Flat feet: understanding and preventing the problems

Flat feet: definition, origins, and classification to better understand this common condition

Flat feet are a particularly common foot deformity, affecting nearly 30% of adults. They are characterized by a collapse of the arch, resulting in full or near-full contact of the sole of the foot with the ground. This configuration alters the natural biomechanics of the lower limb, thus impacting posture and gait. Note that the heel is in valgus, meaning it is turned outward, while the forefoot remains flat, increasing the weight-bearing surface.

• The origins of flat feet are varied and can be classified into several categories: Congenital origin:
• common in children, when the muscular and ligamentous arch is still flexible. Neurological or rheumatological origin:
• certain diseases can affect muscle function and joint stability. Traumatic origin:

resulting from a fracture, ligament tear, or trauma that alters the structure of the foot. In children, it’s important to remember that flat feet are initially considered normal. In 65% of cases, the arch of the foot forms spontaneously between the ages of 5 and 6.

However, a minority, estimated at 3%, will develop symptomatic flat feet requiring treatment. This phenomenon can sometimes be explained by synostosis, that is, an abnormal fusion of the bones in the foot.

1. During adolescence, the onset of pain related to flat feet can occur, particularly due to weight fluctuations, increased physical activity, or rapid growth. In adults, the persistence of flat feet of childhood origin or of late onset can result from infectious or inflammatory diseases, or from mechanical stresses such as pregnancy, obesity, or prolonged bed rest. The classification of flat feet is based on clinical and radiological findings:
2. Stage 1:
3. Widening of the plantar footprint in the center of the foot.

Complete contact of the sole with the ground.

Stage 3:

• Significant collapse with valgus deviation of the heel. This categorization allows for tailored treatments to minimize functional complications. Understanding the origin and nature of flat feet is the essential first step in considering therapeutic solutions adapted to your situation.
• Discover the causes of flat feet, their health consequences, and solutions to prevent daily pain. Learn more to improve your comfort and well-being. Symptoms and complications related to flat feet: recognizing the signs to act effectively.
• The manifestations of flat feet vary according to age and the degree of deformity. Initially, in children, the condition may be asymptomatic. However, over time, particularly during growth, pain may develop.
• Typical symptoms include:
• Localized pain: in the heel, arch, ankles, knees, and even the lower back, often exacerbated by prolonged standing or walking.

Postural imbalance:

• an altered gait with abnormal weight-bearing, which may result in a “duck-like” gait or a limp. Foot and heel deviation:
• the foot is turned outward while the heel tilts inward (valgus). Muscle fatigue:
• a feeling of heaviness or fatigue that occurs quickly when standing. Associated deformities:
• hallux valgus, ingrown toenails, and the appearance of calluses on weight-bearing areas. In the long term, untreated flat feet can lead to complications such as:

Plantar fasciitis: painful inflammation of the fibrous layer under the heel. Morton’s neuroma:

Painful compression of the interdigital nerves, frequently aggravated by changes in weight-bearing.

Metatarsalgia:

Pain under the ball of the foot, often near the metatarsal heads.

Lower back pain:

• Related to poor posture and biomechanical compensation. Furthermore, abnormal wear of the soles, particularly on the inner and front edges, often indicates mechanical and functional overload.
• It is essential to pay attention to these signs to prevent the condition from worsening.
• If you experience persistent pain or significant imbalance, it is recommended that you consult a specialist such as a podiatrist or orthopedist, who will be able to make an accurate diagnosis and guide you toward the most appropriate treatment. Major risk factors: Understanding the causes of flat feet to better anticipate them
• The origins of flat feet are often multifactorial, combining constitutional, environmental, and biomechanical elements. The majority of cases, between 90 and 97%, result from a lack of early treatment during growth. It is important to distinguish the causes according to the stage of life: In children:
• Genetic predisposition: A family history of flat feet increases the risk.

Overweight:

• High weight can lead to a more rapid and pronounced collapse of the arch. Ligament irregularities:
• Ligaments that are too short or excessively elastic disrupt joint stability. Muscle weakness:
• Muscle hypotonia slows the formation of the arch. Biomechanical imbalance:
• Between the forefoot and hindfoot, altering the distribution of pressure on the ground. In adults:
• Persistent childhood flat feet: Without correction or effective management.
• Ankle instability: Promoting excessive pronation.
• Muscle imbalances: particularly in the leg muscles, altering posture.
• Unequal limb length: One leg shorter than the other, leading to compensation that disrupts the biomechanics of the foot.

Degenerative diseases:

Osteoarthritis or rheumatoid arthritis affecting the joints of the foot.

Advanced age:

Loss of muscle mass and degradation of connective tissues, promoting talocalcaneal valgus.

Intense physical activity:

• Repeated stress without appropriate footwear can weaken the arch of the foot. History of trauma:
• Fractures or ligament injuries altering the bone structure of the foot. These factors must be considered during the podiatric assessment in order to develop a personalized treatment plan.
• Orthopedic insoles and shoes: essential pillars for relieving and stabilizing flat feet. Conservative treatment of flat feet relies primarily on good mechanical support. Orthopedic insoles and appropriate footwear play a fundamental role in managing discomfort.
• Custom-made orthopedic insoles: Manufactured after a precise podiatric assessment, they aim to correct foot position and relieve sensitive areas. For children, “stimulation” insoles are preferred to encourage the physiological development of the arch. For teenagers and adults, they help stabilize the foot and prevent the progression of deformities.

Personalized design:

The feet are molded using a specialized device to guarantee a perfect fit.

Targeted support:

• The insoles strengthen the arch and correct postural imbalances. Pain reduction:
• By relieving pressure on overused areas and improving dynamic foot control. Prevention of complications:
• By limiting deformities and reducing the risk of sprains. At the Nantes Orthopedics Podiatry Center, the creation of orthotics includes regular follow-up appointments to adjust the correction according to the patient’s progress. Comfort is systematically checked during the shoe fitting, a crucial aspect for ensuring adherence to the treatment.
• Suitable orthotic shoes: These complement the action of the orthotics and provide additional support. To choose the right orthotic shoes, consider:
• Sufficient depth: to avoid pressure and unpleasant rubbing.

Moderate heel: no more than 6 cm, as a heel that is too high or completely flat compromises balance.Effective closure system: laces or Velcro for good support. Removable insole: necessary for easy insertion of orthotic insoles. Flexibility and durability: shoes that adapt to the gait while protecting against impacts (e.g., lambskin leather). Reputable brands such as Scholl , Birkenstock

, and

Footactive

offer specific models, while accessories like

Gibaud

• , Epitact
• , and Compeed
• can provide additional relief. Be sure to consult a professional before choosing your footwear to avoid mistakes and maintain the quality of your gait. A podiatrist is your best ally for a diagnosis and precise shoe fitting.
• Exercises and practical advice to strengthen the arch and prevent complications
• In addition to orthotics, adopting specific exercises can improve the plantar muscles and delay the worsening of flat feet. Here is a set of simple exercises that can be done at home: Picking up objects with your toes: Take small objects such as marbles or towels and try to pick them up with your toes.

Arch elevation:

• While standing, make an effort to lift the midfoot, as if you were trying to arch your foot, without lifting your heels or toes.
• Walk on your toes, then on your heels:
• to strengthen your stabilizing muscles.

Achilles tendon stretches: