What are the postural problems that are potentially caused by flat feet?

Many people don’t know that flat feet can cause hunchback, hallux valgus (bunion), X shaped legs, O shaped legs and anterior pelvic tilt. 


1. Hunched back

Many parents may not be fully aware that their child is flat-footed, as this condition may not be as immediately noticeable as other physical traits, such as a hunched back.

However, it's important to understand that flat-footed children often experience challenges when it comes to walking efficiently. Despite walking at the same speed as their peers, flat-footed children typically require more energy to maintain their pace.

Interestingly, the increased energy expenditure associated with a collapsed foot arch can lead to compensatory behaviours, such as adopting a hunched posture while walking.

This posture adjustment allows the child to conserve energy and move more swiftly. However, it also exacerbates the physical appearance of a hunched back.

If parents are concerned about their child's hunchback posture, it's crucial to address the underlying issue of arch flattening. By restoring the child's foot arch and promoting proper push-off using the ball of the foot during walking, the excessive energy expenditure associated with collapsed foot arch can be reduced.

As a result, the child may naturally improve their posture over time, without the need for additional intervention on the spinal alignment.

In essence, restoring the foot arch can serve as a foundational step towards improving overall posture and mobility in children. By focusing on restoring the foot arch and optimizing walking mechanics, parents can help their children achieve a more balanced and effortless gait, ultimately contributing to their long-term physical health and well-being.


2.Hallux Valgus 

Hallux Valgus, commonly referred to as a bunion, presents as a noticeable deformity where the big toe angles outward towards the other toes, resulting in the formation of a bony protrusion on the inner side of the foot.

While the visible manifestation of a bunion is clear, understanding its relationship with flat feet requires delving into the mechanics of the foot and considering conditions like hypermobility syndrome.

Hypermobility syndrome is characterized by increased flexibility in the joints, particularly those that bear weight, such as the ankle joints or the joints affected by bunions.

When an individual has hypermobility or ligament laxity on the feet and ankles, the inherent lack of arch support may be exacerbated, making the bunion joint, even more protruding.

In the context of a collapsed foot arch, the absence of a proper arch structure can lead to altered biomechanics during walking. With each step, the foot may excessively pronate or roll inward, placing abnormal stress on the bunion joint.

This repeated stress, compounded by the hypermobility of the joint, can gradually cause the bunion to deform further and shift its alignment.

To illustrate, consider the analogy of walking 1000 steps a day. With flattening arches and hypermobile bunion joints, each step places significant pressure on the bunion, gradually altering its position and contributing to its deformity.

Over time, this continual stress and misalignment can lead to the development or worsening of bunions in flat-footed individuals.

In essence, while the presence of arch flattening alone does not directly cause bunions, the combination of flat feet and hypermobility syndrome can create an environment where bunions are more likely to develop or progress.

Understanding this relationship underscores the importance of addressing both arch flattening and hypermobility to mitigate the risk of bunion formation and promote overall foot health.


3. X-shaped Legs

X-shaped legs, also known as knocked knees or genu valgum, present a distinctive alignment where both knees touch together while standing and walking, resembling the shape of the letter "X". This condition often stems from flat feet and weakened external hip rotator muscles.

Collapsing of the feet' arches contributes significantly to the manifestation of X-shaped legs. When the arches of the feet collapse or are insufficiently supported, the shins are prone to inward rotation, altering the alignment of the knees.

This inward rotation is further compounded by weakened hip muscles, particularly the abductors and external rotators, which play a crucial role in stabilizing the pelvis and maintaining proper leg alignment.

It's essential to recognize that solely addressing the alignment of the knees does not address the underlying causes of X-shaped legs. Instead, the focus should be on correcting the biomechanical imbalances such as the underperforming balls of feet that contribute to this condition.

Strengthening the muscles surrounding the hips, as well as addressing any issues related to arch flattening can help alleviate strain on the knees and promote more optimal leg alignment.

The consequences of untreated X-shaped legs extend beyond mere aesthetics. Individuals with this condition may experience increased stress on the outer knee condyles, leading to accelerated wear and tear over time.

This heightened strain on the knee condyles can predispose them to various orthopedic issues, including knee osteoarthritis, particularly in their late 30s to early 40s.

Furthermore, X-shaped legs can impede daily activities such as walking and running, as the altered biomechanics place additional strain on the lower limbs. This may result in discomfort, fatigue, and reduced mobility, affecting overall quality of life.

By addressing underlying issues of arch flattening and weak hip muscles, individuals can mitigate the risk of orthopedic complications, improve biomechanical efficiency, and enhance overall walking ability.


4. O-Shaped Legs

Similar to X-shaped legs, O-shaped legs, also known as bowed legs or genu varum, involve complex biomechanical factors, including flat feet and knee misalignment. 

Flattening of the feet' arches plays a significant role in the manifestation of O-shaped legs. When the arches of the feet collapse or are inadequately supported, the lower limbs are predisposed to inward rotation, altering the alignment of the knees.

Concurrently, individuals with hyperextended knees, a condition where the knees extend beyond the normal range, further contribute to the distinctive O-shaped appearance of the legs, with the knees positioned farther apart.

O-shaped legs increased stress on the inner knee condyles, and share similar consequences with X-shaped legs, including accelerated wear and tear, and a heightened risk of orthopedic issues especially knee osteoarthritis.

Similar to X-shaped legs, individuals with O-shaped legs may encounter difficulties in daily activities such as walking and running due to altered biomechanics and increased strain on the lower limbs.

Addressing O-shaped legs necessitates a holistic approach that addresses both the structural and muscular imbalances contributing to the condition. This approach may encompass various interventions, including targeted strengthening exercises for the inner thigh. 

Addressing issues associated with arch flattening is crucial. By targeting these underlying factors, individuals can effectively reduce the risk of orthopedic complications, optimize biomechanical efficiency, and enhance overall walking ability.


5. Anterior Pelvic Tilt

Have you ever seen a sweet and pretty girl walk like a gangster, I.e. the trunk is moved forward, and the hip is tilted backwards excessively with the chest wide open? That is the walking posture of anterior pelvic tilt. 

Some people may think walking in this posture is beautiful because it enhances the natural curvature of a woman's body. However, the natural curvature of the body should solely be due to a good ratio of the circumferences of the chest, waist and the hip. 

Excessive trunk and hip tilt is achieved by abnormal spinal and pelvic rotation and this phenomena implies great stress to the spinal joints, most commonly the neck spine at C5,C6,C7,T1 and T2, and the lower back spine at L4,L5,S1, and S2. 

A spine and pelvis with its natural curvature and alignment are in their strongest form to take the weight of the human body and they allow the transfer of weight within the extremities (arms and legs) through the spine.

Let’s say a woman is carrying her 10kg son from the floor, the woman bends her back without proper maintenance of the spinal and pelvic alignment, most of the 10kg weight is born by the spinal columns and may cause slippage of the spinal columns. 

However, if the same woman maintained her healthy spinal and pelvic alignment while bending over, the 10kg weight will be mostly born by the hip muscles such as the gluteus muscle and the hamstring (back of the thigh) muscles. A simple alignment changes could mean spinal injury or the joy of playing with the offspring.

In some cases, anterior pelvic tilt is caused by the inability of the ankle to dorsiflex during the walking gait. Imagine a woman walking on a flat surface, the shins travel forward when the foot lands on the floor.

A woman with limited ankle dorsiflexion will not be able to have her shin travel forward and therefore she has to compensate for the body's forward movement by leaning the trunk forward. This is how anterior pelvic tilt is trained and made into a habit.

What are the odds of having a limited ankle dorsiflexion? It appears to be a common issue among growing teenagers who have limited exposure to calf stretching. Calf stretching is usually done in a lunging stretch but it can also be done when someone walks up a slope or runs.

It is not unusual for a growing teenager to be exposed to too little calf stretching and end up with limited ankle dorsiflexion and eventually flat overpronation. In this case, it appears that flat foot and anterior pelvic tilt coexist in the case of limited ankle dorsiflexion. However, there is also a possibility that anterior pelvic tilt is caused by flat feet that are not due to limited ankle dorsiflexion.

A flat foot has an ineffective push-off ability to propel the body forward in a walking gait. This could lead to the person excessively leaning the body forward just to feel like his body is being propel forward. It is possible for flat feet due to weak muscles to coexist with limited ankle dorsiflexion due to a lack of calf stretching.

A wise treatment plan for anterior pelvic tilt would include a thorough biomechanical assessment from the foot to the ankle before assessing the spine and the pelvis.

The body is constantly acting upon gravity and the contact points of the body with the earth are the feet. The flexibility of the ankle and the strength of the feet dictate the way the body moves. 

At SpineCare Engineering, a biomedical engineering center, our mission is to improve children's gait and our vision is to ensure that childhood excitement becomes a lasting gift. Your child's well-being is our priority, and we're here to provide guidance and support every step of the way.

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