What are fallen arches/flat feet?
Flat feet in infants is a common parental concern; however, all infants will have flat feet up until approximately 2 years of age. In adults, a drop in the arch of the foot (also referred to as pes planus) may be an inherited condition. Other potential causes of flat feet (fallen arches) include fracture induced by foot trauma. Muscle weakness, ligament laxity, pronated feet or paralysis can also give rise to this condition.
Consequences of fallen arches
Fallen arches & foot pronation have been associated with everything from ankle, foot & low back conditions to shoulder & neck pain. This would appear logical given the muscle activity of the entire body will be affected by the manner in which the foot strikes the ground.
Is Foot Pronation & Leg Length Linked to Injury
There is a widespread belief that foot pronation and differences in leg length are major causes of knee, ankle & back pain. It is rare that a day goes by without a patient mentioning one of these factors as the potential cause for their presenting injury. Conventional wisdom suggests that over-pronation is one of the major drivers of injury, especially in runners. When the published literature is analysed, any such link between foot posture & leg length varation with injury is shown to be less clear cut. For example, a recent prospective study found leg length discrepancy was not associated with running injury in recreational runners (Hespanhol Junior et al. 2016).
Research Examining Link Between Pronation & Injury in Runners
Neilsen et al. (2014) performed a 1 year prospective cohort study of over 900 novice runners. They concluded foot pronation was not associated with an increased injury risk. In fact, those classified as having pronated feet sustained significantly fewer injuries per 1000km than those with ‘neutral’ feet. The study points out though, as a limitation, that few runners with ‘highly-pronated’ feet were included in the study. This research suggests that supposedly deviant degrees of pronation may in reality be considered normal and do not contribute to injury.
Are Running Shoes the Answer?
There is too much emphais placed on specialised running shoes in order to prevent injury and support ‘fallen arches’. Research does not support a link between the use of such shoes and a decrease in injury risk. Some research suggests that modern running shoes may predispose to injury because the heavily cushioned soles encourage heel striking while running. This causes a greater transfer of load from the ground into the lower limb joints.
Research into Link Between Pronation & Shin Splints & Knee Pain
An excellent systematic review by Neal et al. (2014) did identify evidence that pronated foot posture may be a risk factor for Medial Tibial Stress Syndrome and Patellofemoral (knee) Pain. This included 21 studiess with varied populations including runners and non-runners. did a similar review of dynamic foot function and found very limited evidence that it was a risk factor for patellofemoral pain, achilles tendinopathy and non-specific lower limb overuse injuries.
Management of foot pain
Foot pain such as that associated with plantar fasciitis or achilles tendonitis can be improved by altering biomechanics and decreasing stress on the involved structures. Resolution of pain may be guided by use of modalities such as taping and also rest. Mobilisation of restricted foot and ankle joints as well as gait and muscle re-education is vital.
- Luiz Carlos Hespanhol Junior, Aline Carla Araújo De Carvalho, Leonardo Oliveira Pena Costa & Alexandre Dias Lopes. Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study. European Journal of Sport Science, 2016.
- Neilsen et al. (2014). Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine, 2015; 45(7): 1017-1026. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473093/
Neal et al. (2014). Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. Journal of Foot and Ankle Research; 7:55.
4. Dowling et al. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot and Ankle Research.
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