Flat Feet Are Normal Until You Hit Four, Then It’s A Problem

When we talk about posture, we often refer to the spine, e.g. is it straight or hunched?

But do you know that your feet have “postures” too?

Just like a poor body posture can have an impact on the feet, poor feet posture can also lead to bad body posture, which then results in pain in the feet and other musculoskeletal issues.

Your feet are the foundation supporting the rest of the body, and when they are misaligned, traumatised or injured, they can affect other body parts, with the usual “victims” being the knee, hip or back.

Our foot has 26 bones, 33 joints and more than 100 muscles, tendons and ligaments – that’s a lot of parts that have to work in sync to enable us to take a step.

Feet that are flat (no arch), pronated (rolled inwards due to a collapsed arch) or supinated (rolled outwards, i.e. more weight on the outer edge of the feet) can affect the joints above them.

And if you are compensating for a sore hip or aching back, this will displace your weight and over-stress your feet.

If you carry excess weight, these forces are multiplied.

According to orthotist and prosthetist Datuk Dr Edmund Lee, flat feet is one of the most common foot problems, especially among Malaysian children.

“Our children are walking less barefooted these days, so their foot muscles are a lot weaker and the chances of their feet pronating are higher.

“Once the feet start to pronate, you cannot delay treatment. Get them evaluated,” he advises.

All babies are born with flat feet and this continues until we are around four years old.

This is due to the pad of fat in the arch area that is present at birth, which will diminish as the baby starts walking and putting weight on their feet.

Therefore, the arch doesn’t start developing until age two or three.

But if flat feet run in your family, e.g. due to a bone abnormality or a tight Achilles tendon, then your child’s arch might never fully appear.

“If you walk into any shoe store, non-qualified sales persons will just tell you to get orthotics or inserts for this age group, but we orthotists don’t believe that this is the proper solution.

“Our concern is that once the child continues with the flat foot position after the age of four, the whole foot may start pronating and developing calluses.

“We advise parents to take action then.

“They might see an orthopaedic surgeon or paediatrician who will say the problem will straighten itself out, but this isn’t necessarily true.

“When the arch continues to fall and they wear improper shoes, this will lead to more problems,” explains Dr Lee.

So, for children above four years with flat feet, he recommends they go through a flat foot correction programme and wear custom-made orthotics for two to three years.

Orthotics help cushion and support the arch so that weight is distributed more evenly while walking, running and jumping.

And when the arch is able to do its job in absorbing impact effectively, there will be less aches and strain to the hips, back and legs.

Flat feet, orthotics, foot problem, Star2.com

A patient (right) has a 3D image of her feet taken as Dr Lee explains what her problem is.

Insoles versus orthotics

To save cost, most of us prefer purchasing a ready-made insole or insert made of gel, plastic or foam from the pharmacy or shoe shop.

Yes, these can provide arch support or extra cushioning on the heel, around the toes or for your entire foot.

Insoles might make your shoes more comfortable, but they aren’t designed to correct foot problems.

Orthotics are devices that you wear inside your shoes to correct biomechanical foot issues.

They address this by spreading the pressure evenly around your feet and making sure that they hit the ground at the right angle.

This is why it is so important that these are custom-made.

“These ready-made insoles do not support the forefoot, while prescription orthotics takes into consideration the whole foot.

“Cushioning just offloads the positioning, but the pain can still come back.

“We take 3D images of the whole foot, examine it, and then customise a foot orthotic,” says the third generation orthotist.

So what is the best type of footwear for children?

Dr Lee says, “I don’t advise parents to allow their kids to wear shoes, flip flops or slippers without support.

“It’s okay for a short duration, but when long walks are involved, there is a tendency to pronate the foot.

“Once we do the corrective position with the orthotics, it leaves a long-lasting effect and creates healthy feet.”

While flat feet are common among children, adults often complain of heel pain.

“A lot of ladies wear improper, ill-fitting shoes or high heels, and don’t do calf-stretching exercises, so their Achilles tendon shortens.

“For men, it is often pain around the arch area.

“For youngsters, they chase after fashion and ignore foot health.

“Patients complain that my orthotics are very hard because of the density and how they affect your weight distribution.

“But once you correct the imbalance and put your feet in the right position, the inflammation is reduced and pain goes away,” he points out.

Walking wrong

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Dr Lee checks a patient’s foot posture on a gel insert. — Photos: SIA HONG KIAU/The Star

Poor foot biomechanics or an uneven gait can easily lead to knee or back pain, because of what your feet are doing – or not doing – when you walk, run or stand for long periods.

Most people tend to walk with a heel-first gait (caused and exacerbated by bad posture), which means your feet absorb greater impact and aren’t able to propel the body forward as effectively.

You’ll have to work extra hard to walk the same distance, which puts additional strain on the fascia and heels.

Proper stretching and adequate support for the feet and heels help ensure that your weight falls first on the balls of your feet as you walk, instead of your heel.

Imagine yourself doing small jumps. You’re not landing on your heels, are you?

Use the same principle when walking. Like ballet dancers, you should land on the toes, followed the balls of the feet, then heels.

Going barefoot

Walking sans footwear a few hours a day is good, says Dr Lee.

If you recall, a decade ago, there was a huge wave of support among runners for minimalist footwear.

These barefoot running products strip away the extra cushioning to free the toes from the confines of traditional shoes, allowing your feet to move more naturally.

The concept is believed to develop all your foot’s micro-muscles, while enhancing dexterity and your sense of balance.

“The person who started this barefoot technology is not from this region.

“We must remember that their roads are better than ours, but this technology also causes a lot of stress fractures in the metatarsal, inflammation of the heel, etc.

“There is still no solid research suggesting it’s a good product.

“Going barefoot is good to strengthen your joints, but again, it depends on the ground and what sort of activity you’re doing,” he says.

Flat feet, orthotics, foot problem, high arch, Star2.com

The three basic types of feet are seen in this filepic: (from top) high arch, normal and flat. foot.

Dr Lee dismisses the notion of ideal footwear.

“There is no such thing! When you choose a slipper or shoe, it should give you solid heel counter support, ample width and space for your toes to move.

“The shoe is important, but orthotics (if necessary) is more important.

“Just like a spectacle frame and lenses – the frame is important to hold up the lenses, but the lenses are more important for your vision!”

Dr Lee opines that generally, six out of 10 Malaysians suffer from foot problems, including bunions and hammer toes (a toe that is bent permanently downwards, typically as a result of pressure from footwear).

“We’re still very backwards in correcting these as we have a high tolerance for pain! We seek treatment for the pain, but do not address the root cause.

“We need to work together with all healthcare professionals for the benefit of the patients.

“The problem now is that everyone has their own theories (as to resolving the pain).

“Our job, for children below 14, is to try correcting 75% to 85% of flat foot problems, depending on their foot structure.

“For adults, we try to support, realign and give comfort – we cannot correct,” he says.

Hence, education is important.

Dr Lee cites many cases of parents blaming their child for not walking properly.

“I try to explain that it’s not the child’s fault and that his feet are severely pronated.

“Due to the lack of awareness, there are a lot of sad feet stories out there.

“Sometime this year, we want to launch a foundation to help those who cannot afford to get orthotics.”

For knee problems, orthotics is not a magical fix, but it definitely helps with misalignment problems.

“I’m not saying that by wearing orthotics, you won’t have to go for knee replacement, but you can reduce the pain and slow down the degeneration, even after surgery.

“Orthotics will work for mild to moderate cases, but for severe cases, you have to go for knee bracing.

“I’ve seen a lot of ‘miracle’ cases where after wearing orthotics, the patient is able to walk painlessly.

“We advise patients to come back for realignment every six months to readjust the orthotics,” he says.

Flat feet, orthotics, foot problem, Star2.com

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