For many many years, if not centuries, researchers, medical professionals and the final population have believed that individuals with flat feet are more vulnerable to developing a wide range of problems.
Specifically, having flat feet was believed to predispose individuals to future pain and other musculoskeletal problems (i.e. to muscles, tendons and/or ligaments).
Flat feet were believed to be a form of time bomb.
However, in a recent editorial published within the British Journal of Sports Medicine, my research team challenges this myth. We show that the idea that having flat feet inevitably results in pain or other musculoskeletal problems, is unfounded.
As a researcher in podiatric medicine on the Université du Québec à Trois-Rivières (UQTR), I’ll explain the essential conclusions of our study here.
Where does this theory come from?
The concept that flat feet are an issue dates back centuries.
It was revived within the second half of the twentieth century by the American podiatrists Merton L. Root, William P. Orien and John H. Weedwho popularized the concept of “ideal” or “normal” feet.
These clinician-researchers were the primary to propose that if feet didn’t meet the precise criteria of normality (for instance, a well-defined plantar arch, a straight heel consistent with the tibia) they were abnormal, less efficient and more vulnerable to injury due to multiple biomechanical compensations, equivalent to greater arch flattening while walking.
This theory became central to the tutorial programs of health professionals. Although today it’s step by step disappearing as modern curricula are updated, the idea was taught for nearly five many years throughout the world, regardless that the scientific basis was weak. In fact, science has never validated the idea: it has remained on the hypothesis stage.
Nevertheless, over time up until the current, many health professionals have continued to support the idea that flat feet pose a serious risk for developing musculoskeletal disorders.
As a result, this concept remains to be firmly anchored within the beliefs of most of the people.
Do flat feet cause musculoskeletal injuries?
Contrary to the idea of Root and colleaguesmeta-analyses, the best level of scientific evidence, have shown no increased risk of developing the overwhelming majority of musculoskeletal injuries amongst individuals with flat feet.
These meta-analyses only identified weak links between having flat feet and the chance of developing medial tibial stress syndrome (pain within the tibia), patellofemoral syndrome (pain across the kneecap), and non-specific overuse injuries of the lower limbs.
That’s it.
Furthermore, a systematic review and a meta-analysis concluded that runners with flat feet aren’t any more liable to injury than those with regular feet.
These analyses call into query the concept individuals with flat feet have a considerable risk of developing musculoskeletal disorders.
However, despite these findings, various sources equivalent to grey literatureskilled web sites, forums and other media, often suggest that individuals with flat feet run the next risk of injury, and even require treatment — even once they don’t have any symptoms.
Unfortunately, this often leads to people having unnecessary interventions, equivalent to using orthopaedic shoes or custom-made foot orthoses for asymptomatic flat feet. It also results in significant concerns amongst patients concerning the appearance of their feet.
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Setting the record straight
Asymptomatic flat feet generally don’t require the intervention of health professionals. Based on current scientific knowledge, assessing whether an individual has flat feet to find out their risk of injury is ineffective and counterproductive.
While it is feasible for an individual with flat feet to develop a musculoskeletal injury, this doesn’t necessarily mean that flat feet caused the injury.
It is kind of possible for 2 variables to be present at the identical time without there being a causal link. There is a vital difference between a causal link and a correlation. A cause-and-effect relationship implies that a change in a single variable (the cause) results in a change in one other variable (the effect). When two variables are correlated, changes in a single variable could also be related to changes in the opposite, but this doesn’t mean that one causes the opposite.
To illustrate the concept, let’s take the next example: we give 500 children aged six to 12 the identical math test. By carrying out correlation tests, we notice a trend: the larger the kids’s feet, the upper their final mark within the exam.
This raises the query, does foot size really influence mathematical skills? Of course not!
Another variable that is just not taken into consideration, age, plays a serious role on this correlation. Since feet get greater as we get older, there may be a robust but false correlation!
The same principle applies to flat feet. If a musculoskeletal injury occurs in an individual with flat feet, current research indicates that flat feet are usually not necessarily the cause and that other aspects should be explored.
The link is one in every of correlation, not cause and effect.
Reducing overdiagnosis in health care
Reducing overdiagnosis in health care has grow to be crucial. This phenomenon, defined because the diagnosis of a condition that brings no net profit to the person, constitutes a worldwide burden with potential antagonistic effects on patients’ physical, psychological and financial well-being.
In financial terms, it is straightforward to know that prescribing custom-made foot orthoses costing a whole lot of dollars to forestall musculoskeletal injuries related to asymptomatic flat feet, has a considerable negative impact. This is particularly true provided that the presence of flat feet only barely increases the chance of developing these injuries.
To solve this problem, health-care professionals must help to cut back the overdiagnosis of flat feet by making a clearer distinction for his or her patients between harmless anatomical variants, and conditions of potential concern.
Since overdiagnosis often results in overtreatment, avoiding unnecessary treatments will help to alleviate patients’ concerns about their flat feet.
Finally, we must abandon the outdated idea, still widespread, that claims having flat feet is an issue that exposes individuals to a high risk of musculoskeletal injury. It’s time to alter our perspective and our approach to the importance of flat feet and to acknowledge their natural diversity within the context of overall foot health.
Above all, it’s time to contemplate asymptomatic flat feet for what they’re…simply an anatomical variant!
