October 26, 2021
Many people think they have flat feet, but how do you really know? Do you feel like you are having a lot of foot issues but you’re unsure of what to blame? Maybe the shape of your foot is part to blame for your pain. Here is how to tell if you have flat feet and learn about commonly related pain.
How to know you have flat feet:
Let’s first look at a few characteristics of a “planovalgus deformity” or flat foot for short. The initial evaluation for the leg should look at the alignment of the foot in a standing position. One of the most important factors in orthopaedic surgery is the alignment and mechanical access of your leg. This means that in neutral alignment the ankle and heel rest underneath the lower leg. If this alignment is off, that can be a reason why you have pain on one side of your foot. Imbalance in the leg adds excess stress to either side of the foot. This results in pain and structures working overtime to compensate.
Early on while evaluating a patient, Dr. Adam Miller wants to see the position and alignment of the leg. This allows him to narrow down the potential issues that the patient could be facing. There are specific characteristics to the shape of the foot that determine the foot alignment and position. One thing Dr. Miller looks for is if he can see the inside of their heel. If the inside of the heel is visible, this means that the foot is higher arched. If he is not able to see the inside of the heel, then their feet are either straight or displaying out to the outside which would be more of a traditional flat foot characteristic.
Next, he looks at them standing from the back side to assess how the heel lines up. This poses the question “Is the heel underneath their leg or is it to the outside?” If it is towards the inside, the patient is more of a high arched individual.
The last thing the doctor will look for is the “too many toes” sign. This means the patients foot rotates out externally or to the outside and a lot of the forefoot is showing even from behind. Here you can see this as well as the heel position in the flat foot.
All these assessments are general tests you can try right at home in front of your mirror! When you try it, stand parallel to the mirror, and let the feet relax at shoulder’s width apart. This will allow you to gauge the general characteristics of your foot. If you start to realize you are trending towards flat foot characteristics, this may be just the issue if you’re experiencing pain.
Common areas of pain with flat feet
There are a few beginning places to look when a patient is experiencing pain and they have some flatness or “valgus” alignment issues in their foot. This will trigger that the foot is the problem in relation to the alignment. The most common area of pain is on the inside of the ankle and foot.
This pain can be isolated to the inside of your arch or be felt behind the ankle going up the lower leg. This is caused by the posterior tibial tendon on the side of your ankle that holds up the arch and controls the foot arch. This is a very large tendon (tendons are like ropes that attach muscles to bones to make your body move.) that essentially controls your arch. When the foot is flatter and sags to the inside, the posterior tibial tendon must “work harder” and is more susceptible to tearing, degenerating, and pain.
The second most common place of pain is on the outside of the foot, right underneath the ankle (fibula) bone which is what we call impingement.
Patients who have more severe flat feet develop this pain. Their foot starts to swing out from underneath their leg such that the heel bone starts to hit one of two ankle bones incorrectly. Instead of your heel bone being underneath your leg, it starts to impinge and hit your ankle bone (fibula). This can become very painful over time.
Another thing often painful for someone who is flat foot is when they go to stand on one foot and raise their heel off the ground. This single heel rise can recreate pain on the inside of the ankle. This maneuver activates the posterior tibial tendon and is common in flat foot related pain.
Many younger patients may have pain and prominence on the inside of the arch on their foot. This may be caused by accessory bones in that area where the posterior tibial tendon inserts. This focal area on the inside of your foot can then again become very painful.
It is important to note that flat feet don’t always have to be painful. It is perfectly normal to have a flat foot. There is a bell curve of normal…. some people are high arched, some people are in the middle, and some people just have flat feet. We try to focus on the individuals experiencing pain. We can’t predict whether people are going to have pain with flat feet, nor can we do anything to prevent the foot from becoming flat. However, the shape may predispose someone to developing pain in certain areas. You can wear your choice of arch support, but this has never been proven to change the natural progression of your arch or alignment.
What can we do/ treatment:
Initially, when a patient first comes in with pain related to a planovalgus (flat foot), we always try to recreate the arch with a support device and make the foot as neutral as possible. Non-surgical treatment is always the best first option which is dependent on the severity of the patient’s pain and problem. If they are unable to walk, we usually will start with a boot. If the pain is mild or intermittent, then an insert in the shoe or a brace may be more appropriate.
Depending on how the patient is tolerating the transition, we will try and wean them back to normal. Many times, improving flexibility and calf stretching is important, along with physical therapy. However, if these measures fail, we then start turning our attention to surgical intervention.
If you think you may have flat feet and are experiencing pain, we are here to help! Dr. Miller is Beacon Orthopedics foot and ankle specialist and is available at several locations around the Cincinnati area. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for your foot and ankle injuries.