“I’ve been struggling with bad tendonitis in my leg because of my flat feet. I’ve had flat fee my whole life. You would know what I’m talking about.”
This was a comment made to me yesterday outside of the office by a friend of my wife. I hear this a lot and it’s extremely hard for me to restrain from making an attempt to straighten out their thinking in regards to flat feet and why it probably has nothing to do with their injury. It’s not a simple explanation and usually time will not allow for me to thoroughly explain as was the case yesterday. So I’ll make an attempt to briefly discuss flat feet and why it’s not as detrimental as most think.
Are flat feet really pathological?
Meaning do they really lead to all the horrific injuries that many people say they do? The answer is not really. Sure there are some cases of feet where the structure of the arch is so bad that the person may have a difficult time with normal walking and functioning but this will be something that has usually been present their entire life. Meaning the difficulty they are having. In other words you typically won’t have someone who’s has lived with flat feet their whole life and then all of s sudden at age 30 develop severe tendinitis that is directly a result of the flat foot. If it were truly related to the arch’s structure this person would have had tendon issues their whole life. Constantly.
I like to use the generalization of feet falling into three categories- flat, normal, and a high arch. There is a large misconception in our society of what a flat foot truly is.
In all reality, there are small degrees of flat feet that really lead to a problem. When present they are obvious structural abnormalities that overtly evident and more often than not the person would not even be able to walk without difficulty let alone run. The prevalence of different foot those can be summarized by the following picture.
Only a small percentage of individuals have a severe enough flat foot to result in injury as is the same for a high arch. The remaining foot types are variances of normal feet which themselves do not directly relate to any increase in injury.
So where did this stigma arise from then? If answering this question were possible, we probably not have the high incidence of foot pain and injuries that present to our offices. I would presume it is multifactorial beginning with the idea that treating a severe deformity by reducing motion with an orthotic will help relieve pain. It then becomes easy to say if it worked for that one let’s try in this one. And so on and so on until you reach a point where orthotics are being placed into shoes of individuals who really don’t have a deformity. There becomes no fine line of who will actually benefit from the use of an orthotic. It developed into a situation of let’s try the orthotic and see if the symptoms resolve. Some will respond to this by saying that’s not the case and that there are true biomechanical deformities which can be measured and defined which can be corrected with an orthotic. The problem with this statement is for every person who presents with this deformity and whatever the symptoms that may be associated with it, there are “x” number of patients who have the deformity with no symptoms. What’s the explanation? Is it really the fault of the foot’s structure? Why in some cases have these individuals lived all their lives with no symptoms and then suddenly they develop pain?
The literature does not support the theory that flat feet as described above inherently causes injury. Our society is fixated on the foot’s appearance and as soon as any lower extremity problem arises, they blame the foot. We all want a “good shoe”, with “good support”. Even those with high arches will sometimes say, “I have a high arch so I need to support it”. Do they?
Very rarely do people blame their training patterns. Consider the the person who just ran a 5k and had a great experience and now wants to train for a half marathon. They present to my office asking for advice on shoes or if they need orthotics because they have knee pain from training. They completely ignored the fact that they just doubled the amount of miles they have been running without slowly transitioning and allowing a gradual adaptation to occur. Or the runner who suddenly adds speed workouts or intervals to a training program to get faster. I can assure you I see more runners who have developed an injury from their training patterns rather than from a biomechanical condition such as a hypothetical flat foot.
Pronation. I have “pronation” or I “pronate” is frequently described by many runners. In fact, this was just discussed in a recent Runner’s World article focused on selecting a running shoe. Not only are these statements using the term pronate or pronation completely out of context, but they are implying that pronation is bad. Our foot was made to pronate. Pronation is the innate shock absorber for our bodies during locomotion. Placing the term “pronation control” on a running shoe is analogous to having a catcher’s mitt that doesn’t bend. Your hand needs the ability to move freely to squeeze the mitt to grab the ball, just as your foot needs to bend and flex to absorb shock. Why do we have 26 bones and multiple joints in our feet if they weren’t meant to move?
Prior to the 1970s we would not even be having this conversation because running shoes with motion control and rigid supportive midsoles did not exist and runners were still breaking 4 minute mile and running 2:10 marathons.
Focus on training patterns and form. Not shoes. You may be surprised as to not only how your pain miraculously resolves, but more so at how much your running will improve.