I have flat feet! Or do I?
Through my childhood my mother insisted that my father had the flattest feet going and that I was born with the same structural dysfunction. Apparently I was doomed to walk forever by slapping the earth with the full brunt of the flippers on the ends of my legs. This was part of my normal and I accepted this self image for many years.
I’m sure that a lot of other people are in this boat as well, because I hear this story time and time again from clients who lament that their intractably flat feet are a cause of various musculoskeletal complaints ranging from plantar foot pain, to painful hips and knees to poor athletic performance in general.
Well, in some ways maybe… it’s true that flattened arches (technically known as pes planus) are associated with pain syndromes like plantar fasciitis as well as mechanical dysfunction like hallux valgus (bunions) and knee valgus.
It’s also true that we need to hold the foot in arch position to generate power in athletic activity like running and Jumping.
However, it is not true that those of us on the flatter foot end of the spectrum are condemned to hopeless dropped arches. The truth is that there are several factors that contribute to arch height, some of which can be controlled and trained.
Passive arch support refers to the architecture of the bones and ligaments of the midfoot. As we push off, these bones are designed to slot together into full arch height, supported by a series of rope like ligaments on the arch underside. We are arguably stuck with passive arch support we have today, it will not get much better than it is today.
Active arch support on the other hand IS changeable. This refers to the arch support provided by the small muscles on the bottom of the foot known as the intrinsic Foot Muscles (IFM), and the larger muscles in your calf whose tendons attach on the bottom of the foot known as Extrinsic Foot Muscles (EFM).
The IFM and EFM are analogous to the deep and superficial muscles of your core, and in fact there is a growing movement to refer to this muscular foot arch support system as the “Foot Core”. Just as the deep muscles of your core (transverus abdominus, pelvic floor, diahragm and mutifidus) do with the spine, the IFM of your foot provide stability to the arch. And similar to how the superficial muscles of the core (rectus abdominus, internal/external obliques, perispinals etc.) provide large movement ability at the spine, the EFM create movement at the arch of the foot.
These muscle sets can be strength trained to improve your arch height and support. The science is showing that performing IFM exercise for a month can significantly improve ability to maintain arch height. So strength training for this active support system absolutely makes a difference.
A foundational strength training exercise for the IFM is the “Foot Shortening Exercise” (FSE). As pictured above, to execute a foot shortening exercise, start from a seated position with your foot flat on the floor. Keep the knee over the foot and not collapsed toward the midline of your body. Lift the toes and notice how the arch accentuates.
Now, maintaining this arch height to the best of your ability, slowly drop the toes so that they are gently resting against the ground. No toe gripping! Maintain the arch! Hold for 5 seconds and repeat 5 times. Complete 5 sets per day. This is your initial exercise. You can progress this exercise by executing in standing or (more advanced) single leg stance.
Once you have the FSE down in this basic manner, try maintaining the arch in foot shortened position while executing a calf strengthening exercise like the heel drop. You can also work on maintaining foot shortened position in traditional lower body strength training exercises like the squat or the deadlift
Another idea for runners surrounds choice of footwear. One 2016 study examined the effects on IFM strength of running in minimalist footwear versus in traditional runners. The researchers found increased muscle volume (and therefore strength) of the IFM in those runners who wore minimalist shoes. However, one warning if you are considering transitioning to minimalist running shoes. It is easy to injure soft tissues (ligaments, tendons and muscles) if you switch cold turkey. I highly recommend a transitional training program executed over a number of weeks.
Positioning also matters! Take a look at the pictures below. Notice that in the knock-knee position the arches also fall into poorly supported orientation. Notice too that in the wide knee position the arch rises into a pronounced and supported orientation. Try this trick right now from where you are sitting or standing. Notice how you can voluntarily change the mechanics of your arch with this simple change in hip and knee position. This counts when you are standing, lifting, walking, running… doing anything! Focus on keeping your knee in line over your foot and take pains to avoid collapsing into a knock-knee (aka “valgus”) position. This habit will do wonders for supporting your arch as well.
[PIC - knock knee/wide knee]
There is also a place for passive treatments like taping. Taping, like the tape job shown below can support the medial longitudinal arch of the foot. It’s important to bear in mind that taping is not a long term solution. There is evidence to show that bracing, including taping can reduce the activity of supporting musculature and this is long term not what we are going for at all. Still, In the short term this can be useful for helping to reduce pain related to “fallen arches”, and in the long run managing posture and strength training supporting musculature are the way to go.
The picture below shows a simple arch support tape job. This is about as simple as it gets for this type of problem and more involved tape jobs are options as well for vigorous activity. This kind of taping can be applied by most people on their own with two strips applied around the bottom of the foot, from outside to inside with a firm lift at the inner arch. Your physiotherapist can instruct you on the finer points of this and similar tape jobs. The white base layer of tape is called hypafix and is a “kind on your skin” layer, while the firm brown tape, called Leukotape is doing the heavy lifting. These tapes can be purchased at most medical pharmacies.
[Pic, arch support tape job]
There you have it! A series of tricks to help manage pain and dysfunction related to poorly supported arches of the foot. Try these out, get strong and don’t forget to have fun in the process!
Further reading (if you really want to impress your friends!)
Chen, T. L. W., Sze, L. K., Davis, I. S., & Cheung, R. T. (2016). Effects of training in minimalist shoes on the intrinsic and extrinsic foot muscle volume. Clinical Biomechanics, 36, 8-13.
Franettovich, M., Chapman, A., & Vicenzino, B. (2008). Tape that increases medial longitudinal arch height also reduces leg muscle activity: a preliminary study. Medicine & Science in Sports & Exercise, 40(4), 593-600.
Goo, Y. M., Kim, T. H., & Lim, J. Y. (2016). The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot. Journal of physical therapy science, 28(3), 911-915.
Heo, H. J., & An, D. H. (2014). The effect of an inclined ankle on the activation of the abductor hallucis muscle during short foot exercise. Journal of physical therapy science, 26(4), 619-620.
Jam, B. (2006). Evaluation and retraining of the intrinsic foot muscles for pain syndromes related to abnormal control of pronation. Advanced Physical Therapy Education Institute.
Kim, E. K., & Kim, J. S. (2016). The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients. Journal of physical therapy science, 28(11), 3136-3139.
McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2014). The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med, bjsports-2013.
Mulligan, E. P., & Cook, P. G. (2013). Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Manual therapy, 18(5), 425-430.
Vicenzino, B., Franettovich, M., McPoil, T., Russell, T., & Skardoon, G. (2005). Initial effects of anti-pronation tape on the medial longitudinal arch during walking and running. British Journal of Sports Medicine, 39(12), 939-943.