Pes Planus: The Truth About Flat Feet and Orthotics | Precision Movement

Pes Planus: The Truth About Flat Feet and Orthotics

Why Orthotics Are NOT the Answer to a Collapsed Arch

By Eric Wong

Think orthotics is the only option for flat feet? Or are you already using them to find your pes planus isn’t improving? To effectively address foot pain, you’ve got to go beyond this band-aid solution.

It’s possible to ease the pain of a collapsed arch, but it requires more than a simple prop in your shoe – something a lot of folks, including my brother, have learned after a lot of time and wasted cash.

My older brother Ty has pes planus, which is the proper medical term for flat feet aka a collapsed arch.

I remember making foot prints on the dock at the cottage after swimming and then looking at Ty’s and seeing how much wider and flatter his print was and thinking he had monster feet!

 

But it was no laughing matter because it affected his physical abilities including not being able to ice skate for more than 5-10 minutes before suffering from intense foot pain that forces him to stop, or vicious shin splints from jogging.

When he was growing up he was shuttled to all manner of doctors and specialists but other than prescriptions for $300 orthotics, he’s gotten no other helpful advice or suggestions.

Here’s the thing – once you understand the anatomy and biomechanics of the foot, it’s clear why orthotics are nothing more than a band-aid solution that may or may not even help!

The Foot – A Complex Structure

Your feet are incredibly complex structures, and they’ve got to be. They provide the support and basis for nearly all of your movement and balance. To examine the anatomy of these complicated support systems, let’s start with the bones, and start at the rear of the foot.

Bones of the Foot

The seven bones at the back of your foot are called the tarsals. These tarsals include the biggest bone in your foot – the calcaneus, or heel bone. On top of that sits the talus bone of your ankle. Just in front of these two bones are 5 more irregularly shaped tarsal bones [1].

In front of the tarsals are your metatarsals – 5 long bones that extend outward toward your toes and make up the middle region of your foot.

Finally, there are the phalanges, or toe bones. Most of your toes have three small phalange bones, but the big toe is only made up of two.

Muscles of the Foot

Connecting to these bones are 2 different types of foot muscles – extrinsic and intrinsic.

Extrinsic muscles start in your lower leg and work to move your foot, while intrinsic muscles are located entirely within your foot.

Extrinsic muscles help with more of the big picture movements, like dorsiflexion or plantarflexion of your entire foot (pointing your toes up and down) while intrinsic muscles control finer movements, like wiggling individual toes [2].

You can think of these intrinsic muscles as the segmental stabilizer muscles of your feet. Just like the core muscles in your torso, they play a big role in stabilization. And if these muscles are weak, you could be setting yourself up for injury [3].

Along the sole of your foot there are 10 intrinsic muscles that help perform fine movements and help stabilize your arch.

To explore the other muscles of your foot, we can divide the foot into 4 different muscle layers, starting on top of your foot.

This first layer of muscles in your foot contains three superficial muscles, the abductor hallucis, the flexor digitorum brevis, and the abductor digiti minimi. These muscles work mostly to flex your toes.

The next layer lies underneath and includes the quadratus plantae and the lumbricals, and again are mainly involved in flexing movements.

The third layer has 3 muscles, 2 of which move your big toe (the flexor hallucis brevis and the adductor hallucis) and one of which moves your little toe (the flexor digiti minimi brevis).

The fourth, or deepest layer, is made up of the plantar interossei and dorsal interossei muscles, which work to adduct and abduct individual toes.

Functions of the Arch

The bones of your foot, along with overlying tendons and ligaments, make up the arch of your foot.

In fact, you can actually think of your foot has having 4 arches – the arch everyone knows that runs along the inside of your foot called the medial longitudinal arch, a smaller arch running on the lateral side of your foot called the lateral longitudinal arch, and two transverse arches that run from one side of your foot to the other – anterior and posterior [4].

per planus the functions of the arch

The arches act like a spring, absorbing energy and shock from your body’s weight and then returning that absorbed energy to movements like running and jumping and even ascending stairs [5].

The use of elastic energy conserves energy making your movements more efficient since you don’t need to generate as much energy metabolically.

Your feet and arches also provide you with proprioception and balance.

Proprioception is your innate sense of where your body is in space. This sense can be seen in your ability to sail over rocks and branches while on a trail run without thinking about precisely when you need to jump, or exactly how high, or with how much force.

Your body communicates this information via proprioceptors – specialized sensors in your nervous system. And proprioceptors are found in huge numbers in your feet and ankles.

In fact, the region of your body with the highest density of proprioceptors is the joint capsule of your ankle [6].

What does this mean for balance? Consider one type of proprioceptor – muscle spindles.

Muscle spindles cause your muscles to contract reflexively when they are stretched beyond a normal range.

When you step on your kid’s toy car and your ankle starts to roll, stretching beyond it’s normal range, your muscle spindles fire and your surrounding muscles contract quickly. While you might still walk away with some pain and strain, these proprioceptive reflexes probably kept you on your feet and protected you from an ankle sprain or worse – a broken ankle [7].

Your feet flex and move with great fluidity, balance, and proprioceptive information as you bound over the earth when running, scramble over rocks on a climb, balance on one leg in a yoga class, or shuffle around in an exercise class, all while providing the springboard for your balance as you stay upright.

The Root Causes of Flat Feet

So how do your arches go from these bounding springs to the collapsed and painful arches of pes planus?

There are several common root causes.

For one, poor footwear is a HUGE contributor to flat feet. We’ll talk more later about what kind of shoes you should be looking for and why, but for now just consider how often your feet are crowded into shoes.

per-planus-shoes-correct-footwear

This cramped state can leave the muscles of your feet unable to move and function properly – meaning they will weaken and fail to perform their duties, like holding up your arches properly, for example.

Atrophy of the muscles of your feet can happen for other reasons, including a simple lack of use. It really is “use it or lose it” when it comes to these small muscles in your feet, and the sad truth is that many of us don’t spend a lot of time considering the strength of this set of “core” muscles.

And when these muscles aren’t sufficiently exercised and begin to atrophy, the joints of your feet can stiffen, further making certain movements difficult. It’s a vicious and easily missed cycle until one day you notice you have very little control over the muscles of your feet.

Why Orthotics Don’t Fix Collapsed Arches

Orthotics can easily seem like a common-sense approach. Your arch is lacking support, you’ve been told it has “collapsed” even! So obviously, prop it up, give it some support, and you’ll fix it, right?

Wrong.

While orthotics might help you temporarily mask symptoms, these tools will NOT provide you a long-term solution and they definitely will not “fix” your flat feet.

Because the root causes of collapsed arches – the ill-fitting shoes, the atrophied muscles, the stiff joints -are never addressed with orthotics, the problem never goes away.

This first step to fixing your flat feet is to understand and treat the underlying causes.

Steps to Rehab Pes Planus

Choose The Right Shoes

First things first when it comes to addressing pes planus is to consider your footwear. If you don’t wear good shoes that fit well, your feet will never get a chance to work and your muscles will never build strength.

So you’ve got to pick shoes that allow your foot to move naturally and allow those small, intrinsic muscles to flex a bit.

This means looking for shoes with a wide toe box and a flexible sole. Your foot should be able to move around slightly and adapt to the environments and surfaces it encounters – that is what it is there for, after all!

And if you’re at a desk all day kick those suckers off and let your feet breathe! Just make sure your feet don’t stink otherwise your feet will be the only ones breathing in the office.

Try Barefooting

Like I mentioned above, it’s wise to give your feet space by kicking your shoes off and even better is to move around barefoot.

When you do, your intrinsic foot muscles will have a chance to work and that collapsed arch can begin to repair itself.

Try barefoot walking in an open grassy field or soccer field (or better yet at the beach)  – the soft earth cushions the impact so as not to not flare up problems like plantar fasciitis but mobilizes all the little joints in the foot and allows the muscles to work.

This simple activity is a powerful exercise for your feet.

per planus exercises walking barefoot

If you want to try barefoot running, be sure to ramp up very slowly as your foot and ankle muscles probably haven’t been worked much for years, so too much too soon can easily lead to overuse injuries like excessive muscle soreness and stress fractures.

Specific Foot Strengthening Exercises

There are many great exercises to strengthen both the extrinsic and intrinsic muscles of the foot.

The most popular is curling up a towel with your toes, however, it doesn’t really focus on the most neglected muscles as flexing the big toe is a movement most still are able to execute.

Instead, you have to look to exercises that restore independent motor control of the other toes and arch muscles.

For example, one exercise I like I call “1 up 4 down” and “1 down 4 up”.

per planus exercises

With your feet flat on the ground, try to keep your 4 lateral toes steady as you extend only the big toe and hold for 10 seconds. It’s easier when you focus on one foot at a time.

Conversely, press the big toe into the ground and lift the lateral 4 toes and again hold for 10 seconds. Repeat 3 times on each foot.

These movements may prove difficult at first – a sign that these muscles are neglected.

If you need to, use your hand to help hold your lateral toes down gently as you lift your big toe up and vice versa.

With practice, you’ll build strength in your foot muscles and be able to rely less and less on assistance and you’ll regain control of your toes.

Another good technique is something that’s often referred to as the “short foot exercise”, but which I call Metatarsal Pressure, because ideally you want to keep the toes elongated and don’t want to actively try to shorten the foot too much.

To perform this one, simply stand up and try to press down through all 5 metatarsals (the bones that are referred to as the ball of the foot for each toe) into the ground and maintain the pressure for 10 seconds, repeating 3-6 times.

This will help you activate the muscles that form the medial arch and may slightly shorten the foot.

Give these approaches a try if flat feet are causing you trouble and the more frequent you do them (multiple times a day) the better.

However, if you do suffer from pes planus, or plantar fasciitis, unstable ankles or any other problem of the feet/ankles, to get a lasting solution you have to look at the whole system – how the feet/ankles function as well as the knees, hips and every joint above because a problem in one area of your body can lead to issues at another because everything is connected.

However, for most people these targeted exercises and strategies that restore proper motor control and function are a piece of the puzzle are a necessary aspect of effectively treating pes planus that orthotics don’t provide.

Orthotics give you support, but that support isn’t doing anything to improve function of your feet. As such, they won’t bring you long-term relief.

So instead of dropping a ton of dough on expensive orthotics, consider investing in some good shoes and make sure to spend time OUT of those shoes while also incorporating exercises aimed at improving the strength and control of all the little muscles in your feet.

About the Author

Eric is the founder of PrecisionMovement.coach and has a degree in Kinesiology from the University of Waterloo. He’s been a coach since 2005 and spent many years focused on training combat athletes including multiple UFC fighters and professional boxers and now dedicates his energy to helping people eliminate pain and flexibility and movement restrictions. He lives in Toronto with his wife and daughter and he drinks black coffee and bitter IPAs.

Click here to learn more about Eric.

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