Friday Q&A: Flat Feet

Q: I have a question about flat feet and Morton's toe. I'm a 57 YO man who walks a lot and I have both. I always have difficulty balancing on one foot—tree, eagle pose, etc., and have recently had a bout with Plantar Fasciitis showing up in my left heel. No fun. I was at a yoga class yesterday and some poses felt good, others hurt. When I left the class, I literally limped home and iced it for 1/2 hr. then heat, then rest. I had acupuncture at Quan Yin this morning for it and bought new, sturdy shoes and heel pads. It feels a little better today. Can you suggest any asana or other treatment I can do at home that may help speed the healing process and prevent future trouble? Any suggestions for flat feet in general?

A: Wow, this is a great question! It is actually a triple whammy: flat feet, Morton’s neuroma and plantar fascitis! With that in mind, I suggest we address each condition individually over the next three Fridays, to get a better understanding of each condition.

So let’s start with the most common of the three, flat feet. Technically known as pes planus, flat feet are extremely common. In fact, we all start out with flat feet as infants, due to the fact that our muscles and tendons that create the arches in the feet (which number three, by the way) are not fully formed, and because we have a pretty good fat pad in the feet then that contributes to the relative flatness of the feet.

As we grow and walk and run, the muscles develop, the tendons tighten a bit and our arches begin to appear around age three or so. The most obvious of the three arches is the one that runs along the inner edge of the feet from heel to ball of the big toe, which is called the inner or medial arch.  When this arch is not present, the inner edge of the foot rests on the floor with the rest of the sole of the foot. Again, this is a fairly common occurrence in many adults, and unless you experience pain, either in the foot, ankle or knee, it is not really anything that needs direct intervention to change.

So why does having a collapsed inner arch cause ankle and knee pain? Well, if the inner arch is collapsed, it can force your ankles to turn inward, which throws off the alignment of your legs and can influence the knees just above.

What causes flat feet? Probably the most common is that the arches don’t develop in childhood. Other causes include injury or simple wear and tear stresses as we age (there it is again, age!). Risk factors for developing flat feet as an adult include obesity, injury, other conditions such as rheumatoid arthritis and, yikes, aging! An interesting distinction is made between flexible and rigid flat feet. Someone with flexible flat feet who stands on the balls of their feet, with heels lifted, will have an arch appear. Someone with rigid flat feet will not. The later case is often associated with pain and greater dysfunction, and may need the help of a foot doctor to address their symptoms. 

Another interesting finding is that people with flat feet may have a very tight Achilles’ tendon, so specific stretches for the calf muscles can be potentially helpful: do I hear anyone out there thinking Warrior 1, back leg?

Many students have no symptoms associated with their flat feet. But others note some foot pain in the heel or arch area, difficulty standing on tiptoe or swelling along the inside of the ankle. Usually it is foot pain that will prompt a visit to your doctor, who will likely examine the foot, may order X-rays and could recommend meds for pain, and possiblly some sort of shoe insert. Rarely do you need to go further with treatment.

I know of at least one yoga student with flat feet who claimed that working with yoga poses in a particular way helped him reform his arches. I know this is just anecdotal evidence for the benefit of yoga, but it is still encouraging, as this student felt better after the change. How might you experiment with this? As already stated, you might work on releasing tension in the Achilles’ tendon, carefully, via standing poses like Warrior 1, Pyramid pose (Parsvottansana) and squatting yoga postures like Garland pose (Malasana). In addition, I find that keeping the ball of the foot on the floor while lifting all the toes up while doing standing poses seems to create an inner arch lift. It may be strengthening the muscles enough to provide the lift needed for an arch in that area of the foot.

Another way to work with the feet is in Reclined Leg Stretch pose (Supta Padangusthasana) with the strap positioned across the center of the sole of your foot, the location of the transverse arch of the foot. As you pull down on the strap, push your heel and the ball of your foot up toward the ceiling and spread your toes wide. This will simulate and possibly stimulate the medial and lateral arches of the feet to appear. Hold the action for a minute or so and repeat on the other foot. Those of you out there with Morton’s neuroma or heel spurs can give this a try and I’ll take up the neuroma next time!

For more information on feet, see Your Feet on My Mind and Friday Q&A: Feet.

—Baxter