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. We 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. 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, place the finger tips of one hand palm up under the arch as far as you can. Now with your thumb, slide as far up to the foot along the fingers as you can. 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 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 exercise is the towel scrunching exercise whereby you have a towel out in front of you and you use your 1st and second digits of the foot to collect up the towel therefore strengthening the arch of the foot (I tend to use a rope with a weight on the end and get my patients to pull the rope). Another option, which is the “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
My professional recommendation would be getting orthotics called ‘barefoot science 5-step multi purpose in-soles’. Barefoot science is a new (ish) type of insert designed to challenge the mid foot. The mid foot is made up of lots of bones (Tarsals) that can get very stiff due to us wearing trainers and shoes and not challenging our feet with unstable surfaces on a regular occasion (like we did in the past!). Barefoot science inserts therefore are designed to make the foot have to decide where the force has to be distributed, therefore causing an increase in movement at the region where it is most necessary for optimum function. This will, in effect, get the foot moving correctly again and lead to a decrease in lower limb related compensations and therefore injuries. These are the best option when it comes to having to wear normal footwear again such as shoes and trainers. They are readily available as the 5 step multi-purpose in sole on Amazon in both the UK and in the USA. The 5-step part refers to how you change the stiffness of the in-sole as your arches adapts to the movement. If you use these in-soles along with performing arch strengthening exercises such as the ‘small foot’ and towel/rope pull you are sure to see big improvements.

5 Step Multi-Purpose Full lenght S

What about Barefoot Running?
Barefoot running is great, the only problem is that more ad more people are transitionig from normal shoes to 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 for example. This is where the Barefoot science will help, as you work your way through the 5 steps of barefoot science you’ll find it easier to run in your barefoot 5 finger trainers. See here for more info.

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 well read Chiropractor (not all are!) or podiatrist (if feet only) to determine the exact cause of  the problem so that they can determine the problem and suggest a treatment plan that is appropriate to you and your body. Remember, “everyone is different“.

I hope this has helped you understand a bit more about your body and Chiropractic, If you have any questions on this topic send me an e-mail at danny@longlevenschiro.com

If you live in Gloucester, UK or surrounding areas and are interested my Chiropractic services and what I can do to help you, then book an appointment to see Danny at the Longlevens Chiropractic and Sports Injury Clinic on 01452 309372

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