What's the deal with flat feet / fallen arches?
July 14, 2014 9:45 AM   Subscribe

My son, who turns twelve in a couple of months, seems to have flat feet. I can't quite figure out what to do next - if it is a serious problem, if it can be corrected with foot exercises, if we need orthotics, or what. Does anyone have any experience with flat feet?

My son is nearly twelve. He is very active: he walks or rides his bike to school, plays ball hockey and soccer, has a paper route. He is not clinically (or otherwise) obese, but he is growing quite fast and has big feet. He went from a size 7 (adult) to size 9 (adult) in just the past three months.

So it's more of a genetic problem than a problem with being sedentary and overweight, which seems to be what causes flat feet when you are an adult.

I did noticed when we bought his last pair of shoes (Nike high tops for ball hockey; in terms of intensity and seriousness, ball hockey is basically like ice hockey or box lacrosse, but with less screaming parents) he appeared to be walking on the inside of his shoes. I figured it was because the heels of the shoes were too roomy and he was sliding around.

We bought some soccer cleats for the fall season yesterday, and the knowledgeable salesman at the local sporting goods shop mentioned that he in fact has flat feet. He recommended some orthotic in-soles to help prop up the arches, and it looks like it worked.

Doing some internet research, however, it looks like orthotics are a bit of a scam, and don't really solve the problem of fallen arches.

We're going to go to see our family doctor, whom I trust a great deal, but I get the sense that feet, like teeth, are the domain of specialists. I'm not sure if I want to go to a podiatrist if the solution is getting expensive orthotics.

There is also the entire "barefoot" movement that says that shoes are the actual cause of the problem.

I just want to help correct the problem, so that I am not setting my son up for Plantar Fasciitis in later life.

Any insights would be appreciated!
posted by KokuRyu to Health & Fitness (28 answers total) 3 users marked this as a favorite
My arches collapsed when I was like 18 (not due to being sedentary/obese or anything, but probably b/c I went barefoot everywhere). I happened to work for an orthopedic surgeon who took some x-rays and examined me, and recommended some physical therapy exercises to build the muscles back up--so that might be a solution. (I was a dumb teenager so didn't actually /do/ the exercises.)
posted by leesh at 9:52 AM on July 14, 2014 [1 favorite]

A number of yoga teachers focus on feet and alignment, and I found yoga classes with a teacher who did so very helpful in reminding me to lift my arches. I think we tend to (or at least, I tended to) think of our arches as static, when we actually can lift them muscularly.

This article on Yoga for Foot Care might be a good introduction to some of the ways yoga might help.
posted by jaguar at 9:57 AM on July 14, 2014 [2 favorites]

I also was diagnosed with flat feet and over-pronation when I was in junior high. I got custom shoe inserts every year or so for many years after. I was also supposed to do exercises like where I was to move a pile of marbles from one pile to another using only my toes to grab onto them. I never did them. Finally sometime after college I quit buying the inserts because they were so expensive.

I don't know if the inserts every really fixed anything. I could certainly tell when I forgot to use them and walking around without them was not fun. I never had calf or knee or back pain which I was told would be the consequence of not correcting my feet. I don't have any of those problems now either.

I would talk to your son's doctor about it the next time, but in the absence of any other problems I'm not sure I would worry about it too much.
posted by sevenless at 9:57 AM on July 14, 2014 [1 favorite]

My family's experience (from my dad's side, we all have flat feet) is that it's a total non-issue. Hasn't caused any foot or gait or back problems. We just have funny footprints.
posted by fiercecupcake at 9:59 AM on July 14, 2014 [8 favorites]

Meh! If he can comfortably walk and get around now, I wouldn't sweat it too much. Get him in the habit of flexing his arches here and there, if plantar fasciitis is a concern.

If he's running and playing soccer, he probably could benefit from an orthotic. It needn't be crazy expensive; Superfeet is a good brand that's widely available.

I've lived three decades with fallen/flat arches, and I've run half marathons and fast 5Ks and played soccer and walked around everywhere I've wanted to go. My feet have never been a problem.
posted by magdalemon at 10:00 AM on July 14, 2014 [3 favorites]

I have had flat feet since 8th-9th grade. I have been fairly active for a while, but only in the last ~2 years have I really begun training intentionally. I currently run and lift, and plan to begin training for a triathlon shortly. When I was younger, being flat-footed was aggravating my scoliosis a lot, but since I began weightlifting the back pain has vanished entirely.

I have experimented with inserts, but I found them to aggravate the problem more than anything else, because once your feet are used to them, any attempt to walk around without them becomes agony. Since I prefer to be barefoot whenever possible, this caused no end of problems until I got rid of the inserts.

Personally, I've never had any problems stemming from flat feet. When I run, I sometimes have to focus on where I'm landing so I don't slap the ground with each step. I think I'm somewhat prone to shin splints for this reason, but I've always increased distance/pace gradually enough, in addition to pairing running with a lifting program, that it hasn't been a problem.

In lifting, I think being flat-footed actually helps me, because I feel like I have a very stable base on which to stand, and my feet aren't inclined to shift when I press down into the floor.

My current doctor is aware that I'm flat-footed. I've told him basically the above story, and was told that based on the fact that I haven't had any injuries from running, it seems like my strategy for dealing with a less efficient foot strike is working, and that in all likelihood I wouldn't have any long term problems as long as I continued to keep the "condition" in mind when creating training plans.

Tl;dr: Inserts caused me more harm than good, but YMMV. Everyone is different, but I'm inclined not to think about it as a big deal at all unless it starts to cause problems later on.
posted by Urban Winter at 10:10 AM on July 14, 2014 [3 favorites]

I don't know that this is something to worry about. I have flat feet. I run (half marathons, 10 milers, 10Ks, 5Ks) and do yoga. I end up buying stability shoes for running. I also and I think that the stability shoes help - they're kind of bulky but they protect my foot so if I do overpronate, I don't hurt myself. I've seen a podiatrist actually and he didn't even mention my flat feet. Shoe salesmen guy might know about shoes and feet but he's also a shoe salesman - his job is to sell you stuff. I might mention it to your kid's pediatrician but I don't think it's a problem.
posted by kat518 at 10:13 AM on July 14, 2014 [3 favorites]

. I was also supposed to do exercises like where I was to move a pile of marbles from one pile to another using only my toes to grab onto them.

Interestingly, this is what my dad, who had flat feet at around the same age, recommends. So we are going to give it a try.

Thanks for all the insights. Buying the inserts was kind of annoying, but on the other hand will help preserve his shoes until the end of the summer. We usually buy indoor shoes to wear a few times a week for indoor sports in mid-spring; these become the summer shoes that are supposed to last a couple of months in summer until late August, when it's time to buy school shoes.

Anyway, now I don't feel so bad about buying him D&G's for school. Super durable!
posted by KokuRyu at 10:21 AM on July 14, 2014

Does your son have pain in the arch? I have an accessory navicular bone (well two, one in each foot) that caused me quite a lot of pain when I was an ice skater as a kid. The rubbing of the boot on the instep caused pain and eventually totally flattened arches. Today I am very picky about shoes (mostly wear "comfort" brands with good arch support) and also have inserts for hiking and skiing. I do get knee pain if I'm not careful about the foot support.

The podiatrist I saw for this problem mentioned that soccer is one of the other sports which can cause aggravation in people who have this extra bone, because it is located where you kick with the instep.

For me this foot problem really hurt, though, and was pretty visibly inflamed; I don't know if structural foot changes can happen this way without the pain.
posted by nat at 10:28 AM on July 14, 2014

A lot of people have flat feet or other less-than-ideal feet. Does it bother him?
It may be worth having a doctor check out what causes the flat feet and if there's anything that can be done about them.

FWIW, I have flat feet and I'm fine. I can get back and neck pain sometimes, but I think those are to blame on my breasts. My brothers have flat feet and they're both very sporty. (My older brother does sports for a living.) My mother has feet problem that cause her significant pain and trouble walking, but she's in her 60s for one and was also an overweight child (and is still somewhat overweight now, sorry Mum). She is also the only one in the family who wears slippers at home, whereas my brothers and I walk on socks or our bare feet.
posted by LoonyLovegood at 10:42 AM on July 14, 2014

It's genetic in our family. My feet are so flat I can make farty noises walking barefoot on a vinyl floor (and to the annoyance of ms scruss, I take enormous delight in doing so). No problems here.

Fallen arches to me are something different, and worse. Some people just don't have arches, and that's okay.
posted by scruss at 10:49 AM on July 14, 2014 [1 favorite]

I have crazy flat feet, combined with really bizarre ankles that have way more bone on them than they're supposed to. It's the kind of thing that you wouldn't really notice unless you were looking for it, which is why my mom didn't notice until I was 12 and I happened to be walking past her on a pool deck while she was in the pool with her eyes at my ankle level. She panicked and took me to a podiatrist, who took a bunch of x-rays and then soberly informed her that I had to do foot exercises every single day for the rest of my life, and also needed to wear custom orthotics, and also needed to quit running and participating in any sports save swimming, because if I did not I would suffer grave consequences that would ultimately result in my having to use a wheelchair by the time I was in my 40's. This is not an exaggeration, and actual licensed medical professional said these things.

So I did the stupid exercises for a month or two, and I wore the orthotics for nearly a decade, and I quit playing basketball to swim exclusively, and I didn't really run at all, and then one day in college I was in the pool locker room telling this very story to a friend who was trying to get me to go running with him, and the guy standing next to me introduced himself as the head of the Orthopaedic Surgery department of the very prestigious university hospital connected to my college (I confirmed this to be true as soon as I got home), and this guy calmly informed me that everything the podiatrist had told me was horeshit, and that as long as I wasn't experiencing any pain in my arches or ankles that I was totally fine to run and jump and do whatever I wanted to do, and that I didn't need take any special precautions or buy any special devices or anything like that. He cited a couple of long-term studies that he had worked on involving tracking the development of flat-footed children in third world countries who had no access to things like orthotics and nonetheless didn't suffer any problems later in life. He told me about the bone structures in the foot and ankle, and what was going on in my own bizarre feet. He railed against podiatrists and their irresponsible scare tactics. It was awesome.

That was 12 years ago. I've averaged about 15 miles of running a week since then, without any problems whatsoever. I am obviously not a doctor, and therefore this obviously does not constitute actionable medical advice, but I would urge you to consider the possibility that podiatrists are huckster assholes, and if your son isn't experiencing any discomfort, there's probably not any need to intervene.
posted by saladin at 10:49 AM on July 14, 2014 [8 favorites]

First, let me state that I am not an athlete.

I have always had terrible flat feet--it's genetic for me. For the past 25 years, I've had custom-made orthotics. I don't think I ever really had foot pain before, but the orthotics have helped a lot with posture and with making my joints work at something approaching their normal function. I definitely walk a lot straighter and more upright with them than without.

Not sure where you're getting your information about orthotics being a "scam." It seems to make perfect sense to me that jacking up your arch a little bit to the position it's supposed to be in will make your joints function more naturally and without stress. Maybe my feet are flatter than most, but let me tell you, with orthotics, my whole body (including my lower back) is under a lot less stress that it is without them.

Just because we're not 100% sure of how or why something works doesn't necessarily mean that it doesn't work or that it's a scam. Orthotics are not homeopathy. As far as curing fallen arches goes, I don't think that anyone makes that claim for orthotics. The idea is to alleviate the pain and stress, not cure the underlying issue. Curing my flat feet is impossible; orthotics help deal with them.

I would recommend giving the podiatrist a try. Maybe the orthotics will work; maybe they won't. For a child whose body is still growing, they may be a good idea, but only a reputable professional would be able to advise you on that.
posted by Leatherstocking at 10:50 AM on July 14, 2014 [2 favorites]

Orthotics are not a cure to flat feet, leading to a future in which orthotics are unnecessary, they are a treatment for the condition and the possible painful outcomes. I would look at mass produced orthotics if you don't have insurance to pay for custom made orthotics.

It wouldn't hurt to get his feet x-rayed to see if there is any abnormalities beyond those any developing youth might experience, and good for you for taking care of it early.
posted by maleru at 11:25 AM on July 14, 2014 [1 favorite]

Purely anecdotal, but I've had really flat feet all my life ( I remember being shocked the first time I saw an arched foot, and thought the owner of it was deformed) and it hasn't been much of a hindrance with my running. I had a stretch where plantar fasciitis was a bit of a problem, but a good stretching regimen, paying attention to my calves, dealt with it just fine.
posted by COBRA! at 11:29 AM on July 14, 2014

My wife and son have flat feet and it has been a total non-issue - other than an interesting topic of conversation sometimes.
posted by Billiken at 11:48 AM on July 14, 2014

I have had totally flat feet since early childhood. In my elementary school years my mom bought shoe inserts and I wore them til I rebelled as a teenager and insisted on wearing shoes that were cute or cool rather than supportive. This was fine til my mid 20s and I started having episodes of plantar fasciitis--increasingly worst til I was nearly crippled. I went to a doctor to get help and my gait was so bizarre that he rather rudely and incredulously called the nurse over to look at it. Who knew. (Note to doc 22 years later: fuck you for such appalling clinical manner.)

I've been wearing custom orthotics ever since and they make a world of difference. I am really rather miserable standing or walking barefoot and avoid it whenever possible. If I have to do it for too long I have terrible foot pain for days afterward.

Just adding to the list of anecdata. If it doesn't bug him, then no biggie, but if it does start to bother him then see a podiatrist.
posted by Sublimity at 11:59 AM on July 14, 2014 [2 favorites]

People in sports stores sell off-the-shelf insoles because they up to sale/commission. In years and years of running with groups of people, I've never seen evidence that off-the-shelf insoles reduced injury. Some people love em. Some people think they're crap.

If your kid has pain (foot, arch, calf) then your doctor will have some suggestions. If he needs orthotics then it's worth asking if custom made ones are the way to proceed. (I actually lean that way - if you need that type of support then you probably need it to be custom made for something as complex as your foot.)

Ask the doctor - who will likely shrug and tell you to come back if your son has any pain or problems.
posted by 26.2 at 12:28 PM on July 14, 2014

I have flat feet and was prescribed fiberglass orthotics when I was 12. Oh, and I'm now 34 and I've ran 30 marathons.

The orthotics are spendy, but he will thank you later because mine did give me some correction and stopped pain before it could become a reality.
posted by floweredfish at 12:39 PM on July 14, 2014 [1 favorite]

I've had flat feet since I was little - like since I was 4 or 5. It's genetic - my mother had them too, and I think because of that it never really occurred to my parents to take me to a podiatrist (and as far as I know, none of my pediatricians referred them to one). When I finally gave orthotics a try in high school I found them super painful because I'd pretty much adapted to life with flat feet. I've never worn them.

I'm 29 now and I run 5Ks and I walk around NYC all day and I go hiking and do other things with my feet with nary an issue, and they are still flat as flat can be.

My vote is, as long as he's not in pain or finding it difficult to participate in the sports and activities he wants to, leave it be.
posted by thereemix at 1:26 PM on July 14, 2014

Since his bones are growing so fast, and I seem to recall that you live somewhat to the north in an area which has a lot of what we call 'filtered sunlight' around here, you might ask the doctor to check his vitamin D levels.
posted by jamjam at 1:37 PM on July 14, 2014

I have flat feet. Have never been to any specialist about it; my pediatrician just casually noted it once when I was in middle school and it made a few things make a lot of sense - and I was a really active athletic kid, so while it wasn't holding me back, it was making a few things more sore than they needed to be. Basically, mine were a "problem" only when they caused ankle or knee pain. If the shoes I wore didn't make me end up with ankle or knee pain, I didn't use orthotics with them. If they did, I used them. (Soccer cleats were the worst for this, in my experience) As an adult, I find some high heels to be extremely painful in the arch itself due to the way my foot has to bend and which muscles are handling that bending, though this is unlikely to be an issue for your son (YMMV). I also find unsupportive flip-flops to be a problem for long periods of waking. Love me some birkenstocks, though.

This is not really a Condition (TM) that you need to be concerned about; just as long as your son knows how to recognize when something is uncomfortable because of his arches, he can adapt the shoes, inserts, or behavior to deal with it. And FWIW, nothing I have ever done or worn has improved (or worsened) the situation. My footprints are just as weird at age 30 as they were at age 10.
posted by olinerd at 3:11 PM on July 14, 2014

This is probably not an option for you but ballet classes are all about strength and flexibility of the feet, virtually every exercise involves all foot muscles and builds amazing arches.
posted by sammyo at 3:52 PM on July 14, 2014

Orthotics are meant to be palliative and to reduce biomechanical stress on flat feet, not cure them. I had them as a kid but didn't wear them, stupidly. I got custom ones a couple of years ago (for something else, though I've also had PF and bone spurs); they've helped me reduce all manner of pain. (Also, 8 years of ballet in childhood didn't seem to help with my flat feet.)
posted by cotton dress sock at 4:49 PM on July 14, 2014 [1 favorite]

I have flat feet.

Doc told my mom to let me go barefoot as much as possible.
posted by St. Alia of the Bunnies at 8:56 PM on July 14, 2014

I've had flat feet all my life, and to those who say it's not a big deal I say this: just wait. It will be.

As a child I was given arch supports, told to always wear lace-up shoes etc and so I did. For a while. As I got older I simply stopped bothering with the arch supports (although I always stuck with lace-up shoes). I reached the "indestructible youth" stage and thought it was all too much fuss. My flat feet meant I couldn't sprint, and that running for any length of time was not on because it became too painful, but I could walk for miles without too much trouble and I became a pretty damned good squash player, although I would sometimes attract ribald comment for my "duck-on-speed" gait around the court. All good fun, really.

Then at the age of 42, I ruptured an achilles tendon for no readily apparent reason. I mean, I was playing squash at the time but merely strolling across court to receive service when it happened - not lunging or stretching at all. The doctor who did the repair told me it was almost certainly because of my flat feet. He noted that my other achilles was in poor shape too - tendonitis, with a prominent nodule. Apparently people with flat feet frequently get achilles problems eventually. So, very likely as a result of my long neglect of the condition, I had to give up the only sport I've ever loved, apart from skiing.

I started skiing at the age of 26. By my early thirties I was getting pretty troublesome pains and weakness in my left knee; a couple of years later the right knee joined it. I have been wearing Terminator-style knee braces to ski ever since. A sports doctor told me that this, too, was very likely caused, or at least significantly aggravated, by the pronation associated with flat feet. I still ski, once a year, but I have to be more restrained than I would like, and I still need those damned braces.

I am now 55, and for the last couple of years I have been getting noticeable arch pain even after walking relatively short distances. I love walking, I have no car, and I walk almost everywhere. So, finally, I splashed out a ridiculous sum of cash on some properly customised orthotic inserts. I have to say, they make walking much more comfortable and I can go much further without pain. I can't help thinking that I really should have done this years ago, when I was still young and growing, to support my arches during their still-formative years.

So, my advice to you is talk to a chiropodist about your son's feet, but seriosuly consider getting him decent arch supports for all his shoes, and look at the exercises that supposedly help the condition. By doing so you might just be giving him a better older adulthood than I'm having. Nothing to lose, right?
posted by Decani at 4:36 AM on July 15, 2014 [1 favorite]

I've had flat feet all my life. This has contributed to a whole bunch of knee, hip, and back problems.

Last year I finally went and got orthotics--get custom ones that will actually fit his feet perfectly. They cost more but one bonus: basically the only company that actually makes them is in BC, so you'll save some shipping costs and have a faster turnaround time.

Basically they'll take a cast of his feet (laying on his stomach, feet dangling off the table), create a 3D model, then build the orthotic from that.

Since doing this, all of my foot/knee/hip/back pain has vanished.

Definitely go for a consult. If he's still growing, though, they may suggest that you wait on custom inserts until he's fully grown, otherwise you're going to be out $300ish at least once a year.
posted by feckless fecal fear mongering at 9:39 AM on July 15, 2014 [1 favorite]

I have the same flat feet my dad and brother have. I went to a podiatrist, got custom orthotics, went to physical therapy, did exercises at home, and was supposed to limit my shoes to lace-up shoes only when I was about his age. I also had problems with the achilles tendon that were addressed at the same time. I'd highly recommend going to see a specialist and getting it addressed now. Let the doctors and therapists know the kind of sports he is involved in, that can help.

Now, as an adult, I wear stability shoes with retail store orthotics (Super Feet) only during athletic activities and wear regular shoes the rest of the time and I do fine, I think partly because I addressed the problems when I was younger. Occasionally I get pain when I am barefoot around the house all day, but when that happens, I just put supportive shoes on. Whatever the merits of the "barefoot movement," some people are born with bad feet -- even no feet! -- and we just have to do what is best for us.

The only thing I would add is DON'T WEAR FLIP FLOPS, or at least don't wear them all day to walk long distances.
posted by bbq_ribs at 10:09 AM on July 15, 2014

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