Why do I have flat feet?


epa03192046 A Kashmiri Muslim potter leaves his footprint in the mud as he works on an earthen pots in the outskirts of Srinagar, India, 22 April 2012. Earth Day is marked annually on 22 April, to raise awareness and public responsibility in environment-sustainable practices to care for the earth. EPA/FAROOQ KHAN

I have always had flat feet. When my feet are wet and I leave footprints on the ground, you can see that I have no arches at all. But I don’t experience pain when walking. What are flat feet?

When the arch on the inside of your feet is flattened, you're said to have flat feet. This means that the entire sole of your foot touches the floor when you're standing or walking. Flat feet is actually a very common condition and it's usually painless. It's so common that in an estimated 20-30% of the world’s population, the arch doesn't develop at all in one foot or both feet.

Why do some people have flat feet?

Infants and toddlers have flat feet because their arches haven't yet developed. It can partly be due to the presence of “baby fat”. In fact, children who go barefoot a lot over ground (not the hard flat surface of your house floor) tend to develop arches a lot quicker.

Arches are developed through childhood. Some people never develop arches as a normal genetic foot variation in the population, and they may or may not have problems in later life. Arches may fall over the years due to wear and tear.

Arches are developed for a reason. The arch provides an elastic connection between your forefoot (front of your foot) and your hindfoot (back of your foot). Much of the forces during weight-bearing when you stand up, walk, run or carry weights are dissipated by the arch before the force reaches the long bones of your leg.

When you have flat feet, the head of your talus bone – one of the bones in your foot – is displaced from the navicular, another bone. It is displaced inward and forward. As a result, the ligament and tendon of your leg muscle is stretched, and you lose the function of that arch completely.

Why do flat feet develop with wear and tear?

This is called “adult acquired flat feet”. This can be due to injury or illnesses, prolonged stress to the foot or faulty biomechanics due to normal ageing. Adult acquired flat feet are most common in women over the age of 40, especially if they're obese, have high blood pressure and/or diabetes. Flat feet can occur in women during pregnancy, but this is usually temporary because of hormonal changes in the body.

Research has shown that people who develop flat feet in adulthood have increased activity of some proteolytic enzymes (enzymes that break down protein). These enzymes break down the tendons and ligaments of the arches and cause the foot to fall. Maybe, one day, flat feet would be treated by drugs targeting these proteolytic enzymes.

Are flat feet always painless?

Not always. Some people experience feet which tire easily, and painful feet – especially around the arches and heels. They may experience swelling of the bottom of their feet. Some people have difficulty initiating certain foot movements, such as standing on their toes. Some people experience back and leg pain. I personally have flat feet. I find it difficult to balance on one foot during yoga class.

How would I diagnose flat feet?

This is very easy. First, get your feet wet. Then stand on a flat surface where your footprint will show. Now step away and look at your footprints. If you see complete imprints of your foot without any curvatures where the arch is supposed to be, you're likely to have flat feet.

But it's best to go to a podiatrist for a true diagnosis. Note that I said podiatrist, not general practitioner. This is because the podiatrist has equipment where they actually record you walking, and they're able to diagnose flat feet properly.

How do I treat my flat feet?

If you don’t have any pain, you probably don’t need treatment. However, these days, plenty of people who don’t have pain wear orthotics anyway. Orthotics are special aids which can be put into shoes or are part of your special shoes to help you walk. Orthotics or arch supports are definitely needed if you have pain.

Note that orthotics will not cure your flat feet, but they can help you walk more easily and less painfully. Some people with flat feet have a shortened Achilles tendon, and they will need physiotherapy and stretching exercises.

> Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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