Quite often I am asked about barefoot running and flat feet. I have argued against the ills of flat feet in runners for years. I have battled pair after pair of orthotics in my clients’ shoes. Some of those battles I have won, and those runners are better for it, but some of them I have lost, and those poor soles are still struggling to run without issues. The truth is that this issue is far beyond the scope of barefoot running, and in fact expands across the entirety of the running community. That’s right; this problem applies to all runners both shod and bare alike. So what’s the answer? Oh, I’ll tell you because I’m not afraid of the truth. Are you?
The answer is that “flat feet” is generally not a life-ending diagnosis. By life I mean running life, but for some of us running is life, and the current mentality on flat feet is that having them means that you cannot be a runner, at least not without all sorts of special shoes, inserts, exercises, and in some cases, surgeries. How we got to this point I do not know, but here are the first two resources a Google Search pulled up when all I typed in was “flat feet”.
Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality.
Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary.
For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces.
In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position.
Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.
Treatment for Children
Going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitis. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot, found that the longitudinal arches of the barefooters were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes. Flat feet can be treated by arch supports. Flat feet can also be inherited genetically.
Treatment for Adults
Treatment of flat feet may also be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back. Treatment may include using Orthotics such as an arch support, foot gymnastics or other exercises as recommended by a podiatrist or other physician. In cases of severe flat feet, orthoses should be used through a gradual process to lessen discomfort. Over several weeks, slightly more material is added to the orthosis to raise the arch. These small changes allow the foot structure to adjust gradually, as well as giving the patient time to acclimatize to the sensation of wearing orthoses. Once prescribed, orthoses are generally worn for the rest of the patient’s life. In some cases, surgery can provide lasting relief, and even create an arch where none existed before; it should be considered a last resort, as it is usually very time consuming and costly.
I could not believe what I was reading as I read the Google Health article on this subject. Are you kidding me? There is not a single word in there about being able to do anything about the issue. Wikipedia at least gave some hope to the reader and offered some advice. I feel Wikipedia’s advice for children with flat feet was spot on and great. However, they took a completely different approach for adults. Why is that? Why is it that once we have grown up, our feet are no longer adaptable, and we can no longer do anything without supports or special shoes? A lot of people in the barefoot community use the literal structural engineering of an arch to make the case that orthotics and support are not the right answer. An arch in construction is actually made weaker by underneath supports so the parallel is that arch support in your shoes is a bad thing.
I’ll take it in a different direction and point out that the arches of your feet consist of a network of muscle and connective tissues. In most cases these muscles can be strengthened like any other muscle in your body. When someone has shoulder, back, leg, or any other kind of pain, they are told to do physical therapy or exercise because strengthening the muscles will help, but when the feet are weak they are told to forget about it. The answer is always to give up activities like running and do something else that doesn’t require the feet to work, something like the bike or elliptical machine. The lucky ones are told to use really expensive custom orthotics in their shoes to support the arch. They are then told that they will need them forever, and as their feet get worse they will need to get more of these wonder braces that are more built up.
This is insane. The world is a big place full of people who have been told their feet are worthless and do not work, to just give up and realize that feet are no good in general without support. I know I am a barefoot/minimal advocate, but this has nothing to do with that. For my clients who still wear conventional shoes, the goal is always to get them strengthened from the feet up so they can get out of orthotics and built up shoes. The goal is always a thin and neutral shoe that they can actually use their feet in. I have them do foot strengthening exercises and drills, and their flat feet improve. They regain the arch they once lost because they are rebuilding the musculature of their feet, the very same muscles that the majority of the medical world seems to believe are useless and cannot be saved. The truth is that the medical world is wrong. Yes, there are cases where the feet are beyond easy repair and will not respond to strengthening exercises, but those are the rare few. The average flat footed person can rebuild those precious arches and watch a lot of their body’s aches and pains go away while they build strength, agility, and balance.
So there it is in no uncertain terms. Flat feet do not have to kill the runner. They do not have to be supported every day for the rest of your life. You can rebuild them, and just like with most other muscular issues in the body, you can watch the problem go away with the proper exercise and attention to the area. If you constantly support a muscle with a brace, it will atrophy, and the average shoe is a brace that does the foot’s work for it. Get your feet out of those shoes, and you see those muscles come back to life. I have written out some of my favorite exercises for the feet in my barefoot running transition articles, and doing those exercises can greatly help you in getting rid of those flat feet. This does not mean you have to become a barefoot runner. You can keep the shoes, but you have to change the way you look at shoes. Look at them as protection and not support. The first thing you tell a salesperson is that you want a neutral shoe with minimal heel to toe drop, and do not let them tell you that you “need” something else. Unless that person has walked a mile with your feet they have no idea what you need. Neutral, thin, and flat are the key words when describing the type of you shoe you are looking for that will not overly support your feet. The average runner will find great success by switching to something like a racing flat, for example.
So for the record my answer is “Yes, you can run and have flat feet”. Flat feet can and will cause you problems as a runner either shod or bare, so it’s best to work on strengthening the feet through foot exercises that forcefully activate the musculature of the arch. Do that and you won’t have to worry about having flat feet because they will go away.