Q: What exactly are flat feet and fallen arches? What causes them, and how should they be treated?
A: Flat feet and fallen arches refer to the same thing. It's a downward sagging of the inside edge of the foot during standing or walking.
The front-to-back arches (called the longitudinal arches) are natural curves along the bottoms of both feet that are supported by muscles and ligaments. When these muscles and ligaments give way, the arches sag with each step. When the arches sag, your weight is shifted toward your big toes.
This can create some sore spots. Sagging arches also change the angle of each heel bone. When this happens, the heel tendons (Achilles tendons) and the muscles in your legs and back can become tight due to a lack of natural stretching. Symptoms from fallen arches can include pain, especially in the heels, sore calf muscles and lower back or leg muscle fatigue after walking short distances.
Because the toes spread out more widely with each step when the arches are lost, it's also common for fallen arches to lead to painful red corns on the toes.
When fallen arches cause symptoms, stretches of the heel tendons are the most important part of treatment. Stretching can be continued at night. You wear a brace or splint (a plantar fasciitis splint) around your ankle. Supportive footwear (with good cushion and good arch support) can redirect where your feet carry your weight.
Many people with true fallen arches will notice that the heels of their shoes wear down over time on the sides of the big toes, instead of wearing down first on the outer edges of the heels. Wedge-shaped shoe inserts that lift the heel (Thomas heels) or a plantar fasciitis strap that lifts your arch can be helpful. Sometimes, arch supports (a firm cushion or molded plastic that props up the arch) can be added to your shoes as well. Any time an arch support is tried, it should be used for both feet at the same time. This helps avoid creating new balance problems.
Don't jump to conclusions that your arches are the cause of foot symptoms, however. Although most people develop a front-to-back arch in their feet during infancy, flat arches can be normal in some people. Your doctor or a podiatrist can be helpful in deciding whether your arches are the source of symptoms.
Dr. Mary Pickett is an associate professor of medicine at Oregon Health and Science University, where she is a primary care doctor. She is a lecturer for Harvard Medical School and a senior medical editor for Harvard Health Publications.Copyright © 2015, The Baltimore Sun