“Every day when I’m in the clinic, I see patients concerned about their feet, flat feet,” says Gabriel Moisan, lead author of the editorial. Such patients have always been told that flat feet are a problem, he adds.
Yes, flat feet, the medical term for the condition is pes planus, may be related to problems, but this is not certain. What’s more important is focusing on the pain and treating it, rather than worrying about how your feet or arches look, Moisan and others say.
You might have a low arch, but a lot of people do, and a lot of people with low arches don’t have anything wrong with them, says Patrick McKeon, associate professor and clinical education coordinator for athletic training at Ithaca College in New York who did it. they do not contribute to the essay. So how can it be a deformity, how can it be a deviation from the normal, especially if many people have it, he asks.
We’re splitting hairs by calling it normal or abnormal, says John Keel, associate professor of emergency and sports medicine at the University of South Florida Morsani School of Medicine and co-author of the paper on pes planus. Kiel and his co-authors note that flat feet are common in children, but most children develop a normal arch by age 10.
Your feet are lifted and wrapped
The arch of the foot, the medial longitudinal arch, is a tough, elastic network of ligaments, tendons, and connective tissue that runs on the inside between the front and back of the foot.
The basis of support for the body, the arch acts both as a shock absorber, dispersing the forces of weight bearing, and as a spring, storing and releasing energy during walking and running.
Instead of considering flat feet as part of normal variation, the medical and shoe fields have for decades rushed to treat flat feet with supportive shoes, orthotic inserts, and surgery, even in the absence of pain or other problems.
But there is little to suggest that treating flat feet helps anything.
If there is a causal relationship between flat feet and injury, most people with flat feet would injure themselves, Moisan says. And that’s simply not the case. Moisan points out a few more important factors to consider, variables such as exercise volume, the surface you walk or run on, and previous injuries.
Several meta-analyses have failed to find a relationship between many biomechanical factors, including foot shape, and running injuries.
One of these, a review of 30 studies and 3,404 runners from 2022, included over 100 discrete biomechanical and musculoskeletal risk factors. The researchers concluded that available research generally does not support biomechanical or musculoskeletal measures as risk factors for running injuries in non-elite runners.
Part of the treatment included shoe selection, especially for walkers and runners. That paradigm prescribes a supportive shoe, stability, or motion control for those with flat feet. Individuals with high arches, because their feet are assumed to be more rigid, are directed towards cushioned shoes. But there is also little evidence to suggest that this approach, matching the shape of the foot to the type of shoe, makes a difference.
A study of military running shoes
Research on military personnel illustrates the point. Because injuries often occur during basic training, injury prevention is an important area of research for military medicine.
In a joint analysis of three studies involving about 7,200 Air Force, Army, and Marine Corps recruits, the reviewers found that choosing running shoes based on arch height had little effect on the risk of injury in military basic training.
Shoes are important, just not as much as we think they are, says Jay Dichari, physical therapist and author of Running Revired: Reinvent Your Run for Stability, Strength, and Speed.
As someone who validates and innovates with footwear for a bunch of different brands, the footwear makes the difference, he says. But a shoe won’t solve your problems. A shoe might make the difference between woe and getting by, but it won’t fix things.
Instead of relying on passive measures like shoes and orthotics to prevent injuries, experts like McKeon are calling for a more active approach to foot care. Similar to core stability for the spine, McKeon says the core of the foot, using the intrinsic foot muscles, can play an important role in injury prevention.
Dicharri agrees: We train the core, hips and knees to improve athleticism. Legs are no different.
That’s really how we started looking at the core of the foot, McKeon says, is that if we can get a person to learn how to better activate their inner foot muscles, there are a number of things that can happen.
First, they become better immediate stabilizers of the foot joints, he says. Second, the foot becomes a kind of sensor, a connection between the body and the surface. By learning how to engage the foot muscles, we got better sensors for how the foot changes with movement, he says.
For runners and walkers, McKeon recommends starting with what he calls your neutral foot, which you can locate by raising your arch up and down while sitting, then standing, and rocking your foot from side to side and finding a middle ground between the two extremes.
When it comes time to go to the shoe store and choose a shoe, Moisan has two rules. The first rule I have is if you’re not injured, don’t change your shoe type. Resist the lure of new colors or trendy brands if it means switching from something that works.
His second rule is that the shoe fits well, it should be comfortable and light. It seems very simple to say, but many people wear shoes that are not wide enough or too short, says Moisan.
Ultimately, Moisan says, the message is simple: Don’t worry about the appearance of your feet.
For clinicians, his opinion is similar. Try to de-emphasize the foot itself and put the emphasis on the problem.
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