Flat feet, or “fallen arches” as they’re sometimes known, can prompt a lot of questions. People often want to know about the long-term implications – for themselves, but frequently for their children too. Are they likely to suffer from knee problems because of them? Let’s dig into some answers.
What are flat feet?
Most people have visible arches on the inner side of their feet, which are formed by the tarsal and metatarsal bones and their interconnecting ligaments and tendons. Flat feet are where those arches are not present, or “collapsed”, so that the under surface of the foot presses flat against the floor. That’s sometimes accompanied by what we call a planovalgus formation, which is where the heel also turns slightly outwards.
What causes them?
Flat feet can have a number of different causes. One of the more common ones in younger people is ligamentus laxity, where unusually flexible ligaments can cause the arches to collapse downwards. In older people, the reason is more likely to be something like a weakness of the tibialis posterior – that’s one of the muscles that provides stability to the lower leg. It’s worth noting that most babies are actually born with flat feet, but most will go on to develop arches.
How might flat feet impact my knees?
Here’s a useful way to think about the mechanics involved. Place the palm of your right hand flat down on a table. Then turn your hand slightly clockwise. What happens to your arm and elbow? They rotate inwards. This is similar to the effect that flat feet can have on knees: they encourage the shinbone (tibia) to rotate slightly inwards. That can pull the kneecap (patella) and patellar tendon slightly inwards, creating a “knock-kneed” effect. In itself this isn’t necessarily a problem, though it could potentially raise the chances of malalignment issues (you can find out more about this and knock knees in this blog). A valgus (inwards) alignment can also put a bit more pressure on your MCL, the ligament that runs on the inner side of the knee, which could potentially cause pain or instability if you stretch it out.
Should I do anything about them?
Now for the good news. Most people with flat feet won’t need treatment for them. Many people function very well with them and don’t experience problems. In fact some evidence suggests flexible joints can actually be quite protective against future problems, which is reassuring for younger people who might be worried about the long-term implications. That said, if you’re worried about flat feet, or if you’re experiencing new issues (including pain, stiffness, or problems with balance), it’s worth having a check-up. There are lots of conservative things we can do to help, and that may involve referring you to an orthotist or podiatrist for specialist advice.
Here are some other possible options:
More supportive shoes – thick-soled shoes (like the kind found in many trainers and hiking boots) can provide extra support to the arches, ankles and surrounding muscles in your feet
Corrective insoles – for correctible flat feet, specialist insoles can help to recreate the arches and bring the heels into a more outward-pointing (varus) position
Physiotherapy – certain kinds of exercises (such as heel raises) may be helpful in strengthening the tibial posterior and providing more support within the feet; a physiotherapist will be able to design a suitable programme for you or your child
While it’s possible to correct flat feet with surgery, this only really tends to be used in the most severe cases. For most of us, conservative approaches usually work well and our flat feet are unlikely to cause major problems down the line. But if you’re concerned, come and have them checked out. It’s always better to seek advice and reassurance rather than to worry unnecessarily.
Can we help you with advice around your knees and flat feet? To make an appointment with Mr Bailey, call our assistant Cheryl on 01962 8261207, or hop across to the simple booking form on our website. We’ll be really happy to help.
Where can I see you in clinic? Find your nearest location here.