Flat feet, also known as pes planus, describes a foot structure where the arch on the inside of the foot collapses, causing the entire sole to make contact with the floor when standing. This condition is common, affecting an estimated 20-30% of the general population whose arches did not fully form during development.
There are two primary classifications of flat feet: flexible and rigid. A flexible flat foot shows a visible arch when not bearing weight, but the arch disappears once weight is applied. Conversely, a rigid flat foot shows no arch, regardless of whether weight is being applied. Flexible flat feet are more common and often originate from childhood, while rigid flat feet can result from structural bone or joint issues.
Why Flat Feet Are More Common in Women
Hormonal fluctuations and biomechanical stressors contribute to the higher incidence of flat feet in women. Hormonal changes can affect ligamentous laxity, or the looseness of ligaments. During pregnancy, the body produces relaxin, a hormone that softens ligaments for childbirth. This hormone circulates throughout the body and can affect ligaments that support the foot arches.
The increase in body weight during pregnancy also places additional stress on the feet, which can strain the arches. This effect, combined with the actions of relaxin, can compromise the foot’s structural integrity. The ligaments supporting the arch may stretch and weaken, leading to the development or worsening of flat feet.
Certain footwear choices can also contribute to pes planus. High-heeled shoes alter the foot’s alignment and place excessive pressure on the forefoot, which can strain the structures maintaining the arch. Shoes with narrow toe boxes can compress the foot, disrupting its natural mechanics and weakening arch-supporting muscles.
Hormonal shifts during menopause can also be a factor. A decrease in estrogen can lead to reduced tissue elasticity, affecting the strength of the ligaments and tendons in the feet. This may lead to a gradual flattening of the arches in later life.
Symptoms Associated with Flat Feet
The experience of having flat feet can range from being entirely asymptomatic to causing significant discomfort. When symptoms do occur, they often manifest as pain in the arch of the foot or the heel area. This discomfort arises from the strain on the posterior tibial tendon, which runs along the inside of the ankle and is a primary supporter of the arch. Foot fatigue is another common complaint, where feet feel tired or achy after prolonged periods of standing or walking.
Swelling along the inside of the ankle is a frequent sign, indicating inflammation of the soft tissues that are being overstretched. The altered mechanics of the foot can also change a person’s gait. This misalignment can lead to a chain reaction of pain, extending upwards from the feet and ankles to the knees, hips, and even the lower back as the body tries to compensate for the lack of foot support.
Over time, the improper alignment and strain associated with flat feet can lead to other foot-related problems. Conditions such as bunions, which are bony bumps that form on the joint at the base of the big toe, can develop. Plantar fasciitis, an inflammation of the thick band of tissue that runs across the bottom of the foot, is another common complication, as the collapsed arch puts extra tension on the plantar fascia.
Management and Support Strategies
For individuals experiencing discomfort from flat feet, several non-surgical strategies can provide relief and support. The foundation of management often begins with selecting appropriate footwear. Shoes with strong, built-in arch support, a firm heel counter to control motion, and a wide enough toe box to allow the foot to spread naturally are recommended. This type of shoe helps to properly align the foot and reduce the strain on the arch.
Orthotic inserts are another effective tool for managing flat feet. Over-the-counter insoles can provide a good level of arch support for many individuals with mild symptoms. For those with more significant pain or a more severe condition, a podiatrist can prescribe custom-molded orthotics. These devices are made from a cast of the person’s feet and are designed to correct specific biomechanical issues and provide precise support where it is needed most.
Specific exercises can help to strengthen the muscles that support the arch and improve foot mechanics. Heel cord stretches, performed by leaning against a wall with one leg back to stretch the calf muscles, can alleviate tightness that may contribute to flat feet. Towel curls, where you sit and use your toes to scrunch a towel on the floor towards you, can strengthen the intrinsic muscles within the foot. Calf raises, which involve rising up onto the balls of your feet, also help to build supporting muscle strength.
Lifestyle adjustments can also have a positive impact. Maintaining a healthy body weight reduces the amount of pressure placed on the feet and arches with every step. If pain is persistent, limits daily activities, or if the shape of the foot appears to be changing, it is advisable to consult with a doctor or a podiatrist for a thorough evaluation and personalized treatment plan.