What are Flat Feet?

Flat feet is a condition in which the arch is either fallen, underdeveloped, or absent from birth. Without the support provided by the arch, a person’s foot mechanics is altered, leading to overpronation (the ankles rolling inward). As a result of this imbalance, additional strain is put on other parts of the foot, causing pain and discomfort.

Symptoms of Flat Feet

Generally, flat feet can exhibit the following symptoms:

• Pain and Discomfort – A common symptom is pain or discomfort. especially around the arch, heel, and ankle. This type of pain is worsened by increased foot activity. You can also feel pain in the shin, known as shin splints, because of the altered mechanics. This pain can be transferred up to the knees, back, and hips as a result of the compensatory movements of these other parts in response to the posture and gait change caused by overpronation or supination.

• Changes in Foot Mechanics - The lack of arch supports causes the foot to roll inward excessively, resulting in misalignment and imbalance.

• Swelling - Because the tendons are constantly being put under strain, there may be some swelling around the arch area or inside of the ankle.

• Fatigue and Stiffness - After activities, you may experience increased tiredness or aches. You may also experience reduced flexibility as a result of stiffness in the feet and ankles.

Aside from these symptoms, flat feet can also cause or worsen other foot conditions like hammer toes or Bunions, Achilles tendonitis, and plantar fasciitis.

What is Plantar Fasciitis?

This is a condition in which the plantar fascia is inflamed or irritated, leading to pain in the heel of the foot. This inflammation or irritation occurs as a result of overuse, stress, or strain on the plantar fascia. This results in micro tears developing, which then leads to stiffness and pain.

The Plantar Fascia

As shown in the image above, the plantar fascia, which is also known as the plantar aponeurosis, is a thick band of tissue that connects the sole of the foot to the toes. This tough but slightly elastic band of tissue has three parts - the medial band that supports the inner arch, the central band, which is the main supportive band, and the lateral band, running along the outer part of the sole.

Causes of Plantar Fasciitis

Plantar fasciitis (inflammation or irritation of the plantar fascia) can be caused by a number of factors. Some of the most common factors are listed below.

• Biomechanics and Foot Conditions - Conditions such as flat feet, keep the plantar fascia constantly stretched, while high arches keep it tight, such that its flexibility is impeded. In addition to this, the change in gait that results from overpronation and other imbalances and misalignments, further increases the stress on the fascia and can easily lead to plantar fasciitis.

• Repetitive Stress and Overuse - Individuals who engage in high-impact activities like running, dancing, basketball, and the like, constantly expose the fascia to repetitive stress. The same applies to teachers, retail workers, the military, cops, nurses, and other such professions where you are required to stay on your feet for prolonged hours.

• Tight Muscles and Reduced Flexibility - A tight Achilles tendon will increase the stress on the arch and heels, while tight calf muscles reduce the flexibility of the ankles, and this increases tension on the fascia.

• Improper Footwear - Wearing shoes with high heels shortens the calf muscles, and this will increase strain to the fascia when you switch to flat shoes. Shoes without proper arch support will also increase strain on the arch, and by extension, the plantar fascia.

• Obesity - Excess body weight increases the burden on the plantar fascia as it has to manage the weight distribution. This can also apply during pregnancy, when you begin to put on weight.

• Aging - As we begin to age, the plantar fascia begins to lose its elasticity and ability to absorb shock. This makes it easy for micro tears that lead to inflammation to occur.

Aside from all the factors listed above, plantar fasciitis can also be caused by pre-existing conditions like arthritis or previous injuries.

Symptoms of Plantar Fasciitis

Certain symptoms are commonly linked to plantar fasciitis. These include the following:

• Heel Pain - This is the main symptom often linked to plantar fasciitis. This pain, which is often described as burning, stabbing, or sharp, is mostly felt toward the inside of the bottom of the heel. The pain can also radiate towards the arch area of the foot.

• Pain Felt with the First Steps in the Morning - This is another classic symptom associated with plantar fasciitis. During rest, the plantar fascia tightens, or contracts. This shortens its length. When you step down from your bed to take those first steps, the fascia is suddenly stretched, resulting in multiple micro-tears being pulled open. This is what causes the sharp pain. As the fascia becomes more flexible with continued activity, the pain will begin to subside. This is applicable every time the foot is allowed to rest for a prolonged period and not just early in the morning.

• Increased Pain After (Not During) Activity - This is another unique symptom that occurs for reasons similar to what causes the early morning pain. While with some other foot conditions, pain will be felt during activities, for plantar fasciitis, the pain worsens after the activity is over. 

• Tightness and Stiffness - You may feel some stiffness around the heel and arch after standing for extended periods or in the mornings. For some people, they may feel some tightness extending towards the calf muscles and Achilles tendon.

If the condition is left untreated for a while, you may begin to experience chronic symptoms. These will include a dull ache that persists all day, pain spreading to the mid and forefoot, and hip, back, and knee pain caused by a change in gait resulting from avoiding heel strike.

Flat Feet Vs Plantar Fasciitis

Up till this point, we’ve looked at flat feet and plantar fasciitis as two distinct conditions. Now, let’s look at these two foot conditions in relation to each other.

Key Differences between Flat Feet and Plantar Fasciitis

Some of the key differences between flat feet and plantar fasciitis include the following:

Nature

Fundamentally, flat feet is a functional or structural foot condition because it has to do with the collapse or inadequacy of the arch, which is a structure of the foot. Plantar fasciitis, on the other hand, is an inflammatory condition because it is the result of degeneration and micro-tears in the fascia that lead to inflammation, causing pain and discomfort.

Causative Factors

This is another point of difference. While a person can be born with flat feet as parents with flat feet pass it to their children, or for other congenital reasons, plantar fasciitis can only occur after a person has been active and met some of the criteria already discussed above.

Effect on Foot Structure

With flat feet, being a structural condition, the foot's structure is affected. When load bearing, the sole of the feet will entirely, or almost entirely, make contact with the floor. This will give the foot a flat look as shown in the image below. The heel may also tilt outward as a result of overpronation.

This is different for plantar fasciitis as it does not impact the structure of the foot directly. There will, therefore, not be any outside sign of the condition.

Pain Location

When flat feet results in pain, the pain is usually generalized. However, it may be felt more around the inner ankle, arch, and midfoot. The pain may also reach the lower back, hips, and knees as a result of the imbalance in gait and movement.

For plantar fasciitis, the pain is largely in the heel. Though tit can extend to the arch, the main pain area is the heel.

Nature of Pain

Pain from flat feet often gets worse during activities like running, hiking, or standing for long hours. However, pain from plantar fasciitis is felt more severely with the first steps in the morning or after periods of prolonged rest. It will also increase after, rather than during, activities.

Pain from plantar fasciitis is also unique in its nature. It can be stabbing, burning, and sharp: almost like you are walking on pins.

Progression

Being structural, flat feet will stay flat unless it is corrected through the use of orthotics, muscle strengthening exercises, or surgery (in severe cases). On the other hand, plantar fasciitis can be resolved within a few weeks to a few months with orthotic insoles, therapy, rest, or lifestyle changes.

Diagnosis

Diagnosing flat feet is quite easy. This can be done visually or with a wet footprint test (explained below). Imaging (x-rays) may, however, be required in cases where tendon damage is suspected.

For plantar fasciitis, clinical examination may be required to be completely sure. If the diagnosis is still not clear or if pain continues after conservative intervention, then scans like ultrasound or MRI may be required to confirm the condition.

Treatment

Flat feet is often managed with the use of supportive shoes and orthotic insoles like these Custom Orthotics for Flat Feet from Stride Soles. However, treating flat feet, in terms of restoring the natural arch, will not be achieved with these supportive devices.

In certain cases, it may be possible to restore the arch with foot and ankle muscle strengthening exercises. In extremely severe cases, surgery may be the solution. Generally, most patients get by with the use of orthotic insoles and some physical therapy.

Treating plantar fasciitis is a more straightforward affair. Depending on the severity, resting the foot and doing simple stretching and strengthening exercises for the plantar fascia and calf may be sufficient to treat the fascia. There may, however, be the need to support this with corticosteroid injections, shockwave therapy, or, on very rare occassions, surgery.

The Connections between Flat Feet and Plantar Fasciitis

How is flat feet and plantar fasciitis connected? Flat feet and plantar fasciitis may be different foot conditions, but they have a strong biomechanical connection. Having flat feet increases the risk of plantar fasciitis developing, and here's how.

Arch Support

Flat feet means that the arch is underdeveloped, absent, or fallen. Whichever the case may be, the plantar fascia, which supports the arch, comes under increased strain as it now has to bear the weight alone, acting as the primary support structure rather than a support for the arch.

This continuous stretching leads to fatigue, irritation, micro-tears, inflammation, and pain in the plantar fascia. When this continues, it will result in plantar fasciitis.

Overpronation

Because of the lack of arch support resulting from flat feet, the foot is likely to roll inward excessively during movement. This is known as overpronation, and it causes the weight of the body to shift unevenly. This uneven shift increases tension on the fascia (around the inner heel and arch). If the foot continues to overpronate, causing the uneven shift, it will eventually lead to plantar fasciitis.

Shock Absorption

As the natural shock absorber of the body, the absence of the arch exposes the plantar fascia to more impact shock during movement. This repeated exposure to impact will lead to plantar fasciitis. This is especially true for people engaged in high-impact activities or those who have to spend long hours on their feet.

Tightness in Support Structures

When the arch is fallen, as is the case in flat feet, supporting structures like the calf muscles and Achilles tendon are compelled to compensate for this lack of arch support. The attempt by these supporting structures to compensate for the missing arch support leads to tightness. With the Achilles tendon anatomically connected to the plantar fascia, its continued tightness will increase tension on the plantar fascia, and this can eventually lead to plantar fasciitis or worsen it if it’s already developed.

Shared Risk Factors

While flat feet generally increases the risk of plantar fasciitis occurring, there are risk factors that increase the risk of both conditions occurring. They include:

• Obesity - Excess weight puts pressure on both the arch and the plantar fascia. If this is not managed, the arch can collapse, leading to more strain being put on the plantar fascia.

• Aging - As a direct consequence of the natural process of aging, the plantar fascia and other foot muscles that support the arch can get weakened, leading to a collapse of the arch. With the arch collapsed, an already weakened plantar fascia will easily succumb to the strain, resulting in plantar fasciitis more quickly.

• Medical Conditions - Conditions like diabetes, connective tissue disorders, or arthritis can weaken the structures of the foot, increasing the risk of arch collapse and the plantar fascia getting stretched excessively.

Combined Impact

The symptoms of plantar fasciitis will often be felt more severely by people with flat feet. This is because of the repetitive stress being put on the plantar fascia. On the other hand, the symptoms of flat feet can get more pronounced with plantar fasciitis. This is because the inflammation of the fascia makes it difficult for the foot to easily compensate for the missing arch support.

Diagnosis

There are different ways to go about diagnosing either flat feet or plantar fasciitis.

Self-Diagnosis

Should you desire to self-diagnose, follow the steps listed below for each condition.

Self-Diagnosing Flat Feet

One of the most effective ways to self-diagnose flat feet is through a wet footprint test. For this test, you will need a container of water, large enough for you to place your foot in, and a sheet of brown paper.

Step 1. Place your foot into the bowl of water

Step 2. Place your wet foot on the brown sheet of paper to make an imprint

Step 3. Compare your imprint with the chart shown below.

You can confirm that you have flat feet if the sole of your foot (or most of it) leaves a full imprint as shown above for flat feet.

Self-Diagnosing Plantar Fasciitis

Self-assessing for plantar fasciitis is less straightforward because you will need to observe certain factors like:

• Pain location - Plantar fasciitis pain is usually in the heel.
• Pain characteristics - Sharp, stabbing, or burning pain. Sometimes like you are walking on pins.
• Timing of the Pain - Felt more with the first steps in the morning or after extended periods of rest, and then eases off after a while, only to worsen after activities and not during.

You can also perform a plantar stretching test. Try to pull your toes back, stretching the plantar fascia. If you feel pain when you do this, then you may have an issue with the plantar fascia. See the image below:

Professional Diagnosis of Plantar Fasciitis

To professionally diagnose plantar fasciitis, your podiatrist will likely go through the following:

• Taking Patient History - This process is more important for plantar fasciitis than for flat feet. Here, your podiatrist will seek to find out the nature of the pain, including when it started, whether it gets worse in the morning, during, or after activities. They will also want to find out about any history of involvement in sporting activities, recent increase in activity, history of injuries, and if you have to spend a lot of time on your feet at work. Questions along these lines will lay the foundation for the examination.

• Visual Inspection and Gait Analysis - Your specialist can draw some important conclusions from watching how your foot strikes the ground. An altered stride or limp that aims to avoid the heel, where pain is felt, can be an indication of plantar fasciitis.

• Physical Examination - By palpating the areas around the arch and heel, the podiatrist can locate pain points that can be indicative of plantar fasciitis.

• Test for Range of Motion - Muscle tightness and ankle flexibility are important checks to make. If your ability to lift your foot upward (dorsiflexion) is hampered, it can mean that your plantar fasciitis has been under strain, and you may have developed plantar fasciitis.

• Imaging Tests - When symptoms persist, imaging may be required to take a closer look. Ultrasound scans can be used to check for tissue inflammation and micro-tears. They can also check to see if there’s a thickening of the plantar fascia. MRI (Magnetic Resonance Imaging) may be used to rule out other conditions like tarsal tunnel syndrome and stress fracture that may also cause heel pain.

Having the correct diagnosis is the first step in determining an effective treatment plan.

Treatment and Management

The treatment and/or management strategy to be adopted for flat feet and plantar fasciitis will depend on whether the conditions are being treated individually or together. If an individual just has flat feet, the treatment approach will be different from one who is suffering from both flat feet and plantar fasciitis.

Let’s look at the common treatment and management approaches.

Treatment and Management of Flat Feet

Since flat feet is a structural condition, the treatment and management approach focuses on correcting the structural issue, which in this case, is the absence of arch support. By providing the missing arch support, foot mechanics is improved, and other associated issues are resolved.

To achieve this, the following methods can be employed:

• Supportive Footwear - Unlike orthotics that are inserted into shoes, supportive footwear are shoes with in-built arch support. These types of footwear will offer good arch support, heel stabilization, and, in some cases, motion control, which helps counter overpronation, especially for athletes.

• Exercises - Some simple exercises that help strengthen and reduce tension from supporting structures are often recommended. Examples include:

i. Calf stretches to reduce tension in the calf muscles

ii. Heel raise, which helps strengthen the tibialis posterior muscle.

iii. Marble pickups to activate intrinsic foot muscles.

iv. Towel crunches also help activate intrinsic foot muscles

• Lifestyle Modification -This is an important component in the treatment or management of flat feet. First, weight management is crucial to ensure that the foot does not have to carry too much weight. Secondly, cutting down on high-impact exercises and switching to lower-impact alternatives will ensure you stay active without putting the arch under increased strain.

• Medical Option - When all other options have failed, this may be the only other option to consider. Bracing may be prescribed for posterior tibial tendon dysfunction. In rare cases, surgical intervention may be required to repair the tendon, reshape or fuse some bones. There are a few other surgical procedures that may be considered, but always as an option of last resort.

Treatment and Management of Plantar Fasciitis

For treating or managing plantar fasciitis, the goal is to reduce the inflammation, relieve the pain, and restore flexibility. This can be achieved with the following treatment approaches:

• Rest and Reduced Activity - Giving the fascia time to heal is critical in the treatment of plantar fasciitis. If complete rest is not possible, you should at least reduce your activity level or switch to low-impact activities like swimming or cycling.

• Heat and Cold Therapy - You can use warm compresses to enhance blood circulation, especially in severe cases. You can also use cold therapy to ease pain. Simply roll a bottle of frozen water under your foot. This can have a soothing effect.

• Strengthening and Stretching Exercises - Some simple stretching and strengthening routines can help increase flexibility and also strengthen important muscles. Some simple exercises that you can do include:

i. Calf stretches (already discussed above) can help reduce stiffness in the calf muscles and Achilles tendon. Just do the stretch about 2 to 3 times each day.

ii. Rolling exercise, which involves rolling a tennis ball (or any similar ball) under your foot, will help break up the tightness in the fascia. It can also improve circulation, reduce pain, and if done with a bottle of frozen water, it can reduce inflammation and swelling.

iii. Plantar fascia stretch can reduce the tension on the fascia. Doing this first thing in the morning before taking the first step will reduce the pain usually associated with the first steps in the morning. This can be done with your hand or a towel as shown in the image below.

• Night Splints - This is used to keep the fascia flexed through the night. This ensures that it does not tighten up, causing you pain in the morning when you take those first steps.

• Orthotics and Supportive Footwear - Footwear that offer comfort and good support can help alleviate the pain. You can also use orthotic insoles. For best results, go for custom orthotics for plantar fasciitis as these are designed specifically for plantar fasciitis. Combining this with the other steps can quicken the recovery process.

• Medication - For immediate relief from pain and inflammation, USAIDs, like naproxen or Ibuprofen, can be taken. For severe cases, corticosteroid injections can be used for relief. These are, however, short-term solutions which should not be used for extended periods.

• Advanced Medical Intervention - For severe and unresponsive cases, more advanced medical options can be used. These include:
  i. Extracorporeal Shock Wave Therapy (ESWT), which tries to stimulate healing using sound waves.
  ii. Platelet-Rich Plasma (PRP) Injections aim to leverage the body's natural healing to speed up the healing process. It does this by injecting a concentrated form of platelets taken from the patient's blood into the fascia.
  iii. Surgical procedures like plantar fascia release are options of last resort. This will only be considered if the condition persists for up to 12 months and has not responded to other conservative treatment options.

Combined Treatment Options

For patients dealing with both flat feet and plantar fasciitis, treatment can be combined. From the treatment options discussed above, there are a number of them that work for both conditions.

In addition to these treatment plans, you can also use dual-purpose orthotic insoles. A single orthotic insole that is designed for both flat feet (providing arch support) and plantar fasciitis (offering comfort and support) will provide the right foundation for other treatment options to be carried out.

Going for custom orthotics is one of the surest ways of getting an insert that can do both jobs. Since custom insoles are designed to fit the exact needs of each foot, the design will take into consideration every existing condition. This is why orthotics from Stride Soles are getting amazing results.

Prevention Strategies

Prevention, they say, is better than cure, so it’s always better to prevent these conditions rather than trying to treat them. While it may not always be possible to prevent conditions like flat feet, especially the congenital kind, we can, at least, try to take proactive steps to reduce their effect.

Below are some simple steps that we can take to prevent or minimize the effects of these conditions.

• Footwear Choice - Always go for footwear that offer good arch support. They should also have good heel support, comfortable padding, rigid midsole, and must be a good fit. Avoid spending too much time in flat sandals, worn-out sneakers, flip-flops, or high-heeled shoes.

• Regular Exercises - Make it a habit to always do strengthening and stretching exercises, some of which have already been discussed above. These will ensure that the foot is more flexible and less susceptible to injuries.

• Manage Your Weight - Weight management will help your health as a whole and your feet's health in particular. By keeping your weight down, you reduce the stress on the foot structures, making it easy for them to continue to work efficiently for much longer.

• Activity Management - Avoid sudden increases in your activity level. Always increase the intensity of your activities gradually. You should also ensure that your body is well-conditioned before you begin intense workouts and make space for rest to allow your body recover.

• Use Orthotic Support - If you spend a lot of time on your feet or you often engage in high-impact activities, then using the right orthotics can help prevent injuries. The right orthotics will provide adequate support while keeping your feet comfortable.

• Be Proactive - Sometimes, despite your best efforts, you may notice some symptoms beginning to develop. It's important that you quickly address these symptoms so they don't worsen. Simple steps like stretches, ice and heat therapy, use of compression socks, foot elevation, gentle massages, the use of orthotics, and rest may be enough to make a difference. You should also not be afraid to talk to your podiatrist if you think the symptoms are not going away. Early intervention can save you months of pain and discomfort.

Conclusion

Flat Feet and Plantar fasciitis are two common foot conditions that affect millions of people around the world. We’ve taken some time to look at these two conditions and how they are connected. With the information we’ve shared in this article, you now have the tools you need to better manage either or both conditions.

Take control of your foot’s health and live your best life without inhibition.