Ah, those golden arches…
This is a response I gave to a MD colleague who inquired into WHY she was seeing an increase in flat feet in her patients and WHAT she as a doctor could do about it. I thought I’d share this information with you as there is very little literature on the CAUSE of flat feet – only the pain and injury that results after walking so many years on a foot without muscle activity.
From a biophysics point of view, the arch of the foot is created by the simultaneous innervation of the intrinsic foot musculature (as opposed to extrinsic) and the external rotators of the femurs (pelvic musculature – the obturators being the most significant).
1. The above mentioned musculature can only contract with the necessary quantity of force required to maintain the foot arch if the sarcomeres (segments of a muscle fiber) are at the correct length. The quantity of force produced is dependent on the correct distance of muscle attachment sites. Since the attachment site distances are dependent on skeletal alignment, parents/teachers/pediatricians need to be educated on the objective markers children need to be instructed on. However, children learn gait via observation – so new parents need to be demonstrating correct gait as well, in order for the child to pattern it. More simple: There are 3-4 basic assessment postures one can use to determine the effectiveness of the musculature and corresponding exercises every child/adult can do to restore function.
2. The ideal footwear is “none” for any human. A shoe will weaken the function of the musculature within the foot (intrinsic) by limiting the motion to the ankle. This all being said, the foot needs to be protected in our bacterial and potential puncturing environments. Footwear – select one that moves most like the foot (again, this is an entirely different structure than the ankle!) Think lighter, less structured, and one that moves at multiple segments along the foot bed (I like Kalso Light bottom from Earth Footwear and I think Nike Free used to make one, but have since removed the flexible bottom in favor of a more rigid one). Absolutely NO HEELS – which includes athletic shoes with excessive padding underneath the heel (good for runners while running, but not at any other time…) – as a heel elevated above the toe box will increase posterior tilt (further weakening the pelvic floor and increasing plantarflexion – which increases tension in the plantar fascia and also weakens the intrinsic foot muscles). I like the negative heeled footwear due to the fact that most folks are also dealing with an anterior shift in total mass.
***A arch support cannot strengthen musculature of the foot any more than a sling can increase the strength of a bicep. Quite the opposite, right?
Regular barefoot walking is good (in a safe place) and NO FLIP FLOPS or mis-sized footwear where the patient has to grip the toes to keep it on. Toe flexion is NOT a desired action for the foot – it is extremely overused due to the toe gripping most do in response to lack of balance during a typical gait pattern. Developing children should not be in footwear unless required for school. For my bed-wetters, back pain, scoliosis, and flat-footed kids under the age of 8, I have them in ballet slippers and socks as much as possible. There are also more and more foot-sleeve companies popping up (as an alternative to shoes).
3. Again from an engineering perspective, an orthotic should be used only to supplement to a gait and muscle strength restoration program. Just as a sling weakens shoulder and arm musculature, a inert device that gives shape to the arch will only weaken the muscles ability to contract. A “flat foot” is simply a foot with non-innervated foot and hip musculature. An arch support should be 50% of the treatment protocol as a developing child or athlete will be at risk for further injury due to the fact that the ligaments of the knee are also out of place to resist normal lateral and torsional forces (especially ACL) and any condition arising out of low tone in the pelvic floor (bed-wetting, hernia, severe menstrual cramps, sacral pain to name a few…)
Did you like this? If so, please bookmark it, 
Thanks for the great 411, it totally makes sense!
I loved this piece….so am I to understand that this lack of muscle activity is (besides heels), one of the major causes of flat feet? And the exercises on the feet dvd…are these exercises sufficient to restore flat feet or is there another video coming that will address this issue?
I am a KMI practitioner / structural integrator, like Rolfing but a different school. We study the mechanics of the “body machine” and ultimately try and bring the body into its most vertical and functional position (in gravity) as possible. We try and correct compensations in the body to reduce strain on the over compensated areas for example the ACL mentioned above. I have been walking barefoot from May till October for 4 years. I recently found a company that most people know, Vibram that makes a five finger shoe. It is the non-shoe, to protect from all the dangers of “sticky outy bits” on the streets. I love the way you write and I think you put the focus and support where it is most needed and forgotten about in peoples lives. It is nice to know someone else on “my side.”
I do have one correction to make though with this statement. “A “flat foot” is simply a foot with non-innervated foot and hip musculature.”
This statement is not 100% true. We are all born with flat feet some children never develop the arches. (Though that might have to do with what you mentioned above about watching and learning from parents’) If the cuneiform bones do not form into the “keystone” shape the child will always have flat feet no matter what you do to the muscles! So you might want to change “flat foot” to fallen arch or a pronated foot.
Below are a few links, if you don’t mind to help expand on these ideas.
http://www.vibramfivefingers.com/ (5 finger shoes)
http://nymag.com/health/features/46213/ ( An article that relates very close to yours)
http://en.wikipedia.org/wiki/Structural_Integration (This is about Structural Integration)
Hi Jason,
Thanks for just a thoughtful and informative comment! Please share your insights as a KMI practitioner, and I will spend some time checking out your site!
Yes, this is why my arch was always so beautiful. I was a barefooter! I’m less so today, but that’s more due to the crap that is always around on the ground these days. Instead I buy footwear from Soft Star Shoes. They even make a lovely warm boot for adults in the winter and as I am in Sweden where it can get to -20 C and deep snow, this is a good thing!
I’ve noticed my arches falling over the past couple of years and wondering what I could do to help that. SO I am happy to find your site, katy!
Jason,
When I asked my sister about her toddler’s flat feet, she quoted her pediatrician who believed, like you, that “all children are born with flat feet, and will continue to have flat feet up to about age 4.” Her child, at age 11 still has flat feet, or fallen arches, whatever you want to call them. This information is incorrect, and my sister missed a window to help her child correct a debilitating condition. My children were both born with arches, yay for me, but I was surprised, because I believed what her pediatrician told her.
Since I noticed this discrepency, I’ve been quietly observing the feet of babies and children. There are lots of flat feet, and some that are not. My purely anecdotal correlation is…ta da: artificial vs. natural feeding (formula fed=flat footed, breast fed=arches)
I often notice that doctors tend to confuse common with normal–as in “osteo-arthritis is a normal part of aging.” Personally, I think that our poor nutritional status in general affects the quality of health of our children. Why might breastfed babies be born with arches? Women who choose to breastfeed could be more concerned with eating well, and maybe their better nutrional status before they conceive has a positive effect on the quality and functionality of the connective tissue of their children.
I could be full or it, but there you have it.