Do Flat Feet Cause Heel Pain and Plantar Fasciitis?

People with flat feet often experience a variety of symptoms which affect the way they walk, the way their body feels and the way they wear out their shoes. They may not realize that what is causing their problem is the change in the anatomy of either one or both of their feet, leading to inflammation at the bottom of the feet and heel pain.

What are Flat Feet?
A normal foot forms an arch when one is standing, and this is formed by the bones which are supported by ligaments and tendons. The foot’s longitudinal arch allows the inner part of the foot to be slightly raised above the ground. People with flat feet (also called pes planus) have fallen arches, so that the gap under the foot is lost.

Anatomy of the Foot
To understand what flat feet are, it is necessary to have a little background of the functional anatomy of the foot. The foot may be divided into three main parts, namely the forefoot , the midfoot and the hindfoot. The forefoot consists of the toes (phalanges) and the thin longer (metatarsal) bones connected them. The midfoot consists of the 3 cuneiform, the cuboid, and the navicular bones, which form the medial longitudinal arches of the feet. The hindfoot consists of the talus bone which supports the leg bones and forms the ankle, and the calcaneus bone which forms the heel of the foot.

Along the different surfaces of the feet run the muscles, tendons, and ligaments which allow complex movements to maintain balance and perform activities such as running, walking, and jumping. The plantar fascia ligament which runs from the heel to the metatarsals at the bottom of the foot supports the arch.

Fallen Arches
A person normally lands his foot on the outer side of the heel when walking, and passes his weight along the inner side of his sole, then rolls the foot back to the outer side. This is the normal pronation movement of the foot. A person with fallen arches or flat feet, however, tends to walk with excessive pronation, such that his body weight flattens the medial or inner arch of the foot, straining the plantar fascia that lies beneath.

The medial longitudinal arch (MLA) plays an essential role in shock absorption and the transfer of energy during walking. Its function depends on factors like the shape of the foot, bony structure and stability of its ligaments. Previous studies have shown that the MLA may be evaluated by measuring the navicular drop (equivalent to the drop in height of the navicular tuberosity) to assess foot pronation. These studies show that a greater navicular drop is associated with greater strain on the plantar fascia which leads to pain.

Plantar Fasciitis
With constant stretching and strain on the plantar fascia, inflammation may occur, a condition called plantar fasciitis. Repeated pulling on the insertion of the ligament on the heel or calcaneus may lead to heel pain, which is the most common effect of plantar fasciitis.

Although not all people who have flat feet experience heel pain, people who have greater navicular drop are more likely to experience more strain on the plantar fascia, leading to heel pain. On the other hand, people with a fixed arch height and do not have a significant drop in the height of their navicular bone are less likely to suffer from plantar fasciitis and heel pain.

What Causes Flat Feet?
Young children usually have flat feet because of the fatty tissues and under development of the feet. However, as they grow older, they develop longitudinal and transverse arches which enable them to do a wide range of motions and to maintain stability. On the other hand, a congenital abnormality in the arches of the feet may persist to adulthood.

In adults, a variety of factors can cause flat feet and the most common ones include trauma to the bones, stretching or tearing of tendons, rheumatoid arthritis, nerve problems, and damage or inflammation of the tendon of the lower leg (posterior tibial tendon). Other conditions that may influence development of over pronation of the feet include diabetes, obesity, pregnancy, and aging.

Symptoms of flat feet include swelling and pain in the inner side of the ankle, under the foot, the calf, the knee, the lower leg and the back. Stiffness of one or both feet may be experienced, and the individual may notice uneven wearing out of shoes.

Aside from pain, a person with flat feet may get tired easily and feel swelling and discomfort on the bottom of the feet. Other movements, such as standing on one’s toes, may also be difficult.

If the condition is associated with plantar fasciitis, heel pain and stiffness may be experienced, and this is significantly felt in the morning as one gets out of bed or after sitting for a long time. The pain gradually increases during the day and hurts more when one climbs the stairs or stands for long periods of time.

Although many people may not seek treatment for minor symptoms, a person who experiences significant pain and difficulty in moving should seek medical consultation and treatment. The condition is often diagnosed from a complete medical history and physical examination, but a doctor may also include examinations to test the strength of one’s muscles and tendons, and to evaluate anatomical defects through the use of x-rays and MRI.

Treatment of Flat Feet
The management of flat feet depends on the cause and severity of the problem. Some people do not experience any pain or discomfort any no treatment may be necessary for flat feet.

Home Remedies
In people who experience minor pain or difficulties, home remedies may be sufficient. These include resting and applying ice on the swelling to relieve pain and avoiding activities that strain the feet. Doctors may recommend the use of pain relievers such as nonsteroidal anti-inflammatory drugs which may also be available over the counter. Stretching exercises may also be done to improve muscle tone in the feet and legs.

High impact sports like basketball, tennis and soccer must be avoided since these activities may trigger more pain. Risk factors such as obesity and diabetes must be managed to improve symptoms. An increase in weight imposes pressure in the feet and can worsen one’s symptoms.

Patients may also be advised to wear proper footwear and shoe inserts to support the arches of the feet.

Other Forms of Therapy
When home remedies are not enough to relieve symptoms of flat feet one must consult a physician or foot specialist for other forms of therapy. These may include:

• The use of corrective shoe inserts or orthotics which are placed inside the shoe to fit and support the arch of the foot – This may be in the form of a wedge inserted into the inner side of the sole to help support the arch and reduce the risk for tendinitis. A doctor may also prescribe the use of a semi-rigid insert or long arch pad or an extended heel counter. One must consult a physician before buying an orthotic device because the wrong type of device selected could change the mechanics of one’s gait and cause further problems.

• Application of physical therapy – a physical therapist instructs the patient on how to perform a series of exercises to help stretch the plantar fascia and Achilles tendon to relieve plantar fasciitis, strengthen the lower leg muscles, and stabilize the ankle and heel. The therapist may also show the patient how to support the bottom of the foot by applying athletic taping.

• Injection of corticosteroids – in patients who do not respond to oral analgesics corticosteroids may be injected by a physician to reduce inflammation and relieve plantar fasciitis.

In some patients who have severe foot damage and experience significant pain and limitation in motion surgery may be recommended. Surgical procedures aim to improve the overall foot alignment and may involve cutting or reshaping a bone, removing calcium deposits or spurs from the heel, permanently fusing bones to restore stability of the foot arch or transferring tendons to repair damaged tendons. The choice of surgery may depend on the age of the patient, the structural changes needed to improve foot alignment and other factors related to the patient’s foot function.

Collapse in the arches of the feet may be caused by various factors leading to flat feet. Although some experience mild discomfort, other individuals suffer from intense pain and difficulty in moving caused by an associated plantar fasciitis which results from constant strain on the plantar fascia ligament at the bottom of the foot. Flat feet can also cause heel pain from the repeated pulling on the insertion of the ligament on the calcaneus, which is the most common effect of plantar fasciitis. Treatment depends on the cause and severity of the flat feet, which may range from home remedies to radical surgical procedures to correct anatomical deformities.

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