I have flat feet and my left foot is flatter than my right.
But I don’t wear custom insoles. I don’t wear motion control shoes. I don’t have ankle or foot issues and I’ve never had any lingering pain.
The rest of my body isn’t crooked because of the shape of my feet and I’m not worried about developing problems in the future.
I don’t need to “fix” my flat feet and you probably don’t either. I’ll tell you why.
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What Is Normal Foot Posture?
Let’s start by answering the question – “What is normal foot posture?”
When viewing a foot from behind, many people would assume that a normal foot should have a heel that lines up with the lower leg and sits at a right angle to the floor. This position would also be associated with a “normal” arch.
If you don’t meet this standard, then you’d generally be classified as having a low arch with a flat or pronated foot, or as having a high arch with a supinated foot.
However, a study by McPoil et al in 1988 found that 84% of healthy females between the ages of 18 and 30 displayed more of the pronated foot posture. Additionally, ⅓ of the participants demonstrated asymmetries between their feet.
A different study by Astrom and Arvidson in 1995 examining pain-free males and females between the ages of 20 and 50 concluded that “None of the subjects conformed to the ‘ideal’ foot…”
Over a decade later in 2009, Christopher Nester, a well-known podiatrist and researcher, wrote the following: “Rather than continue to apply a poorly founded model of foot type whose basis is to make all feet meet criteria for the mechanical ‘ideal’ or ‘normal’ foot, we should embrace variation between feet…”
And this doesn’t just apply to static foot posture, but also to variations in movement. Researchers in 2019 emphasized these two statements:
- “Pronation is a natural movement of the foot, which corresponds to a term that is widely used, but not well understood. Pronation is often associated with running injuries; however, evidence for this association is weak.”
- “There is no clinical definition for ‘over-’, ‘hyper-’ or ‘excessive’ pronation. Thus, these terms should be avoided.”
The problem is that we’ve pathologized “normal,” meaning that if your feet don’t meet this unrealistic and unsubstantiated standard that was arbitrarily set over 100 years ago, then you’re broken and need to be fixed.
What If You Have Pain?
Well, I’m not trying to say that the structure of your feet can never be a contributing factor to your symptoms, but that still doesn’t necessarily mean that you need to “fix” your feet.
When it comes to rehab, the goal is to modify the possible contributing factors to your symptoms. But they have to be modifiable.
As an analogy, think about someone who is at risk for a heart attack. Let’s say they smoke, don’t exercise at all, and have a family history of heart problems. Interventions would focus on influencing their smoking status and exercise habits because those are modifiable risk factors. Their family history can’t be changed.
Similarly, it’s unlikely you are going to significantly change the appearance of your feet. This is why you should be weary of the before and after pictures that you see on social media. With just a slight change in the angle of the camera, shifting of my bodyweight, turning of my leg, or conscious awareness of what I’m doing, it’s extremely easy to create a drastic looking transformation in a matter of seconds without actually having changed the structure of my feet.
Whether you have pain or not, and pretending your endurance isn’t a limiting factor, answer these questions:
- Can you walk for 3 minutes?
- Can you hop on one leg for 60 seconds?
- Can you run a marathon?
- Can you run a marathon daily for a week in a row?
Why did you say “yes” to being able to walk 3 minutes, but “no” to at least one of the other questions?
Did your answer have anything to do with the shape of your feet?
Probably not.
Your answer likely had more to do with what you think your feet and ankles can tolerate.
Therefore, it’s easier to think of most foot and ankle issues as load-related problems. You can either reduce the frequency, volume, or amount of loading that’s contributing to your symptoms, or you can slowly improve your ability to handle more load.
Or you can do both – unload the area as needed at first and then gradually reload it so you can perform the activities meaningful to you.
Tibialis Posterior Tendinopathy Example
Let’s use tibialis posterior tendinopathy, which is pain on the inside of your foot or ankle associated with loading of the tibialis posterior, as an example.
Rather than using the extremes that I presented before, pretend that you have pain after walking for 20 minutes.
One way to reduce the load on the tibialis posterior to minimize symptoms would be to keep your walks to less than 20 minutes initially.
Simple enough. But there are other ways to do this as well.
For example, research by Maharaj et al in 2019 suggested that using a wider step width may help unload the tibialis posterior. A different study by Maharaj et al in 2018 found that supportive, athletic footwear may be beneficial because the shoes help decrease the amount of work done by the tibialis posterior. Lastly, a study by Williams et al in 2003 demonstrated that inverted foot orthoses may reduce the loads experienced by the tibialis posterior without actually changing foot mechanics.
Whether you make slight changes to your footwear, insoles, or your duration of walking, the idea is that you are temporarily reducing the load on the provocative tissue or area, which in this case is the tibialis posterior. You are not changing the structure of your foot.
I like this quote from sports podiatrist, Ian Griffiths, who sometimes compares insoles to crutches or a sling: “Foot orthoses are considered by many to be life sentences, which when viewed through the lens of the historical belief that they were ‘realigning the skeleton’ or ‘correcting deformity’ sort of makes sense. However, it seems appropriate to adjust this belief given what we now understand about foot orthoses. For the majority they may be far more likely to be a short to medium term intervention rather than a life sentence.”
When someone is experiencing pain or an injury, a specific shoe or insole may be helpful. But for most individuals, you can choose what you wear based on comfort, appearance, or function.
After this period of relative unloading, or trying to reduce aggravating activities, there’s going to be a period of reloading. This can involve using a certain shoe or insole less, gradually doing more of the activity that was previously provocative, incorporating exercises to improve your tolerance to handle more load, or performing a combination of the three.
Exercises For Flat Feet
When it comes to exercises for flat feet, I want to present the idea that there are no exercises for flat feet. There are just exercises for feet.
Preparation is far more important than structure, especially if you don’t have much influence on the structure.
If you want to become a better basketball player, you’re not going to focus on increasing your height. You’re going to work on your jumping ability, defense, 3 point shooting, etc.
If you want better functioning feet and ankles, you don’t need to focus on “fixing” your feet. Instead, work on your overall strength, range of motion, power, and other related variables to prepare yourself for any task.
Regardless if you have a low arch, high arch, or something in-between, heel raises 2-3 times per week are beneficial. Start with 2 legs on flat ground and work your way up to a single leg on a step.
If you’re already doing some resistance training, throw in some single leg exercises, such as a single leg deadlift and lateral step down.
If you play sports, incorporate hopping, bounding, and jumping.
If you have symptoms associated with tibialis posterior tendinopathy or another diagnosis, you can do lower level movements to start like towel curls or banded exercises if needed.
Even walking is a foot exercise.
And if you want to get creative with your single leg balance exercises to challenge your feet even more, go for it.
But your capacity to handle load and your ability to recover from that load based on your preparation are exponentially more important than the appearance of your feet at rest.
Plus, static foot posture doesn’t perfectly predict how your foot is going to function during walking, running, and other activities.
What If You’re Trying To Avoid Problems In The Future?
There’s no evidence to suggest that your standing foot posture is going to cause you problems in 20 years.
A systematic review by Neal et al in 2014 did find “that a pronated foot posture increases the risk of medial tibial stress syndrome and patellofemoral pain…” But they go on to say: “However, this relationship is of small effect, indicating that a pronated foot posture may only be a minor component of the injury risk profile for these conditions. They also concluded that “Foot posture was not found to be associated with the risk of foot and ankle injury…”
Once again, it’s more useful to focus on larger, more important modifiable factors.
The closest thing I have to a crystal ball is my dad who is over 30 years older than me.
Despite having significantly flatter feet than me and never having done any foot or ankle specific exercises in his life, he plays pickleball pain-free for 2-4 hours per day.
Will some people need specific treatments or surgery associated with their feet? Yes, and that should be discussed with their surgeon, podiatrist, or other healthcare professional.
But for the majority of the people reading – if you’re worried about your feet based on what you’ve heard or read, please understand that you’re likely far more normal than you think.
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