Flat feet are a relatively common condition that affects up to 30% of the population. So what exactly are flat feet?
The term flat feet refers to a lack of arch support in your feet. There are many reasons this occurs, including, failure of your arches to ever develop. When you’re born, your feet are flat and your arches develop as you grow. For some, these arches never form, resulting in flat feet.
On the other end of the age spectrum, flat feet can develop as you get older. After years of wear-and-tear, the tendons that support your feet can begin to weaken, causing your arches to fall.
Why Are Arches Important?
Your feet are incredibly complex, starting with the fact that they house more than one-quarter of the total bones in your body. And all of these small bones are connected by a host of tendons, ligaments, and muscles that keep everything together. This large cast of players all work in concert to provide you with the support and mobility you need, and every component, literally, needs to pull its weight.
Critical to this are the arches in your feet. While we commonly talk about the foot having one arch, in reality, each foot has three arches: two longitudinal arches and one transverse arch. Your medial longitudinal arch is the main arch, and it’s the one usually referred to when doctors discuss flat feet. This arch is primarily responsible for shock absorption when you’re moving around. It fields the impact when you’re walking or running.
How Do You Know If You Have Flat Feet?
The easiest way to tell if you have flat feet is to do the footprint test. Find a surface that marks easily when it gets wet, like a concrete floor. Dip your bare foot in a pail of water and step on the surface, leaving a decent-sized imprint. The only areas that should be visible are the back, front, and toes of your foot. If you see that there’s no gap in between the ball and heel, you may have flat feet.
Aside from back pain, other symptoms of flat feet may include:
- Fatigue, especially in the foot area
- Swelling on the inside of the feet
- Painful foot movement
How do your feet affect your knees?
Try this simple experiment to see the relationship between your feet and knees.
- Stand with your shoes off and feet flat on the ground to see the position of your knees
- Now roll your feet outward so you’re standing on the outside of your feet (pinky toe side). Notice that your knees move outwards when you stand on the outside of your feet?
- Now roll your feet inwards and notice that your knees are facing inwards. Notice that when your knees move inwards as they are following the movement pattern of flat feet!
Ok, So How Is That Causing Pain In My Knees And My Lower Back?
Enter feet roll-in.
Your feet are Ground Zero when it comes to your musculoskeletal system, so when there’s a problem in this foundational support, its effects may be felt elsewhere in your body. For example, if you have flat feet, your ankles may roll slightly inward when you stand or walk. This altered gait can then affect the alignment of your knees and hips.
The extra inward rotation of the leg due to the movement of the foot will directly impact the structure right in the middle – the knee joint. The knee is very much subject to the relationship and movement patterns of the higher and lower joints (the hips and the feet). This action will have impact on knee alignment and in some cases, may cause the knee cap to not track properly. This in turn may cause misalignment of the hip.
With these major joints out of balance, the impact can also travel up to your lower back and cause chronic pain. Unfortunately, when flat feet lead to lower back pain, this means that your other primary foundational support system — your spine — is compromised. Ultimately, flat feet that lead to lower back pain mean that much of your body’s main structure is out of alignment, and balance needs to be restored.
What Are The Chances That My Flat Feet Be Blamed For My Knee And Back Pain?
Short answer - high!
A flat foot is characterized by your feet having low arches, which makes the entire sole of your foot touch the ground when you walk. Flat-footed people are 50% more likely to experience back pain compared to people with normal or high arches, with other factors like lifestyle and pre-existing conditions aggravating the symptoms.
A study in 2011 found that those with flat feet were 30% more likely to have knee pain and 40% more likely to have knee cartilage damage (Gross, K. Douglas et al. 2011). This shouldn’t come as a surprise as foot function is always closely associated with knee joint health too.
What Are The Risk Factors For Developing Flat Feet?
While injuries or other health conditions can cause flat feet, it’s mostly hereditary.
Besides you can get flat feet as an adult if you experience:
- Torn tendons in the calf and leg
- Inflammation or damage of the posterior tibial tendon
- Broken bones
- Rheumatoid arthritis
- Nerve damage
- Obesity
My feet roll-in. What should I do?
If you’ve noticed a flat foot or flat feet with walking or running there is a high chance that your knees could be affected. With this in mind, you should get your feet and leg alignment assessed by an Orthopaedic or a Physiotherapist.
When it comes to alignment or positioning of the feet, they will provide comfortable custom orthotics or unique arch supports which helps to add stability to the feet. Orthotic therapy allows a reduction of pressure from flatter feet and more equal force distribution. This, in turn, helps to take the pressure of nearby joints and is a great prevention strategy for the long term to protect joint function. Footwear recommendations can also be provided.
Exercises To Reduce Pain And Correct Fallen Arches
1. Heel Stretches
2. Tennis Ball Roll
3. Arch Lifts
4. Calf Raises
5. Towel Curls
6. Toe Raises
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Medical Review: This article is written by Dr Nishtha Mittal (Senior Health Content Editor at Zanskar Health) and has been medically reviewed by Dr Rashi Goel (Senior Physiotherapist at Zanskar Health). This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.