Why do people have flat feet

Flat feet: what to do about pain in flat feet?

Flat feet are the best way to prevent enough movement - ideally barefoot to train the muscles.
© iStock.com/scyther5

The human feet are complex miracles of nature: a person covers around 130,000 kilometers on average in the course of his life. Unfortunately, we don't thank them with an extra helping of attention, but risk developing foot deformities with poor footwear, one-sided strain and too little movement. Flatfoot (Pes planus) is very common and, to a lesser extent, it is also known as the flat foot and is often the result of a flat arch or flat arch. Experts estimate that eight to ten percent of all adults have flat feet.

What is a flat foot?

In the case of flat feet, the longitudinal arch of the foot is completely sunk. This can be seen well during a walk on the beach: While a healthy foot on soft ground leaves a sickle-shaped imprint due to its intact longitudinal arch, with a flat foot the entire sole of the foot digs into the sand. When walking, a flat foot is usually bent inwards (buckled foot) and its outer edge is slightly raised, so that the shoe soles are usually most worn at the inner tips of the shoes. The Achilles tendon is often shortened.

Doctors differentiate between flexible and rigid (contracted) flat feet: If the inside of the foot assumes a normal curvature as soon as the patient stands on tiptoe, one speaks of a flexible flat foot; if the entire sole of the foot is already stiffened, it is referred to as a rigid flat foot. Furthermore, a distinction is made between symptomatic (painful) and asymptomatic (non-painful) flat feet.

What are the symptoms of flat feet?

Usually, people with low acquired flat feet have no pain and can move around on their feet normally. Due to the misalignment, however, further sequelae can occur in the course of life:

  • Misalignment of the toes
  • Pressure points
  • Calluses on the soles of the feet
  • Corns
  • Heel pain
  • Problems in other joints, such as the knees, hips, or back
  • Joint wear

In a healthy foot, the longitudinal arch cushions the body weight and provides momentum when walking. Therefore, a pronounced flat foot can disturb the entire body statics. As people get older, people often experience back or knee problems. Pain in the soles of the feet, for example under the heel, is also often a symptom of untreated flat feet: the tendons of important muscles are then so overstretched and strained that running without special orthopedic shoe insoles can be a torture. Pain, swelling or inflammation on the inside of both ankles are also possible. If the heel is crooked, it also puts a strain on the ankle joint and the associated tendons and ligaments.

Flatfoot can cause arthritic discomfort in the metatarsal joint. Often the metatarsophalangeal joints or the heads of the metatarsals in the ball of the foot are also overloaded. Toe misalignments can occur. Calluses and corns on the ball of the foot can also be the result of foot deformities such as flat feet.

When do you have to have a flat foot treated?

Today, congenital flat feet are usually operated on immediately after birth and treated with physiotherapy.

Things are different with acquired flat feet: If it is a flexible flat foot that is only weak and does not cause any symptoms, orthopedic therapy is usually not yet necessary. In order not to miss the right time to start a flat foot treatment, people with flatter feet should see a specialized orthopedic surgeon as early as possible. If a pronounced flat foot is not treated permanently, it can fix itself in the bone (rigid flat foot), so that any treatment is only possible with great difficulty. It is never too early to mobilize the foot with the help of certain exercises and targeted training.

How does a flat foot come about?

Every child is born with apparently flat feet: the arches of the feet of infants are padded with a layer of fat that gradually disappears after learning to walk. A congenital flat foot is rare and only occurs in less than one percent of all births.

Much more often than the genes, external circumstances are responsible for the foot deformity. Whether in childhood or later in life: too little exercise, being very overweight, one-sided stress and poor footwear play an important role in the development of flat feet. In addition, our feet are not adequately trained on asphalt paths and in shoes: The muscles and ligaments that support the arch of the foot, especially the deep calf muscle (tibialis posterior muscle), are often too weak as a result.

Diagnosis: Difference between natural and pathological flat feet

The orthopedic surgeon can diagnose flat feet based on their typical appearance. An X-ray examination can give precise information about the shape of the foot bones, especially in congenital flat feet.

It should be noted that babies and children up to the age of about six naturally have more or less pronounced flat feet. However, this is not a malposition of the foot, but rather fatty tissue that gradually disappears. This natural flat foot in children must be distinguished from a pathological one.


How can a flat foot be treated?

A general distinction is made between active and passive therapeutic approaches. The first category includes physiotherapy training and foot exercises that mobilize flat feet, stabilize the muscles and improve walking. Passive treatment options are, for example, orthopedic insoles, orthotics (aids that stabilize, relieve or immobilize the foot, ankle or leg) and orthopedic shoes.

Most orthopedic surgeons prescribe custom-made orthopedic insoles that support, stabilize and cushion the foot so that pain when walking disappears and consequential damage is prevented. However, there are physiotherapists who take a critical view of this: orthopedic insoles do not train the foot, but simply immobilize it, so that the misalignment can even worsen in the long term.

In addition to passive ones, so-called activating (sensorimotor) insoles are increasingly being used against flat feet. They are intended to permanently eliminate tension and pain by specifically changing and promoting the activity of individual muscles or muscle groups when moving or while standing. While orthopedic insoles on prescription are usually covered by the statutory health insurance, this is not yet the case with sensorimotor insoles.

Pronounced flat feet, which have already affected tendons or joints and which can no longer be treated with exercises, shoe insoles and other aids, sometimes have to be operated on to prevent further deformations. During the procedure, for example, tendons or the heel bone are shifted, depending on the problem. In the case of a rigid flat foot, surgical changes to the soft tissues of the foot or joint stiffening are sometimes necessary. It is usually a complex operation, after which the feet have to be protected for several weeks.

If a tendon is acutely inflamed by a flat foot, anti-inflammatory drugs and immobilizing the foot can help. Affected people often have to wear a cast for a long time.

Are there exercises that help and prevent flat feet?

Congenital flat feet cannot be prevented.

Good shoes, frequent barefoot walking and a weight appropriate to your height can help prevent flat feet in the course of your life.

In a foot school or with a physiotherapist, you will learn exercises that are individually tailored to your feet and physical problems, which correct flat feet and an unbalanced body statics and optimize your gait.

What you can do to counteract flat feet

In general, any kind of mobilization makes sense with flat feet - as with any other foot deformity. Those affected with flexible flat feet can try the following measures and exercises at home. If you are unsure, you should consult your doctor beforehand.

  • To run barefoot: When walking without shoes on different surfaces, all foot muscles are trained; The muscles, connective tissue and fasciae of the soles of the feet remain elastic and strong. From childhood on, you should walk around barefoot or in (stopper) socks as often as possible. If you have to wear shoes for hygienic, health or aesthetic reasons, you can buy special barefoot shoes with a very thin, flexible sole.
  • Reflexology: While sitting, take one foot on the thigh of the other leg and use your thumbs to acupressure all soft parts and reflex zones of the respective sole of the foot.
  • Fascia massage: With light pressure, roll a small, hard rubber ball back and forth under the soles of your bare feet. This maintains and stretches the connective tissue sheaths of the muscles (fascia). Gradually, the entire sole of the foot should be worked on.
  • Foot exercise: The exercises described below can train and mobilize the foot muscles in a simple way. Of course, they are not a substitute for flatfoot exercises that have been put together individually and controlled by the physiotherapist.

Simple exercises for foot gymnastics

In stand:

  • Switch barefoot from tiptoe to heel and back again.

While standing or sitting:

  • Practice picking up things with your toes (such as a handkerchief).

While sitting:

  • Take a tennis ball between the soles of your two feet and lift it up.
  • Place your toes on a tennis ball (the heel stays on the ground). Use your toes and forefoot to press firmly against the ball without pushing it away.
  • Place a tennis ball on the floor and place your flat foot behind it. Then use your other foot to roll the ball up and down the top of your foot.
  • Balance a tennis ball on the back of your foot by pulling your toes towards your leg and slowly lifting your foot off the ground.

All of the flat foot exercises described should be performed without shoes and with both feet, one behind the other. You can adjust the duration of the exercise to your fitness level and gradually increase your workload over time.

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