Targeting Flat Feet:
Understanding Flat Feet
There are numerous websites claiming to “Fix Flat Feet” through exercise, and yet we still see patients coming in with pain due to over-pronation/flat feet, especially when participating in running/jumping sports, especially long events where fatigue sets in (running sports, etc).
Ever wondered why some over-weight “couch potatoes” have “normal” arches even though they rarely or don’t exercise and their feet are incredibly weak? And some strong athletes who run marathons and Ironman events have low arches/ flat feet and have had flat feet since childhood?
It’s basically GENETICS, or more specifically:
It’s sometimes called DOUBLE-JOINTED, the real name for it is HYPERMOBILITY (too much joint range) DUE TO LIGAMENT LAXITY (genetically stretchy ligaments)
A sports physician I worked with half-jokingly called it “Choosing the wrong parents”. Parents will understand: “You get what you get and you don’t get upset”.
Hypermobility is more common in females than males due to oestrogen (and can even be more severe at certain times of the month due to oestrogen spikes), and is more common in some racial groups. In both cases it is the trend, not the rule. It comes in varying degrees of severity and is EXTREMELY common.
Less extreme ligament laxity can be an advantage for martial arts, yoga, gymnastics and circus performers, but presents different requirements for running and jumping sports where tighter ligaments are an advantage.
We also see patients (many of them elite athletes) with one over-pronating foot secondary to a trauma such as a bad ankle sprain, and one “normal” foot that hasn’t been injured. These patients often have sufficient foot muscle strength, but an insufficient ligament/fascia support structure. And regardless of exercises to strengthen foot muscles, an injured foot typically pronates more and the longer the exercise, the more those muscles will fatigue because these muscles/tendons are working harder than the non-injured foot with TIGHTER ligaments.
We focus on foot strength, joint range (especially ankle/calf) and proprioceptive training with our patients, but:
STRENGTHENING YOUR MUSCLES WILL ASSIST BUT IT IS UNLIKELY TO REPLACE YOUR STRETCHY LIGAMENTS
I’ve seen plenty of websites showing before and after pictures where feet have been photographed STANDING STILL with arches. Almost everyone can do this. Then add several kilometres/miles of running and film the person running when fatigued. Basically, a hypermobile runner will logically fatigue faster than a runner with tighter ligaments.
Have you noticed how almost nobody bought a second pair of minimalist shoes……They’re actually hard to find these days at stores. For a while there they were an excellent generator of new patients for podiatrists and physios.
Answer: In our clinical view, they are helpful for working your foot muscles and are great for low-impact gym workouts, but if you run in them, YOU MAY FATIGUE FASTER, INCREASE SHOCK TO YOUR BODY and BE MORE PRONE TO OVERUSE INJURY. Especially if you are hypermobile. I wear some casually at times, but running in them can increase injury risk.
Have a look at how many ultra-runners are now wearing maximalist (super thick soled) running shoes (e.g: Hoka One One, Nike Vapor Fly). https://runningmagazine.ca/nikes-sub-two-hour-marathon-shoe-doesnt-look-way-think/
So back to hypermobility:
Basically, Fatigue > Efficiency. So even if your muscles are stronger, and your technique is good, if your ligaments are stretchy your muscles will fatigue faster than a runner who isn’t hypermobile.
So, if you’re double-jointed, yes, exercise and strengthen your feet, but if you want to manage the risk of an overuse muscle, tendon or joint injury, you’ll probably benefit from orthotics to give your feet some temporary “functional support.”
