Flat Feet and High Arches

Flat Feet

Flat Feet (Pes Planus) is where the foot has an arch that is lower than usual. It can also be referred to as hyperpronation or overpronation. Overpronation is when your foot rolls inward toward the arch excessively during gait which may cause stresses and strains and make you susceptible to various conditions.  Athletes with overpronation, particularly runners, see an increased likelihood of developing overuse injuries.

Symptoms of flat feet

Flat feet symptoms can be associated with:

• painful or achy feet, especially in the areas of the arches and heels
• stiffness
• numbness
• problems with balance
• feet tire easily
• the bottom of your feet become swollen
• back and leg pain
• easily injure your feet or ankle

Flat feet can progress slowly and you can develop deformities and stress injuries such as shin splints, muscular pain along the front edges of the shin.

Causes of flat feet

Flat feet can be congenital or acquired. Congenital flat feet means you are born with or have an hereditary predisposition to having flat feet.  Acquired flat feet is often because of muscle insufficiency when weight and force are applied down through the foot, the arch slowly pronates and flattens towards the ground.  Flat feet can progress slowly as you increase your feet’s exposure to weight-bearing activities.

Ethnicity can be an important factor in whether you have flat feet and some ethnic groups are born with a susceptibility to acquiring the flat feet.

Sometimes the feet did not grow properly in the womb and in rare cases it can be the result of injury. Flat feet are normal in many children, they usually last until 6 years of age and can self-correct.

Flat feet can be caused by or exacerbate other foot problems such as:

• Tibialis posterior tendinopathy – An overloading of a tendon in your ankle. The tibialis posterior is a muscle in the lower leg. The tendon from this muscle runs behind the inside bone on the ankle under the instep and attaches under the sole of the foot. This important muscle helps to hold the arch of the foot up. Sometimes the tendon becomes stretched and inflamed due to overuse or injury.
• Plantar fasciitis – Pain at the bottom of your heel or your arch sometimes described as an overuse injury.
• Stress fractures – Tiny cracks often caused by repetitive forces through the bone due to intense exercise.
• Achilles tendinopathy – A common overuse repetitive injury causing heel pain.
• Patellofemoral pain syndrome – Pain in and around the kneecap.
• Bunions – lump that forms on the side of your big toe joint causing your toe to bend inwards and the joint to jut out. A bunion can press against shoes putting pressure on the joint which can become inflamed, stiff and painful.

Risk factors include:

• obesity
• diabetes
• aging
• pregnancy
• rheumatoid arthritis
• injury

Treatment for flat feet

A specialist biomechanical assessment can give a diagnosis and treatment plan. Treatment can include footwear advice, strengthening and stretching exercises. You may be prescribed a bespoke orthotic insole which may help support and stabilise the foot to prevent stresses and strains on the ankle, knees, hips and lower back.

Call 020 8348 5553 to make an appointment

High Arches

The stress and the extra pressure of high arches can make a person susceptible to a wide variety of symptoms and conditions. A person can have high arches in one or both feet, occur in all ages and can be inherited.

Symptoms experienced with a high arch

One of the most common symptoms experienced in patients with pes cavus is metatarsalgia, a pain in the ball of your foot, as extra stress is placed there which can increase stresses and strains.

Other symptoms can include:

• foot or leg pain walking or standing
• recurrent sprained ankles
• calluses on the ball, heel or side of the foot
• toes that are bent (hammertoe)

Athletes with high arches should pay extra attention to their lower limbs as pes cavus is not the most efficient foot structure for absorbing shock and feet with a raised midfoot can be more prone to overuse injuries.  The high arched foot tends to roll outwards (supinate), as it rolls through step there can be foot instability and the increased risk of ankle sprains and other conditions. See the Ankle injury page for more detailed information.

High arch causes and conditions

High arches can be an inherited structural abnormality or caused by a neurologic disorder or other medical conditions including:

• Charcot-Marie-Tooth disease
• stroke
• spina bifida
• muscular dystrophy
• cerebral palsy
• a nerve or leg muscle injury

Metatarsalgia, hammertoe and mallet toe, Achilles tendonitis and plantar fasciitis are conditions associated with high arches.

Other issues and conditions linked to high arches include:

• reduced stability
• pain in the ball of your foot
• sprained ankles
• ankle, foot, knee and hip conditions
• lower back pain
• tight lower calf muscles
• stiffness
• calluses on the ball, side or heel of your foot

An experienced podiatrist can help you diagnose conditions that may have been exacerbated by high arches and give you a treatment plan.

Treatment of symptoms experienced with high arches

If you have high arches and you have conditions that are causing you concern an experienced podiatrist can check your gait during a biomechanical assessment and make a diagnosis of your condition and its underlying causes.  The aim of treatment in pes cavus is to distribute weight across a larger area of your foot and a bespoke orthotic insole may help reduce pressure by conforming closely to your arch profile.  You will also be given footwear guidance and advice for the best shoes to wear with orthotics and high arched feet. See the High arches page for more information.

 call 020 8348 5553 to make an appointment

Rachel Miller is a highly experienced podiatrist specialising in biomechanics and orthotic insoles who sees many patients with high arches. Her clinic is in the Highgate Health Centre in Highgate village, N6, London every weekend on either Saturday or Sunday and every Tuesday. Contact the Centre for an appointment on  020 8348 5553. For clinic directions and maps see the Contact page and for information about orthotic insoles and biomechanics see the Biomechanics page.