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I have flat feet, Podiatrists hear this on a daily basis.

Pes Planus is a term podiatrists use to describe a foot that has a flattened arch. There are a number of causes for flat feet; many of them are due to some form of genetic predisposition. It may be that the bony alignment in your foot just sits that way. Compared to a standard foot the ligaments within the foot may be more mobile. This may cause the foot to appear flat when you stand barefoot. The foot may take on that shape to compensate for other issues. Tight calves or a leg length discrepancy can cause compensation to occur. There could be a weakness, or rupture, of the tibialis posterior tendon, which is an important tendon for maintaining the arch height. Or there may be an abnormal fusion of bones inside the foot.

A flat foot on its own does not have to be the cause of pain or injury. The compensation and unnatural movement of the foot can cause discomfort.

This movement is called pronation. Pronation is the way the foot rolls inward when you walk and run. It is part of the natural movement that helps the lower leg deal with shock. Some people pronate more than others.

As the foot comes into contact with the ground the foot naturally pronates. This is a normal shock absorption mechanism. A small amount of pronation is important and healthy, however if the movement is excessive – such as is often seen with flat feet – the force on the supporting structures can be increased to a point where they become stressed and damage occurs.

When the foot pronates, or rolls in, there is tension placed upon the muscles and tissues in the bottom of the foot, as well as those at the inside section of the lower leg. The shin bone (tibia) rotates inwardly, which can change the position of the knee joint. Similarly, the thigh bone (femur) also rotates inward. This causes the hip to tilt down forward and inward.

As a result, excessive pronation movement of the foot can contribute to a wide variety of problems, including bunion development, plantar fasciitis, medial tibial stress syndrome, tibialis posterior tendinopathy, knee pain, hip pain, and back pain.

Podiatrists treat pain associated with overpronation by assessing muscular strength and range of motion of all of the joints in the leg and foot. The problem can normally be corrected with strengthening exercise and sometimes orthotic therapy.