So My PT Says My Flat Feet Are Messing Up My Back… Now What?

So, you’ve just come back from the physical therapist and got news that your flat feet might be the culprits behind your nagging back pain. It sounds a bit surprising, right? How could something as low as your feet affect your back? Well, it’s all about the connection and alignment within your body. Let’s dive into this a bit deeper and see what’s going on and what you might do about it.

First off, flat feet, or pes planus, is a condition where the arches of your feet are lower than usual or completely absent. This might not sound like a big deal at first, but the structure of your feet impacts how you stand, walk, and even how your entire body is aligned. Think of your feet as the foundation of a building—if the foundation is skewed, the effects can ripple up to the higher structures, which, in your case, includes your back.

What Causes Flat Feet

During my recent visit to the physical therapist, I gained some fascinating insights into what causes flat feet. It turns out, the problem is the structure of the foot itself, specifically a bone called the talus. The talus bone is critical in maintaining the arch of the foot, similar to how a keystone holds up an arch in a stone bridge.

Imagine a stone bridge arching gracefully over a river. Each stone in the bridge is necessary to maintain the arch’s integrity, but there is one central stone, known as the keystone, that holds the entire arch together. In the foot, the talus bone plays a similar role. It sits right at the top of the foot, inside the ankle joint, acting as a crucial stabilizing element.

Typically, flat feet develop when the talus bone is hypermobile, meaning it moves more than it should. When you walk or put weight on your foot, if the talus bone is hypermobile, it tends to shift forward. This movement of the talus can cause the rest of the foot’s structure to ‘unlock’ or collapse, leading to the flattening of the foot’s arch.

How Flat Feet Impact the Rest of Your Body

When you have flat feet, the lack of arches causes the feet to roll inward excessively — a movement known as overpronation. This isn’t just a foot problem. Overpronation leads to increased internal rotation of the tibia, or the lower leg bone. This internal rotation changes the dynamics at the knee, a hinge joint that ideally moves primarily in one direction: forward and back.

The misalignment introduced by overpronation can cause uneven forces on the knee joint, stressing both the joint itself and the surrounding tissues. The menisci, which are cartilage pads that cushion the knee, can become unevenly compressed. Over time, this uneven pressure can lead to wear and tear, increasing the risk of knee pain and conditions like meniscal tears.

As the ripple of flat feet moves upward, the next affected area is the hips. The inward rotation of the tibia often leads to a compensatory outward rotation of the femur, the thigh bone, to help maintain balance. This rotational mismatch at the junction where the thigh meets the pelvis can lead to altered hip mechanics and increased strain on the hip joint.

The altered mechanics in the hip can lead to changes in pelvic alignment. One common compensatory pattern is the anterior pelvic tilt, where the front of the pelvis drops and the back rises. This tilt is more than just a hip issue; it significantly impacts the spine’s natural alignment.

Spinal Complications of Anterior Pelvic Tilt

An anterior pelvic tilt due to flat feet-induced changes can lead to hyperlordosis, where the lower back curves inward more than normal. This excessive curvature strains the muscles and ligaments of the lower back, leading to tightness and pain. Over time, the continuous strain can lead to chronic lower back pain, a common complaint among individuals with untreated flat feet.

The spine’s alignment depends heavily on the pelvis’s position, which in turn can be influenced by lower extremity mechanics. A misaligned pelvis due to foot posture not only affects the lower back but can have implications for the entire spine, potentially leading to an overall imbalance in spinal posture and movement.

The chain reaction doesn’t stop at the spine. As the body tries to compensate for the instability caused by flat feet, there can be further adaptations in body posture and muscle usage patterns. These compensations can lead to the overuse of certain muscle groups while others weaken, a phenomenon often seen in the muscles of the hips, thighs, and lower back.

For instance, an anterior pelvic tilt can lead to tightened hip flexors and weakened abdominal muscles, which further exacerbates back pain. Additionally, the altered stance and gait can lead to muscular imbalances around the spine and pelvis, contributing to discomfort and dysfunction in daily movements.

Corrective Exercises for Flat Feet

Having flat feet can really throw a wrench into the works when it comes to overall body mechanics. To mitigate some of these effects, there are specific exercises you can do to help improve the condition of flat feet. It’s not just about providing temporary relief; these exercises aim to strengthen and stabilize the foot to support your arch better and correct the alignment naturally over time.

Strengthening the Arch

One effective way to start addressing flat feet is to focus on strengthening the muscles that support the arch. This can be done through a simple exercise known as foot flexion. Here’s how you do it: Sit with your feet flat on the ground. Keep your heel and toes on the floor, and try to pull them closer together. This action contracts the muscles in your foot, and you should see the arch lift slightly. Hold this contraction for two to three seconds, then relax. Repeating this movement about 30 times a day can significantly help to build up the arch-supporting muscles.

Towel Scrunches

Another great exercise involves using a common household item—a towel. This exercise, known as towel scrunches, not only engages the smaller muscles in your feet but also helps in promoting toe strength and flexibility. Lay a towel flat on a smooth surface and place your foot at one end. Use your toes to scrunch the towel towards you, then spread it back out and repeat. Performing this action for about a minute engages and strengthens the intrinsic muscles of your feet, crucial for stabilizing your arches.

Stretching and Strengthening

For those with flat feet, the muscles on the outside of the legs, known as the peroneals, can often become tight due to the inward rolling of the foot. To stretch these muscles, you can use the figure-four position: sit and cross one leg over the other, grab your foot, and gently pull it upwards and inwards until you feel a stretch on the outer side of your shin. Hold this for 20-30 seconds and repeat three times.

Simultaneously, strengthening the muscles on the inside of the leg can also help correct the pronation. Using a resistance band, anchor it to a stable object and loop it around the affected foot. Pull the band inward against the resistance, focusing on moving through the ankle. This targets the posterior tibialis muscle, which supports the arch. Repeat this motion about 30 times to strengthen this crucial muscle.

Dynamic Movements

While seated exercises are beneficial, incorporating standing movements can more closely mimic the forces and postures you encounter in daily life. A simple standing inversion exercise involves standing with feet hip-width apart and then gently rolling your ankles outward to lift the arches of your feet. Hold this inverted position for a few seconds before relaxing. Doing several repetitions of this exercise can help train your feet to maintain a more natural arch position.