Flat feet is a fairly common complaint and a hot topic of debate in medical circles. While it is often dismissed as just a foot problem, special orthopedic footwear or treatment to correct the arch can also improve issues with the knee, hip, spine or other parts of the musculoskeletal system, according to specialists of the J. Girskis Spine Treatment Centre.

‍

What to observe?

“Flat feet are typically seen in babies and children under 3 years of age due to fat deposits in the area of the feet, laxity of ligaments and lack of neuromuscular control. Over time, as the muscles and tendons form, the arch of the foot also develops. As the muscles strengthen, the arches of the feet become more prominent around 3-6 years of life, and they are finally formed by time children reach the age of 8-10,” said Dr Būtėnaitė.  

The causes of flat feet can be congenital or acquired: either the arch of the foot does not form or, it forms naturally then begins to deform due to the flattening of the longitudinal and/or transverse arches of the foot. According to Dr. G. Būtėnaitė, some  congenital causes of flat feet can include: cerebral palsy, Down, Ehlers-Danlos, Marfan syndromes, congenital vertical talus, and other congenital deformities of ligaments, joints or bones. “Chronic diseases (rheumatoid arthritis, seronegative arthropathies, diabetes mellitus) and obesity increase the likelihood of developing flat feet,” said Dr Būtėnaitė.  “Weight gain during pregnancy is another significant factor in the development of flat feet.”  

Greta Girskė, head of the J. Girskis Spine Treatment Centre and consulting kinesitherapist, says that specialists should treat acquired flat feet as a warning sign that the entire human support-movement system is impaired: “The feet are at the bottom of the link of the human musculoskeletal system, which means that the loads from the body’s joints and muscle structures above are “dropped” into them. Therefore, you need to start from the top in order to correct the disturbed biomechanics in the feet: assess the loads on the pelvic, hip, and knee joints and the condition of the muscles responsible for them, so you can restore the balance of the musculoskeletal system,” says kinesitherapist G. Girskė.

After all, it is significant that the pains associated with flat feet are rarely felt in the feet themselves, and often appear in the ankles, calves, hips, knees or even the back. “Flat foot is an obvious warning sign to check what is happening in the major joints and muscle groups of the body. This is the opposite of what we are usually told: that the condition of the feet determines the biomechanics of the spine or pelvis, posture. Specialists of our spine treatment center strongly disagree with this theory, as they believe that flat foot is a sign of issues elsewhere in the body,” said G. Girskė.

“Try to imagine a scenario where the pelvis would change its position to the correct one as a result of strengthening the tiny muscles of the foot, which are located at the bottom of the body -- or where the spinal curves adjust to match the picture from the anatomy textbook. Is that possible? Absolutely not!”

How to correct?

The specialists of the J. Girskis Spine Treatment Centre believe strongly that an individual examination of the human movement system is essential before selecting the right treatment method. Many years of treatment practice have demonstrated that the most effective way to eliminate  the causes of flat feet is to perform regular targeted therapeutic movements that strengthen weakened muscles and lengthen muscles that have lost their elasticity – this is the only way to correct the loads on joints, ligaments, and tendons.

The muscles of the buttocks (especially gluteus maximus and gluteus medius) have a great influence on our posture and gait. “These muscles use their strength to keep the pelvis, hips, and knees in the correct position. They are also important for supporting the arch of the foot and reducing the load on them,” said G. Girskė. An imbalance in the tone of the thigh muscles (adductors and abductors, internal and external rotators, foot pronators and supinators) leads to the appearance of knee valgus (turning inward) position, which is also associated with flat feet. The bony arch of the foot is not independently stable by itself and requires support from ligaments that can often become overloaded. “The ligament’s primary function is to send a signal to the muscles, alerting them to perform their function when stretched. Even an anatomically perfect foot can gradually become flat if the muscles of the buttocks, lower leg and thigh do not have a balance of strength and tone,” – says G. Būtėnaitė, Doctor of Physical Medicine and Rehabilitation.

Flat feet can also form when there is an imbalance in muscle tone in the legs (thighs and lower legs), when some muscles compensate for others, resulting in a loosening of the ligaments that fix the joints of the foot. According to Dr. G. Būtėnaitė, the looseness of the posterior tibial tendon (PTT) as described in the literature, can eventually causes flat feet, other foot deformities, and shortening of the surrounding tendons, such as the Achilles. As a result, the muscles that perform eversion (slight retraction and outward rotation) of the ankle (m. gastrocnemius and m. soleus) become the muscles that perform inversion (slight adduction and inward rotation). ”When performing targeted exercises, it is important to strengthen the loosened posterior tibial tendon of the lower leg, while also relaxing the overstretched muscles of the back group of the lower leg, the Achilles tendon, by performing stretching movements,” said Dr. G. Būtėnaitė. “In order to prevent flattening of the arch of the foot, it is also necessary to strengthen the anterior muscle of the lower leg (m. tibialis anterior) and posterior muscle of the lower leg (m. tibialis posterior), flexors of the big toe (m. flexor hallucis longus), abductors of the big toe (m. abductor hallucis), and other internal muscles forming the arch of the foot.”

In order to correct the flat arch of the foot, the main task of the purposeful support-movement system is to restore the disturbed functions of the musculoskeletal system: lost muscle strength and/or elasticity. These properties, says  G. Būtėnaitė,  enable the adjustment of the loads on the body’s joints and improve the depth sensation (proprioception). For additional training of proprioception, it is recommended to walk barefoot on uneven, different textured surfaces (grass, pebbles, spiky mats) in your free time.

‍

What to wear?

There is great debate among doctors about the best orthopedic footwear for people with flat feet and whether it is necessary to wear specially adapted insoles with this foot deformity. While most  orthopedists will automatically say yes, the specialists of the J. Girskis Spine Treatment Centre, who look holistically at the biomechanics of the body, have a different approach. ”Today, it is rare to find a flat-footed person who does not have individually adapted insoles. However, we do not believe that wearing a specially adapted device can cure flat feet or restore the normal axis of the foot in the long run,” said kinesitherapist G. Girskė. “Insoles can help the feet fit more comfortably in the footwear, and feel more comfortable due to better cushioning of the foot, while they also protect the footwear from faster and uneven wear. But that is all.”

G. Girskė says that long-term wearing of insoles can often mean that pain in the feet eventually turns into pain in the knees, hips or spine. This may be due to the artificial alignment of the axis with inserts encouraging the body to adapt to the unnatural changes in the axis below it. As a result, the body will compensate for these artificially induced overloads by experiencing soreness in other problem areas of the axis of the body, requiring further treatment with targeted movements, not insoles.

‍

What to supplements with?

While flat feet do not develop as a direct result of a lack of vitamins or trace elements, Dr. G. Būtėnaitė believes that nutritional deficiency can become a secondary cause: “For example, vitamin D deficiency, which causes rickets in children and osteomalacia in adults, leads to the development of bone deformities, which in turn can lead to flat feet. Calcium, which is important for bone mineralization, is closely related to vitamin D metabolism. Lack of calcium makes bones more prone to fractures during trauma. In cases of frequent tendinitis (inflammation of the tendons), the use of vitamin C is recommended. Repetitive trauma and tendinitis are among the most common causes of acquired flat feet.”

Therefore, a varied, complete, balanced diet should be recommended, ensuring a sufficient amount of vitamins and minerals obtained from food.  Foods containing calcium and vitamin D, which are important for bone mineralization, include dairy products, tofu, almonds, chickpeas, leafy vegetables and eggs. Vitamin C, which is found in tomatoes, strawberries, kiwi, spinach, and oranges, is extremely important for strong immunity and prevention of inflammation. It is also important to consume foods containing group B vitamins (cottage cheese, salmon, sardines, eggs) to maintain optimal functioning of the neuromuscular system. Alcohol and products containing trans fats, red meat, and sugar can trigger inflammatory processes, so they should be avoided.

‍