Flat Feet: A Common Cause of Lower Body Pain
John, a patient of mine, was drafted into military service in 1942. The letter was hand-typed and to the point. He followed orders and showed up to a chaotic gathering of young men. Lines formed for processing, and a cursory medical exam was performed from head to toe. John recalled feeling like livestock. "You're flat-footed," he was told coldly, and, just like that, the process was over. He was not going to war.
John wondered aloud to me at a recent visit what implications flat feet could have which would prevent him from military service. It's a great question, and one that I deal with frequently as a family doctor.
The Problem and Its Implications
Flat feet, or pes planus, is caused by a collapse of the arch of the foot. This causes a rocking of the feet toward the midline, hinged at the ankle.
Go on. Stand up, and drop your arch toward the floor and see what happens-- uncomfortable, right? Did you feel the strain on your ankles, knees, and hips? Now consider walking thousands of steps like this every day.
Our bodies subconsciously require proper mechanics. As such, some area of the body usually picks up the slack if something is out of whack. And we are talking about a lot of work here with the full force of our weight shifting from foot to foot with each step we take.
Often, extra work is assumed by the muscles and tendons beneath the foot called the plantar fascia. Down the line, the problem of plantar fasciitis (inflammation of the plantar fascia) may develop with symptoms of heel pain that is usually worse in the morning.
Over years, with poor mechanics, arthritis can develop in the ankle from consistent inversion. Up the leg, the muscles of the shin can develop tendonitis and pain (shin splints). This is particularly common in runners. Compensation of mechanics can occur all the way up the leg and into the lower back. In the knee, pain often presents toward the side of the joint facing the midline. In the hip, tendinitis can develop on the outside knob called the greater trochanter. Pes planus should even be a consideration with chronic low back pain.
Fixing the Problem
Supporting the arch to correct the mechanics of the foot is paramount. This is accomplished with orthotics (arch supports). I steer my patients away from soft, spongy arch supports in favor of a more rigid plastic support. With progressive compression in step after step, the softer devices eventually lose their supportive abilities. While the rigid supports may initially feel "like walking on a golf ball" as one patient described to me, the magic eventually sets in, correcting the various problems.
What about custom orthotics? These do work well, a bit better than the off-the-shelf orthotics, but at a severely higher cost ($15-20 vs upwards of $300). Because of the huge cost differential, it's definitely a good idea to try the mass-produced orthotics. After all, this is what we do with shoes as opposed to visiting a cobbler. Finding a good, reputable shoe/foot store in your community should give you what you need with a sales associate who can fit you properly. If the store-bought orthotics don't work I then recommend seeing a podiatrist for a custom fitting.
Flat feet, or pes planus, is a common problem often with painful sequelae that can reach beyond the foot, up the leg, and into the back. If you have ongoing ankle, knee, hip, or back issues, look at your feet as a possible cause. Treatment with rigid arch supports can give major improvements.