Foot types can be divided into three major groups: the flat foot (Pes Planus), the high arched foot (Pes Valgus) and the normal to low arched foot. A true 'flat foot' is very rare. In fact, less than 5% of the population have flat feet i.e. a foot with no arch present whatsoever and the entire bottom surface of the foot being flat on the ground. About 5-10% of people have a high arched foot. The majority of the population have a normal to low arch. Even though the arches appear to be normal most of us suffer from over-pronation during walking, running and standing, due to the hard, flat unnatural surfaces we walk on, combined with wearing unsupportive footwear. With every step we take the arches flatten and the ankles roll inwards. Pronation itself is not wrong because we need to pronate and supinate as part of our natural gait cycle. Pronation (rolling in) acts as a shock-absorbing mechanism and supination (rolling out) helps to propel our feet forward. Over-pronation occurs when the foot pronates too deep and for too long, not allowing the foot to 'recover' and supinate. Over-pronation hampers our natural walking pattern. It causes an imbalance and leads to wear and tear in several parts of the body with every step we take.
Flat feet don't automatically mean you have a problem. The problem can be divided into a flexible flat foot or rigid flat foot. The rigid flat foot is one that does not change shape when the foot becomes weight bearing. i.e. it does not go through the excessive motion of pronation. Generally speaking this foot does not provide too many problems. The flexible flat foot is the type that when it becomes weight bearing the foot and ankle tends to roll in (pronates) too far. This type of person will often say I have great arches but when I stand up much of this arch disappears as the foot excessively pronates When the foot is excessively pronating and causing problems like sore ankles, feet or knees when standing or exercising then arch support is extremely important to restore the foot structure.
Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.
A quick way to see if you over-pronate is to look for these signs. While standing straight with bare feet on the floor, look so see if the inside of your arch or sole touches the floor. Take a look at your hiking or running shoes; look for wear on the inside of the sole. Wet your feet and walk on a surface that will show the foot mark. If you have a neutral foot you should see your heel connected to the ball of your foot by a mark roughly half of width of your sole. If you over-pronate you will see greater than half and up to the full width of your sole.
Non Surgical Treatment
The following exercises help retrain the foot and ankle complex to correct overpronation. Exercises may be performed while wearing shoes, or for an even greater challenge, in bare feet. Duck Stand. This exercise is designed to prepare for the more dynamic BT exercises ahead by waking up the gluteal muscles and teaching clients how the gluteal muscles control the degree of foot pronation. For example, when the glutes contract concentrically, they rotate the leg outward. As the leg rotates outward, the arch of the foot raises (i.e., supinates). Stand beside the BT with both heels together and feet turned outward. (Note: As you progress, perform this exercise while standing on the BT.) Try to rotate legs outward by tightening buttock muscles while tilting pelvis under. As legs rotate outward, arches of the feet raise up out of pronation. Hold position for 30 seconds. Big Toe Pushdowns. This exercise is designed to strengthen the muscle of the big toe that holds up the arch of the foot (i.e., flexor hallucis longus muscle). This stops the foot from overpronating. Stand on top of the BT dome with feet facing forward. Use gluteal muscles to raise the arches of the feet (see previous exercise - "Duck Stand"). Keep arches raised while pushing down big toe into the BT. While pushing down, tension build in the arch on the underside of their foot should be felt. Hold position for 15 seconds.
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.