Flatfoot: Where does it come from and whether to treat it
Flat feet - a phenomenon that seems to be familiar to everyone but surrounded by conflicting opinions. On the one hand, it is believed that the foot simply cannot be perfect for a person who lives in a city and wears shoes, and everybody has flat feet in varying degrees. On the other hand, we are often convinced that without individual orthopedic insoles, not only the legs, but the spine will suffer over time, and the posture will irreversibly deteriorate. We tried to figure out how the foot works, when it needs special care and what shoes are best not to wear.
What is it all about?
When on the inside of the foot there is no gently curved arch, the so-called arch of the foot, this condition is called flatfoot. If the arch of the foot is present only at the moment when the person is standing, but disappears when the leg is raised - this type of flatfoot is called mobile. If the shape of the foot does not change when the foot is in weight, it is rigid, or rigid, flat-footedness.
Mobile flatfoot is considered normal in young children - they are not born with a normal arch of the foot. In newborns, the foot seems to be bent outward - there is a fatty lump there, which dissolves with time; It is needed in order to soften the load. In some cases, the formation of the arch of the foot is completed by seven to ten years, but usually it happens earlier. In adults, mobile flat-footedness is noted in 15-25% of cases - and more often it does not cause any concern. In many adults with mobile flat-footedness, this condition is hereditary, and in such people it is usually extremely flexible and very mobile joints. Flat feet can also develop in adulthood due to diseases of the joints, such as rheumatoid arthritis.
Rigid flatfoot, unlike mobile, is often the result of a more serious problem that affects the structure or position of the bones that make up the arch of the foot. For example, it may occur due to a rare congenital situation in which the bones of the foot are not properly aligned, or the state where the union of several bones occurred together, this greatly impairs flexibility. These are rare hereditary conditions that can often be observed in several generations of the same family. In the case of an initially normal arch of the foot, acquired flat feet can develop as a result of an injury - for example, dislocation of the talus. This is usually due to damage from a fall from a height, a car accident or a sports injury.
Can shoes provoke or prevent flat feet?
The arch of the foot is a genetically programmed element of the anatomy. Initially, our foot is designed for walking barefoot - that is, nature does not know what footwear, instep supports, orthopedic insoles are. In Soviet pediatrics, it was believed that if you set a certain fabric for the development of a foot in the form of an instep and a rigid back, then the child’s foot will develop according to the set parameters - and, unfortunately, many doctors still adhere to such recommendations, forcing parents to buy children hard shoes from the very first steps. Nevertheless, the shape of the arch of the foot is laid genetically, it is impossible to change it with instep supports, and there is not a single study that confirms the opposite.
The instep need in shoes for the simplest reason: it is much more convenient to wear shoes that follow the anatomical shape of the legs. For example, sports shoes are always with an arch support - it is needed so that the athlete's legs are comfortable and they are stable, but the arch support in running shoes does not exactly form the arch of the runner's feet. Shoes with a suitable arch support and precisely matched in size are a matter of convenience and prevention of other problems, such as ingrown nails or the appearance of corns.
High-heeled shoes do not deform the bones of the foot (unless, of course, the size is chosen correctly), but it greatly increases the tension of many small muscles. Those who wear heels for more than forty hours a week, the effectiveness of the muscles when walking is disturbed, their fatigue accumulates. Normally, nerve endings constantly determine the position of our muscles in space and relative to each other — this is called muscular feeling, or proprioception. At the slightest imbalance, the brain instantly receives information about it and directs the impulse towards leveling the position. With long heels, tired muscles can signal that the balance has been disturbed, with a slight delay, and the nervous system does not have time to react in time - so the risk of falling or injury, even when walking on a smooth floor, increases.
Why can the leg increase during pregnancy?
It is often said that during pregnancy, the leg "grows" by size - in fact, of course, this is not about growth, but about deformation due to the rapid increase in body weight. In 2014, a study was conducted with the participation of 49 pregnant women; the dimensions of the arch of the foot were measured in different states (at rest and in motion), first in the first trimester of pregnancy, and then 19 weeks after delivery. During pregnancy, the height and stiffness of the arch of the foot decreased significantly, and this was accompanied by lengthening the foot - thereby increasing the size of the shoe. During the first pregnancy, the changes were more significant.
In another study conducted in Russia, changes in the feet after cyclic physical exertion in runners were studied. One hundred and twenty athletes performed a special exercise - a long run on an inclined plane. As a result, there was a significant decrease in the height of the arch of the foot. Interestingly, in men this decrease in the arch was transverse, and in women it was longitudinal. At the same time, the resulting flatfoot was of two types: compensated (or dynamic) and true. With compensated flat-footedness after a special period of rehabilitation, the parameters of the foot returned to the original, but with true flat-footedness, the arches of the feet remained reduced.
As for the connection of the shape of the foot with the posture - during the examination of 58 children of seven years of age, it turned out that flatfoot does not affect the posture itself. But it is affected by excessive pronation (collapse of the foot); requires attention and correction to avoid subsequent problems. This also happens in adults - scientists have found that women with excessive foot pronation have a higher risk of pain in the lower back than in those who put their legs in a neutral position.
When you still need to see a doctor?
Correction and treatment are needed only in cases where there is discomfort associated with flat-footedness - pain or, for example, excessive pronation of the foot (a condition where the foot is too "collapsing" inwards or outwards when walking). Non-surgical treatment is recommended first, although in some cases surgery may be required. The doctor may recommend wearing comfortable shoes that support the leg well, use special insoles that support the feet and do not allow them to collapse, take painkillers for discomfort, normalize body weight, if it is excessive, do stretching the leg muscles.
It should be understood that these procedures will not change the shape of the feet, but may help reduce some problems associated with flatfoot. If these measures do not help, the next step is to contact an orthopedic surgeon for advice about a possible operation. To prevent flat feet is impossible - it is a hereditary phenomenon. All that can be done is to wear comfortable shoes so that the legs are comfortable, and not to increase the load on the feet.
Photo: fotofabrika - stock.adobe.com (1, 2)
