Flat feet and insoles: top tips and myth busting.

Nick was recently asked to comment on a feature for an online publication on the subject of “flat feet” – this is one of those frequently asked questions in clinic and online via our social media and newsletters.

Makes sense that we would share the Question and Answer feature right here on our blog too!

How can flat feet impede our performance on the track or in the gym (strength training)?

There is this misconception, that a flat foot is a bad foot.  However when we look at the injury data, there is no solid evidence that a flat foot is a bad foot that will impede our performance.  It is more important to look at what that foot can tolerate and this is normally related to strength.  Perhaps showing that a flat foot does not impede your performance is to look at one of the great marathon runners of his time, Haile Gebrselassie, who has extremely flat feet, yet can run a marathon in 2hr 3min 59 sec and was the World record holder.  There is plenty of myth busting to do still.  In addition, if you have a flat foot while standing this doesn’t mean it will function like a flat foot when running or lifting weights.

What injuries are likely to arise as a result of collapsed arches – and why do arches collapse?

The likelihood of getting an injury is not increased, you just get different injuries.  If you have a foot with a collapsed arch, or a foot that is pronated to its maximum amount, this can put increased load through the structures through the inside of the ankle and the shin, so we do see people with tendinopathy around the tibialis posterior tendon, people with plantar fascia pain and problems around the big toe joint area. 

The majority of people are born with a flat foot and there are many people with flat feet that will never get an injury while people with normal looking feet that will get plenty of injuries.  However, we are concerned if the arch suddenly collapses, this normally means there is a tibialis posterior tendon issue or a problem around the spring ligament in the foot. Normally when this happens you feel something go ping and the foot does swell up considerably.  Another reason is that as the tendons could be exposed to increased load over time naturally these become stretched and elongated so as we get older they cannot serve their purpose so that gradually gets flatter and flatter over the period of many years, which may increase the chance of developing a tibialis posterior tendon dysfunction and arthritis in the middle of the foot.

Can you rebuild them?

Surgery can be used to change the shape of the foot shape, however this is rather drastic.  The best way is not to rebuild the arch but make the foot strong enough to cope with the activities that you want to do so focusing on strengthening around the small muscles in the feet and the muscles around the ankle.  It is also important not to neglect strength around the hip and knee region as well. People often say that you can put insoles / arch supports / orthoses in your shoes to gradually help the arch return back to a ‘normal shape.’ Unfortunately, this is a myth! While insoles can be extremely helpful in managing certain problems, the aim is to really use them to help offload a structure.  In my opinion, in the majority of times when you are given an insole, there should also some strengthening exercise given at the same time. Also ask the if you need to use the insoles all the time or can you remove when the feet are strong enough.

If so, how? What exercises do you recommend people try?           

A nice simple exercise I like people to do is calf raises and the key is to try and build this into your daily routine. While you are brushing your teeth in the morning, stand on one leg keeping the knee completely straight and just raise up and your tiptoes and lower down and try and build up to doing 15, then once easy place of book or something that you can then lower your heel off the back of to make it slightly harder and then add a backpack and shove some household items in their 2 increase the weight.

Also work on your balance : practise standing on one leg with your eyes open. When you can do this for 30 seconds,  repeat with your eyes closed, then progress even further,  standing on a wobbly surface like a sofa cushion or mattress.

Try some single leg hopping, practice just trying doing single leg hops and trying to land in the same place every time, once this becomes easy then get some masking tape or similar, then place two strips around 60 cm long on the floor in a cross pattern. Then practise hopping from the centre forward then back around in a compass fashion.

Those are three really simple exercises that you can do at home which take no longer than it does to brush teeth or boil a kettle that help you work on balance, strength and a bit of agility as well.  You can then start incorporating some hip exercises in as you progress.

How long do you reckon it would take to start feeling a noticeable difference in your arch support if you start to work on it?

Like with any strengthening exercises, you have to put a lot of effort in in the early days for very little visible gain so my advice is always be patient and start expecting some results in 6 weeks time, A top tip with the exercises  is to make sure they are been done at effort level of 7/10, where 0 is no effort 10 is maximum effort. Keep on progressing the exercises forward and making them harder to  ensure you stay in that effort level. This is known a RPE (rate of perceived exertion)

So, what’s next?

Flat feet are only bad feet if they cause you problems, and if you have flat feet they are not guaranteed to cause you a problem.  The key is to make yourself nice and strong and any exercise change should be easy to incorporate and gradual.  The use of an insole or supportive footwear may be helpful, however they may not be required long-term.  And also a flat foot is unlikely to result in significant reduction in performance during sport and exercise

Questions?

Get in touch with the NK Active team with any questions or book an appointment now. #NKActive #moveforward