Flat feet are common around the world, and are the root of many foot problems among those who don’t walk barefoot from an early age (which is pretty much the greater part of the world). A flattened foot will require the body to adapt somewhat to the added foot flexibility, and will force the body to devote energy to maintain the foot from over-collapsing and making walking strenuous. In turn, many aspects of how a foot is commonly supposed to function change, and the foot can develop aches, strains, and even deformity. This article discusses five of the most important problems that those with flat feet can develop.
Heel pain is the more common foot problem associated with flat feet. As the foot flattens out, the tissues on the underside of the heel, particularly a rubbery ligament called the plantar fascia, strains, and stretches with every step. This is a daily process occurring over a lifetime. Eventually, after the urging of some minimal injury that most people don’t even notice, this strain will gradually cause microscopic tears to take place in the tissue. Ultimately this leads to inflammation of the plantar fascia and other surrounding structures. Arch fatigue will also develop, making it hard to stand in force or walk for a long period of time. As this strain continues in the heel and arch, the condition worsens and pain will then develop either on the first stage in the morning, after a little while of activity, or both. The heel and arch pain can become so intense that not even a supportive shoe is comfortable. Although many people assume this pain is combined with a spur on the heel bone, in reality a bone spur is rarely the cause of pain in the back of the heel.
Makes you wonder!
Bunions are a very complicated deformity of the big toe joint, but are most directly related to the flat feet. Although some people are born with bunions due to a defect in the training of long bone are attached to the big toe (first metatarsal), most people develop bunions over the framework of a long period of time. When someone develops a bunion, the first metatarsal begins a gradual shift toward the interior of the foot in the sense of the opposite foot. Along with this, the clappers of the big toe gradually shift towards the second toe as certain parts of the joint tighten and certain parts loosen. The way under which the body has to adapt to walking with a flat foot has a direct impact on the muscle and tissue imbalance that forces these bones to move in the first place. The result is a big bump on the inner side of the foot that rubs against shoes. This bump can get inflamed. Eventually even very wide shoes will still irritate it. Over time, the deformity will wear down the big toe joint itself, leading to arthritis that will cause pain even when one is barefoot.
Hammer toes develop in a similar manner to bunions. The strain the body must undergo in order to maintain a flat foot stable will finally cause the toes (other than the big toe) to contract upward, forming a hammer toe. Although high arches can also cause hammer toes for another reason altogether, the most common cause is flat feet. As the reverse side of the toes contract upward at the first knuckle , the edges of the toes contract downward. This leads to toes that have too much pressure on top while in shoes, as well as toes that have too much pressure on the top of the toe because it is driven down into the shoe or ground. Corns can develop as the skin tries to protect itself against this increased pressure. The hard skin of the corn can be painful if too thick. Although shoe use usually causes hammer toes to become painful, over time the toe can become painful even with barefoot walking as the joints stiffen and become less flexible. The contraction of the toe can even push the joint of the long bone found at the foot of each toe downward, leading to joint inflammation and pain in the ball of the foot.
Hammer toes are contracture of the toe, usually the middle joint on the toe, but may likewise involve the end joint of the toe or the joint where the toe attaches to the foot. Hammer toes are the product of a tendon imbalance due to foot mechanics or structure. Other causes include shoes, neuromuscular disorders, injury, and congenital disorders.
Flat feet can cause many different parts of the feet to strain. One tendon in particular can strain to the extent that it actually degenerates and worsens a flat foot. This tendon is known as the posterior tibial tendon. It is situated on the inner side of the foot near the ankle joint. The tendon starts from the muscle of the same title in the leg. Then wraps behind the ankle bone and attaches to a bone on the inner side of the foot. When the foot flattens, the inner side of the foot stretches. This tendon stretches along with it, eventually weakening owing to the strain on the tendon fibers. The more the tendon weakens, the more it begins to degenerate. Eventually the tendon becomes frayed and inflamed, causing pain and disability through a process called tendonitis (meaning tendon inflammation). If this process continues during the course of several years, the tendon may drop to a state where it’s no longer repairable. At that point, it is conceivable that only a surgical fusion of the foot into the proper position will restore functioning. Not everyone who has flat feet will develop this tendonitis. However, flat feet make this tendon damage more likely.
Pain in the ankle can have a wide variety of causes. One cause in particular is due to flat feet. The outer side of the foot comes into closer touch with the outer side of the ankle, as the foot flattens. When this occurs, some individuals develop a condition called impingement syndrome , in which the foot impinges onto the ankle as it flattens out. This can create a variety of pain from vague and dull to sharp, felt along the upper part of the foot near the outer side of the ankle. The pain can be felt during extended walking or standing due partly to bone and soft tissue compression. It is usually worse at the expiration of the day, and can be worsened by floppy or flexible shoes. A nerve in this general region can be annoyed by the compression, as well as a cavernous space in a joint found under the ankle joint called the sinus tarsi. This condition is sometimes difficult to identify, as symptoms can be vague and nonspecific to many physicians not well formed in the foot and ankle.
Many of the above problems can be avoided, or in the event of bone deformity, slowed down, with the use of supportive shoes and prescription shoe inserts called orthotics. Store-bought inserts can help, but are ineffective in actually forcing the foot to stay fully in a normal position. Surgical reconstruction of the flat foot is an option, but is generally made available for the relatively small group of people who cannot tolerate orthotics, or those in whom orthotics provided no relief. Treatment is available for all the above conditions when and if they do develop. In the case of painful bunions and hammer toes, surgery is usually necessary unless the symptoms are mild. All the other conditions discussed above can be readily treated without surgery if identified early enough. Proper evaluation by a foot and ankle specialist (podiatrist) may give rise to identification and comprehensive treatment of these conditions. Starting the process by visiting ones family physician can be a start. However, generally the assistance of a specialist are necessary because of the complexity of the flat foot structure and the conditions that follow.