Understanding Flat Feet and Pain: A Physical Therapist’s Perspective
As a physical therapist in Durham, NC, I see a lot of people for foot pain and foot related injuries. Once of the most common things I hear people say is “I know I have flat feet and this is probably why I have pain”.
I have to disagree. Usually, I’ll ask if they have had flat feet their whole life and follow that up by asking if they have had foot pain their whole life. Typically, the first answer is “yes” while the second is “no”.
Flat feet by themselves are not inherently good OR bad. It’s just how you were made! However, we do need our feet to flexible, yet also stable and when we are missing one of these components it can lead to pain or injury.
In this blog we’ll cover the anatomy of the feet, the functions of our feet and toes and exercises and stretches you can try if you’re having foot pain.
Anatomy of the foot
The foot is compromised of 28 bones and 29 muscles as well as ligaments which hold the bones together and allow for our foot to move. The shape of our bones in addition to muscles and ligaments help to form the arch of our foot. These include the plantar fascia, which is a thick band of tissue running along the bottom of the foot which helps to support the arch. Additional muscles such as our posterior tibialis, fibularis muscles and intrinsic foot muscles (the muscles that are only in the foot and do not cross the ankle joint) help to support the arch of our foot.
All of these muscles and ligaments help to keep our foot stable to aid in balance, but also allow necessary movement of our foot to allow us to walk, run and jump! This is important because without the combination of mobility AND stability we can run into trouble.
Functions of the Toes
Our toes do more than just look like short, stubby, fingers, they actually help us navigate the ground and aid in balance. Our big toe specifically is very important in balance and helping us to grip the ground and push off with ease during walking and running. When it comes to foot pain, an integral part of physical therapy is looking at the flexibility and strength of the big toe!
A Functional Foot
This brings me to what I call the “Functional Foot”. A foot that is strong, yet also mobile is the ultimate goal. Someone can have a flat foot, yet their foot can still be providing them with enough stability. The opposite is true too, that someone can have a high arch but their foot is still flexible enough to provide them with the necessary motion needed for walking and running.
This is why just simply having “flat feet” isn’t a reason in itself to cause pain. However if you have flat feet and are looking for a way to make your foot more functional you can try the exercises and stretches in this blog.
Causes of Foot Pain
If the shape of our foot doesn’t directly cause our pain then what does? One of the most common things I see as a physical therapist is that people with foot pain are typically overusing some part of their foot due to a compensation pattern. For example, someone with very flexible feet but tight hips may be compensating by over stretching the bottom of their foot to make up for tightness at their hip joint during running. This repetitive over-stretching of the tissue and muscles in the foot leads them to become weakened and painful. In this case, strengthening the muscles in the foot while also working on mobility in the hip will be a key part of physical therapy to overcome the foot pain.
Another example of foot pain could be related to lack of flexibility at the big toe. The big toe needs about 60 degrees of extension (or bending backward) for walking and running. If we do not have adequate flexibility we will start to compensate by overusing another muscle, often times the calf muscle. This can lead to Achilles tendon Pain or plantar fasciitis. In this case, physical therapy would focus on decreased irritation to the injured tissue while also improving the flexibility of the big toe.
Physical Therapy Exercises for Foot Pain
Toe Yoga
Toe yoga is an amazing way to stretch and strengthen your feet and toes. Start with trying to alternate lifting your big toe with your 4 little toes without letting your foot roll in or out. If you need to start with holding down your toes with your fingers, that is okay!
Lacrosse Ball Massage
Rolling your foot on a lacrosse or tennis ball is an amazing way to decrease any tension or stiffness in the bottom of the foot. It can easily be done while sitting at your desk or watching TV. Start with about 2 minutes each foot.
Arch Lifts
Remember, if you have flat feet your goal isn’t to create a super high arch, rather ensure that the muscles of your feet are providing you adequate stability.
Big Toe Stretch
This stretch can be intense, so don’t sit all the way back initially if it feels like too much. Start with 60 seconds, 1-2 times per day.
If these stretches cause pain or don’t seem to be solving your problem, you may benefit from short term use of orthotics or taping. While orthotics are not always the best long term solution, they can be helpful for decreasing your pain and providing you foot a bit more support throughout the day.
Physical Therapy for Foot Pain
Physical Therapy is a great option for foot pain. Working with a physical therapist will help you identify the root cause of your issue, provide you with specific exercises for your foot and be able to perform hands on techniques to help decrease your pain. Your physical therapist can also help you modify your training and ensure you are progressing at an appropriate pace to prevent future injuries.
If you are dealing with foot pain, contact us today to get started on your custom plan!
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