My foot has collapsed! What the heck is a flat foot anyway?
As podiatrists, we tend to hear the statement “My arches have collapsed” reasonably frequently. With visions of bridges falling down, the idea of your foot arch collapsing seems serious - which indeed it is - and a foot with a true collapsed arch is very painful and difficult to walk with. However, in most cases where patients have either decided on their own or been told by someone else that their arches have fallen, it is thankfully not something that needs worrying over.
What is an arch?
There are a total of 3 arches in the foot – one on the outside of the foot from the heel to the little toe (lateral longitudinal arch), one across the width of the foot (transverse arch) and one on the inside of the foot from the heel to the big toe (medial longitudinal arch). The latter being the one people are referring to when they say their arches have collapsed. The height of all three arches varies greatly from person to person and also from sitting and standing positions. The medial longitudinal arch should have a small rise that is visible when standing – enough that you can get a few finger tips underneath without any trouble.
What is a flat foot?
The definition of a flat foot tends to vary between medical practitioners. In recent years, a foot profiling system has been tested and proven to be a reliable way to consistently and accurately diagnose those people with high, normal, slightly flat and very flat arches. Most podiatrists and some physiotherapists use this system to determine a patient’s arch profile in order to assist with other investigations and possible treatment options. Some people will note that their feet change with time and report their arches are collapsing as they age. This can simply be due to the normal loss of muscle tone and strength that happens when we get older. In some cases there is a dysfunction in a muscle in the calf, which causes a severe flattening of the arch along with a lot of pain and discomfort when walking. In these cases, early orthotic intervention is essential to prevent severe deformity of the foot. Another reason for severe flattened arches is due to a neurological condition such as Charcot foot as seen in people with diabetes and those with neuromuscular disorders such as muscular dystrophy and cerebral palsy. One group that frequently reports arch collapse is pregnant women. The increase in the oestrogen and progesterone hormones during pregnancy increases tendon and ligament flexibility, which may lead to a lengthening and flattening of the foot.
Does it need treatment?
Just because someone’s foot is flat, doesn’t mean that there is a problem. As we have mentioned before, every foot is so different it is hard to determine what exactly is normal. Because of this, most practitioners will treat based on appearance of symptoms and/or severity of the gait abnormality. Often, advice on supportive footwear is all that is needed. Sometimes, however, orthoses are needed in addition to good shoes to help control foot function and prevent the rolling in.