obese adults: a biomechanical analysis. Hills, A.P, Hennig, E.M, McDonald, M., et al. School of Human Movement Studies, Queensland University of Technology, Brisbane, Queensland, Australia. International Journal of Obesity and Related Metabolic Disorders, 2001 Nov;25(11):1674-9..

So don’t get cold feet when it comes to controlling the pain. It’s time to treat the feet right and take care of those tootsies.