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August 28, 2012 | Comments: 1

Watch Out for Falling Arches

One major way we differ from our ape ancestors is in having arched feet. Still, plenty of highly evolved humans have flat feet.

As humans began to evolve, the foot developed from something that could grasp branches easily to one more suited for upright movement. To propel yourself forward, you need an arch that keeps the foot stiff when you push off with the toes, but is also flexible enough to act as a shock absorber when your heel hits the ground. The recent discovery of a three-million-year-old foot bone with a full arch suggests that our early human relatives (A. afarensis) were upright walkers.

Nevertheless, as many as one in four people have flat feet, once referred to as "fallen arches." One or both feet may be affected. There are two general types. "Rigid" flat feet are flat all the time, whether they are bearing weight or not. More common are "flexible" flat feet, in which the arch collapses only when weight is put on it. Flexible flat feet may become more rigid over time.

Flat feet tend to run in families and increase with age. They may result from congenital bone deformities or injuries to bones or soft tissue; most frequently, they occur in adults due to overstretching and degeneration of the posterior tibial tendon on the inner side of the ankle. People who have occupations that involve lots of weight-bearing activity, are very active, or are very overweight are at higher risk. Diabetes, rheumatoid arthritis, and other conditions also increase the risk of flat feet.

How do you know if you have flat feet? Wet your feet and stand on a dry surface that will leave a footprint. A foot with a normal arch leaves a print that looks like a wide band from the heel to the ball of the foot, with a large indent on the inner side. If there is little or no indent, your feet are flat. Other telltale signs are toes that point outward, ankles that turn in, difficulty standing on tiptoe, and a tendency to get bunions, calluses, and hammertoes.

A flat-out disability?

Many flat-footed people experience no pain or problems. But having flat feet can alter the way you walk (overpronate) and contribute to overuse injuries. You can develop foot, ankle, knee, and even hip and back pain; there may be fatigue in your feet and legs, and sometimes pain, tenderness, or swelling around the tendon of the ankles. Doing a lot of weight-bearing activity (such as running, hiking, or even walking) can worsen symptoms. Flat feet can also contribute to arthritis, recent research has confirmed.

Raising the arch

If you have chronic pain in your feet, knees, legs, or hips, see a specialist such as a podiatrist or orthopedist for evaluation and a diagnosis. You may be referred to a physical therapist, who can design an individualized treatment program that includes stretching and strengthening exercises and possibly braces and special taping of the foot.

One exercise is to stand on one foot and try to increase and then decrease the arch of that foot. Another is to sit in a chair and with your heel planted on the floor as a pivot, sweep your little toe toward the center of your body.

Losing excess weight and wearing shoes with good arch support can help manage symptoms of flat feet. It's debatable how effective orthotics (custom-made or prefabricated shoe inserts) are; some studies have shown them to have little, if any, benefit. Over-the-counter anti-inflammatory pain relievers and cutting back on weight-bearing activity may also help. Surgery should be considered only for the most severe cases.

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