There is an easy way to figure out if you have flat feet and it’s called the Wet Foot Test.  It is a straightforward method to check the shape of your feet.

Simply wet the bottom of your foot or feet in water, then stand on a flat surface that will show an imprint such as a brown paper bag, a sheet of paper, a brown paper towel or even a dry concrete surface. Make sure there isn’t too much excess water on the feet. Your foot’s imprint should match one of the three generalized foot types:

Normal Feet: neutral arch –  imprint is flared, with forefoot and heel connected by a wide band on the outside. A normal foot lands on the outside of the heel, then rolls inward (pronates) slightly to absorb shock.

Flat Feet: low arch leaves an imprint that looks like the whole sole of the foot. A flat foot strikes on the outside of the heel and rolls inward excessively; over time this can lead to injury.

High-Arched Feet: imprint has a very narrow band connecting forefoot and heel. This type of foot usually doesn’t pronate enough and isn’t good at absorbing shock.

Keep in mind that everybody’s feet are unique and yours may not be exactly like any one of the three foot types shown above. You might have slightly flat feet with a smaller footprint than the one in the picture or the print from your left and right feet may not be identical.

Another way to test if you have flat feet is described here.

Osteoarthritis is the most common type of Arthritis and generally develops in people who are over 50 years of age. Also, it tends to be more common in women than in men. Osteoarthritis affects the joints in the human body. Most commonly affected joints are the knees, hips and small joints of the hands. Although not as common, Osteoarthritis can also affect younger people, usually as a result of joint injury or other condition affecting the joint.

Osteoarthritis plagues roughly 8 million people in the UK, and another 27 million people in the US. In the US, Osteoarthritis accounts for 25% of visits to family physicians and most anti-inflammatory drug prescriptions.

Typically, the joints affected by Osteoarthritis show the  following:

• Damage to cartilage – (cartilage lines the bones and reduces friction, allowing the  joints to move smoothly and easily,
• Bony growths developing around the edge of the joints (after cartilage loss the bone starts wearing down and the body creates new bone to keep up with the wear),
• Mild inflammation of the tissues around the affected joints (synovitis).

Causes of Osteoarthritis

There are two main types of Osteoarthritis: Primary and Secondary.

Primary Osteoarthritis: is usually related to aging but not necessarily caused by it. The cause of Primary Ostheoarthritis is a degradation of the joint’s cartilage. The main chemical structure of the cartilage changes either through loss of water or from other reasons. The cartilage starts to wear down faster and the joint becomes arthritic.

Secondary Osteoarthritis: has the same symptoms as the primary, but the causes range from congenital joint misalignments, injuries, diabetes, obesity, hormonal  disorders, etc.

Although joint trauma and joint misalignments are considered to be the main causes of the disease, there are indications that suggest Osteoarthritis can be hereditary.

Symptoms of Osteoarthritis

• acute sharp or burning pain in the joint and associated muscles and tendons
• stiff joints
• crackling noise in the joint
• muscle spasms

Treatment of Osteoarthritis

• Change in lifestyle such as weight loss; reducing sweets is also said to reduce inflammation
• exercise and wearing suportive devices such as knee braces and using a cane or walker to reduce weight on the affected joint.
• Medical treatment: icing, anti-inflammatory drugs, steroids and even surgery
• Alternative treatments such as acupuncture and herbal supplements.

I’m quoting Wikipedia here:  Functional, gait, and balance training has been recommended to address impairments of proprioception, balance, and strength in individuals with lower extremity arthritis.

Osteoarthritis and Flat Feet

Flat Feet (hyperpronation, low arches) cause joint misalignments not only in the foot, but also, knees, hips and back. Misaligned joints lead to faster and uneven wear in the cartilage, causing Osteoarthritis or worsening it. Posture Control Insoles help attain a correct posture innovatively, through proprioception, so your muscles can keep your feet and body balanced. Here you can read more about my experience with the Posture Control Insoles.

The arch of the foot is formed by the tarsal and metatarsal foot bones and is strengthened by ligaments and tendons, The arch allows the foot to support the weight of the erect body in the most efficient way.

Arch Pain generally feels like a burning or stabbing sensation in the arch region of the foot. Arch Pain is usually present either close to the peak of the arch or closer to the big toe.

Causes of Arch Pain

Arch Pain, also referred to as arch strain is generally caused by an inflammation of the plantar fascia, a broad band of fibrous (ligament-like) tissue located along the sole of the foot. The plantar fascia has a big role in supporting the foot and creating and stabilizing the arch.  Other foot muscles from the arch region can also become inflamed and cause pain. Learn more about the Plantar Fascia and Plantar Fasciitis.

The most common cause for Arch Pain is over-pronation (Flat Feet, fallen arches and ankles rolling in). Over pronation also causes the heel to lean in, causing increased tension in the both the fascia and its tendon attachments.

Wearing arch supports can also cause pain in the arch area; the arch supports, as the name says, help support the foot and, in time, the foot may loose its ability to support the body’s weight by itself. That is why some people that are used to wear arch supports may feel arch pain when walking barefoot.

Treatment of Arch Pain

Once again, if over-pronation is the cause, the obvious treatment for Arch Pain is reducing it and therefore strain in the Plantar Fascia and the arch overall. Posture Control Insoles without arch supports may be considered by those who feel that the arch supports weaken their foot muscles.  The insoles also help strengthen foot muscles through Proprioception.

The Achilles Tendon, also known as the calcaneal tendon or the tendo calcaneus, is located in the back part of the leg, behind the ankle. Its purpose is to attach the calf muscle to the heel bone in the foot.

Named after the Greek warrior who could only be mortally wounded in his heel, the Achilles tendon is the strongest and thickest tendon in the human body. It supports your body’s weight during exercise and everyday activities such as walking and climbing stairs. Pain in the Achilles tendon area is commonly reffered to as Achilles Tendonitis (Tendinitis) or Achilles Tendon Pain.

Causes of Achilles Tendonitis

In general Achilles Tendonitis Pain is caused by excessive or unbalanced tension in the Achilles tendon which causes micro tears in the lower part of the tendon, wehre it attaches to the heel bone. Symptoms of this condition include pain in the Achilles tendon during activity; pain can even increase once activity was stopped. In general, tenderness can be felt along the course of the tendon and sometimes a nodule can form on the tendon. Excessive wear of the shoes in the heel region can also be a sign associated with Achilles Tendonitis and pain.

Tendon injury can be caused by an imbalance in the calf muscle or by excessive pronation which is generally associated with Flat Feet.  Sometimes pain in the achilles tendon area is caused by friction (rubbing)  of the shoes against the tendon in the heel area. Excessive phisical activity, pronation or other imbalance that affects foot mechanics may cause higher than normal shearing or stretching forces to be placed on the Achilles tendon. Excessive pronation seems to be the most common cause of  pain associated with Achilles Tendonitis.

Treatment of Achilles Tendonitis

Insoles or orthotics can help relief the tendon by the correction of malalignments that strain and stress Achillles Tendon and ultimately reduce the pain that is commonly associated with Achilles Tendonitis .  Depending on the severity of the injury, a doctor could prescribe appropriate medication. In severe injuries such as Achilles tendon rupture, surgery can be necessary to repair the damaged tendon.

Achilles Tendonitis and Flat Feet

One of the factors leading to Achilles Tendonitis can be Flat feet or over-pronation during walking or running. Posture Control Insoles are an innovative insole that corrects over-pronation through proprioception. Here you can read more about the Posture Control Insoles.

Plantar Fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia.The plantar fascia is the thick tendon-like connective tissue which supports the arch of the foot. It runs from the front of the calcaneus  (heel bone) forward to the heads of the metatarsal bones.

The Plantar Fascia contributes to support of the arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight.

Causes of  Plantar Fasciitis

Under normal circumstances, the Plantar Fascia acts like a shock absorbing bowstring, supporting the arch in the foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

A few quick facts about Plantar Fasciitis:

• Develops gradually.
• Feels like sharp pain in the heel.
• Commonly affects just one foot, although it can occur in both feet simultaneously.
• Is worst with the first few steps in the morning, although it can be triggered by long periods of standing or getting up from a seated position.

Treatments for Plantar Fasciitis

Medications:

• Nonsteroidal anti-inflammatory drugs such as Advil, Motrin and Aleve may ease pain and inflammation, although they won’t treat the underlying problem.
• Corticosteroid injections can reduce the pain but multiple injections are not recommended because they can weaken the Plantar Fascia and possibly cause it to rupture, as well as shrink the fat pad covering the heel bone.

Therapies:

• Stretching is the primary therapy because it helps to loosen the inflamed fascia tissue.
• The doctor may prescribe orthotics or heel supports, either over-the-counter or custom fitted, to help distribute pressure to the feet more evenly. Podiatrist David Yee asks patients to wear appropriate footwear even in the house. No bare feet or rubber slippers. “It’s like when you break your arm and have a cast. You don’t take the cast off in the house,” he explained.
• A night splint fitted to the calf and foot and worn while sleeping holds the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.
• A physical therapist can develop a series of exercises to stretch the Plantar Fascia, calf muscles and Achilles tendon and to strengthen lower leg muscles that stabilize the ankle and heel. A therapist may also assist with athletic taping to support the bottom of the foot.
• Surgery is a last resort, used only when the pain is severe and all else fails. Patients who opt for surgery usually do so because they don’t want to wait for other therapies to work, which can take months or years.

Plantar Fasciitis and Flat Feet

Having Flat Feet coupled with excessive physical activity or  being overweight can cause increased stretching of the   plantar fascia and trigger Plantar Fasciitis. Proprioceptive treatment with the Posture Control Insoles helps strengthen the foot muscles and achieve a correct gait that puts less strain on the Plantar Fascia.  Additional posts on the Posture Control Insoles can be found here.

For most of us, a single criterion overshadows all others: we lust for a pair of sneaks that lets us train without injury.

Certainly, no manufacturer makes a shoe that provides immunity from stress fractures, plantar fasciitis, shin splints, or other common running ailments – but not for lack of trying.

Over the past four decades, running-shoe companies have relentlessly developed sophisticated features for cushioning, arch support and motion control. But have these whiz-bang “improvements” reduced injuries to runners?

It’s tricky to submit that question to scientific investigation, because so many factors (such as running surface, weekly mileage, and intensity) are involved. However, anecdotal evidence suggests that runners are sustaining higher injury rates than in the past, even as shoe offerings get more technical. Moreover, some researchers, medical professionals, and coaches point out that enveloping the runner’s feet in highly protective shoes may promote atrophy in foot musculature, and inhibit the natural development of a strong arch.

Doctor Joseph Froncioni, an orthopedic surgeon and devoted runner, recently authored an extensive essay, entitled “Athletic Footwear and Running Injuries.” In it, he referred to a number of studies which back up his contention that runners will experience fewer lower extremity problems if they can wean themselves from fancy footwear.

Froncioni cited a 1992 survey published in The Journal of Bone and Joint Surgery, in which 2,300 Indian children were examined for flat feet (”fallen arches”). The children who wore shoes daily had over three times the rate of flat feet, compared to those who spent most of their time barefoot.

Froncioni also discussed an experiment in which barefoot subjects stepped down on four identical platforms. The subjects were told, however, that each platform had a different degree of cushioning. The subjects consistently recorded higher-impact forces on platforms which they thought were more cushioned. From this study, it’s not far-fetched to assume that runners may unconsciously forego their innate ability to land lightly, if they’re clunking along in cushy shoes.

So, should we toss all our high-tech footgear in the dumpster, and commence with completely unshod running? Probably not. But gradually exposing our feet to natural impact — and letting them adapt to careful stress — makes sense.

You might start with a few minutes of shoeless running on grass, two or three times a week. Too, slipping into thin-soled racing flats for some of those shorter training runs can build foot strength. Personally, I will now spend all my time in the yard barefoot … as soon as I get rid of those fire-ant beds.

Source: tallahassee.com

They are also culturally and genetically normal in certain ethnic groups (Fig. 1).

Fig1. Foot with normal arch (left) and a flat foot without an arch (right).

Most children develop an arch in their feet when standing between 4–5 years old (Fig. 2).

Fig 2. Children develop a foot arch in standing at the age 4 or 5.

However, one in five children never develop an arch in standing. Most of these children have low arches because they have loose ligaments. Their arch flattens when they are standing and their feet appear to roll in. However, an arch can be seen when the child stands on tiptoes or their feet are off the ground (Fig. 3).

Fig 3. The foot arch flattens when the child stands (a), but is visible when standing on tiptoes (b) or if the feet are off the ground (c).

Flat feet will not cause long-term problems. Most adults with flexible flatfeet have strong, pain-free feet and are able to do all activities and sports.

Special shoes, shoe inserts (orthotics) or exercises will not make an arch develop in a child with flexible flat feet. Arch supports may create a temporary arch in the foot, but the posture of flat feet returns once the supports are removed. Many children do not feel comfortable with arch supports in their shoes.

However, it is important to consult a paediatric

orthopaedic surgeon if the flat feet are:

• stiff

• painful

• causing difficulty with activities

(e.g. running, jumping)

• only one side is affected.

Source: Departments of Orthopaedics and Physiotherapy, The Royal Children’s Hospital, Melbourne

“When there is an increased amount of weight and stress being placed on the foot, that can cause some significant changes in foot structure,” Dr. Darryl Haycock, a foot and ankle surgeon in private practice in Lima, Ohio, told Reuters Health.

Children’s feet aren’t fully developed until the age of 14 or 15 for girls, 15 to 17 for boys, meaning their foot bones are “easily moldable,” Haycock added.

As few as 15 to 20 extra pounds can contribute to flattening of the arches and inflammation of the growth plate in the heel, according to Haycock, who says he used to only see this type of foot pain in very active children, but is seeing it increasingly in overweight kids.

It’s difficult to determine whether children are obese because they have foot problems in the first place, which make it painful for them to be active, or whether the obesity is causing the changes in foot structure, Haycock added.

“It’s the proverbial chicken and the egg thing,” he said. Complicating matters is the fact that many children are born with foot deformities that can reduce their activity levels, such as flat feet or hammer toes.

But it is clear that foot problems in obese kids can cause a vicious cycle, with the foot pain making it more difficult for them to be active, which makes it more difficult to trim down, Haycock and his colleagues point out.

Treatment of foot problems such as flat feet generally begins with conservative therapies such as custom-made shoe inserts, known as orthotics, and physical therapy. If such approaches don’t work, surgery to correct the problem may be recommended.

Source: Reuters

Walking Shoes: If you search the web for “Shoes for Flat Feet” it is pretty hard to come by them. Most reccomendations are for orthotics for flat feet that you can wear in your shoes. And it makes sense.  With flexible flat feet, the amount foot flatness varies quite a bit from person to person. The shoes produced in commercially, even though they mignt be advertised as “shoes for flat feet”,  will not fit everybody the same. I expect that for most people it is a matter of trial and error.  The other much more expensive choice is to have the shoes specially  designed  for your feet by a podiatrist.

Sports Shoes: This is a reccomendation of somebody who might know what they are talking about: Try cross-training or court (tennis) shoes, which are made to accommodate side-to-side movements, rather than running shoes, which are meant for forward motion, says Stephen Pribut, DPM, president of the American Academy of Podiatric Sports Medicine. Make sure you find a shoe with plenty of support: When shopping, place the toe of the shoe on the floor with the heel pointing toward the ceiling. Press straight down on the heel. If the shoe bends in the center, it won’t provide enough support, he says.

Hiking Shoes: Since most people with flexible flat feet have less stable ankles, It is common sense to look for hiking boots with good ankle coverage, boots that wrap the ankle snuggly but without hurting. This helps the ankles stay aligned and not roll inwards. Combined with a good orthotic or insole, this should make for a good hiking. Keep in mind though that a stiff arch support can actually cause pain to the arch are of your foot, especially when carrying a heavy backpack.

I wear proprioceptive Posture Control Insoles in all my shoes. This way I can wear my favorite pairs of shoes all the the time. I bought the ones that don’t have arch support because they take very little space in the shoe and I don’t need arch support. You can find more info about how these insoles work here on this blog or on the Morton’s Foot website. It is my choice to promote them here because I’m very satisfied with them.

Flat Feet are a fairly common condition, encountered in roughly 25% of the world’s population. Commonly people have a space on the interior (instep or inner  ) side of the foot, where the sole or bottom of the foot is off the ground; this is called the arch of the foot. How well this arch is developed varies from person to person. People with a very low arch or no arch at all are said to have Flat Feet (also refered to as Fallen Arches, Collapsed Arches, Pronation of the Foot, Pes Planus, Hypermobile Feet, Pes Planovalgus, and Physiologic Flat Feet). The term fallen or collapsed arches is somewhat misleading because for many people, this is how their arches always were.

The arch of the foot is created by the tightening of the muscles and ligaments present in the foot structure. These muscles and ligaments support the many bones of the foot; the role of the arches is to create the optimum foot/leg position that allows an even distribution of the weight of one’s body across the feet and legs. Our body’s inability to construct this arch leads to a less-than-optimal posture of not only the legs, but the entire body. Usually, the flatter the feet, the more seriously affected is the Posture. Apart from having flat feet, here are several medical conditions associated with flat feet.

Following are a few images of Flat Feet and how they compare with Normal Feet.

	In a Normal Foot, the weight o the body is distributed straight  down  through the foot structure.
	In the Flat Foot, because of the Over-Pronation (the ankle rolls inwards), the weight is not distributed as effectively to the foot; more weight is transferred to the inside of the sole.

	Front-view of the Flat Foot compared to the Normal foot position. Notice the shifting of the ankle position towards the interior of the foot.
The next image is a lateral view of  the arch region in a Flat Foot and how it compares with a Normal Foot.
Following are a couple of pictures of  flat feet viewed from the side an from the front.

Types of Flat Feet

There are two main types of flat feet: flexible and inflexible.

Flexible Flat Feet

This is by far the most common condition. The foot may appear flat when standing in a weight-bearing position (normal standing), but when pulling back the toes an arch forms. If you don’t know what pulling back the toes (or dorsiflection) means, drop a napkin on the floor and try to grab it with your toes while still supporting your weight on both feet.

Although this condition can be painless, in time, due to aging, physical activities and other factors can trigger secondary conditions associated with pain, not only in your foot, but also ankles, knees, hips, back. This is all due to the incorrect posture induced by the flat feet. You can think about it like this: while you are young, your body is strong and can repair / regenerate fast damaged or inflamed tissue, especially in the joints and back and it is likely you won’t suffer. As you get older or more overweight or increase the stress on your joints through work or physical activity, the bad posture creates wear and tear in the joints and muscles; Because the body is not able to repair itself fast enough, the result is chronicle pain. The joints are not the only ones affected by a bad posture. Imbalances in the strength of the different muscles also develop. Bottom line: the better the body is balanced, the less stress on joints and muscles ergo – less pain.

Inflexible (rigid) Flat Feet

Is an abnormal condition (less than 3% of cases) and may indicate bone abnormality in the foot due to disease or injury. Flat feet that are inflexible and painful may result from a condition called tarsal coalition. Tarsal coalition occurs when two bones in the foot fuse together. This results in a highly inflexible foot and pain during walking, and shoes with arches may make the condition even worse. Children who exhibit flat feet and complain frequently of foot pain should be evaluated by a doctor, and normally undergo surgical treatment in their pre-teen years to correct the fusing. Surgery needs to be undertaken while the foot is still growing in order to be effective.

Causes of Flat Feet

Flexible flat feet develop very early in life and may represent a genetic predisposition. There are studies that imply this condition starts before birth. Flat feet can also develop as an adult (”adult acquired flatfoot”) due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics, or as part of the normal aging process. Flat feet can also occur in pregnant women, due to our body’s normal tendency to devlop increased tissue elasticity during pregnancy. If developed by adulthood, flat feet generally remain flat permanently.

Treatment of Flat Feet

For flexible flat feet: Classical treatment: supportive (arch support) orthoses or orthotics. Inovative treatment: proprioceptive – Posture Control Insoles. Exercises for flat feet are also said to help strengthen the foot muscles. Wearing the right kind of shoes suited for flat feet also makes a big difference.

For inflexible flat feet: usually surgery.

Diagnosis of Flat Feet

It is recommended to have a specialist diagnose the condition and recommend treatment. If you think you have Flat Feet, there are self-diagnose techniques such the wet footprint performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. Morton’s Foot website also presents a straightforward self-diagnose for flexible flat feet. You can also read more about the Wet Foot Test, a helpful method for determining if you have Flat Feet.