Arch Enemy

While most people with flat feet (25% of Americans) don't have a problem, flat feet can cause disabling foot pain as well as knee pain, shin splints, achilles tendonitits and plantar fasciitis. "A person with foot or leg pain should pay particular attention to whether one foot is flatter than the other," stated Glenn B. Pfeffer, MD, Assistant Clinical Professor of Orthopaedics at the University of California, San Francisco, speaking at the American Academy of Orthopaedic Surgeons Orthopaedics Update web conference. He emphasized that "a falling arch should cause rising concern."

It is important for people with foot pain to know if they have flat feet. The following tests can help you determine your arch type:

1. Footprint Test
   When you get out of a swimming pool, look at your footprint on the concrete. The front of the foot will be joined to the heel by a strip. If your foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake ("flat as a pancake"). With a normal arch, the strip is about half the width of the front of the foot. If you have a high arch, only a thin strip connects the front of the foot with the heel. Both footprints should be the same.
2. Shoe evaluation
   Put your shoes on a flat table and view them at eye level from behind. See if the sole is worn evenly. A flat foot will cause more wear on the inside of the sole, especially in the heel area. The shoe will easily rock side to side. A flat foot will also cause the upper part of the shoe to lean inward over the sole. Both shoes should wear about the same way.

If you have pain in one foot, you should make sure you don't have a fallen arch on that side. There are two good tests you can perform at home to detect this problem:

1. Tiptoes Test
   Place your fingertips on a wall that you are directly facing and stand on your tiptoes on one foot. If you can't do it, a fallen arch may be the culprit.
   
2. Too Many Toes Sign
   Stand with your feet parallel. Have someone stand in back of you and look at your feet from behind. You can also do it yourself if you stand with your back to a mirror. Normally only the pinky toe is visible from behind. If one foot is flatter than the other, the 4th and sometimes the 3rd toe on that foot can also be seen.

If you have flat feet and foot pain, especially if one foot is flatter than the other, you should have an evaluation by an orthopaedic surgeon. You may have a problem with the posterior tibial tendon, the main tendon that supports the arch. Factors that can contribute to this problem are obesity, diabetes, high blood pressure, certain types of arthritis and athletic overuse.

In some cases a shoe insert/orthotic can be used to alleviate the symptoms of flat feet. However, Dr. Pfeffer strongly advises that you first see an orthopaedic surgeon in order to make sure the source of the foot pain is not serious.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.