Why Do My Flat Feet Hurt? 3 Factors Causing Your Pain

If you have flat feet and you're dealing with heel pain, bunions, aching feet, ankle problems, or other recurring foot pain, you may be wondering if your flat feet are the cause.

The answer is probably—but not necessarily.

Are My Flat Feet The Cause Of My Foot Pain?

Some people have very flat feet and never experience any problems from them. Others develop plantar fasciitis, Achilles tendonitis, bunions, tendon problems, and other painful foot and ankle conditions that may be related to the way their flat feet function.

Why do flat feet cause pain in some people and not in others? 

The reason is that not all flat feet are created equal. 

• Little or No Arch. Most people think flat feet simply means having little or no arch. That's only part of the story.
  
  
• Foot Function. When I evaluate someone with flat feet, I'm much less concerned about how the foot looks than I am about how it functions. Think of your foot like the suspension system on your car. If the suspension is too stiff, it doesn't absorb shock very well. But if it's too loose, you have a different problem. The car becomes unstable and other parts have to work harder to control all that extra movement. 
  
  Your feet work in a similar way. They're supposed to move. That flexibility helps absorb shock and allows your feet to adapt to the ground. But they also need to become stable enough to support your body and push you forward. When a foot moves too much, the muscles, ligaments, joints, and tendons have to work harder to stabilize it. Over thousands of steps a day and millions of steps over a lifetime, that extra stress can add up.
  
  
• Flat Foot Type. One of the things I look at is whether you have a flexible or rigid flat foot.
  
  
  • Flexible Flat Foot 

    With a flexible flat foot, you may have a visible arch when you're sitting. You may even see the arch reappear when you stand on your tiptoes. But when you stand normally and put your full weight on the foot, the arch drops. That flexibility can also allow the foot to roll inward more when you walk.

    That inward rolling motion is called pronation, which is completely normal. Your foot needs to pronate to help absorb shock and adapt to the ground.

    The problem occurs when the foot rolls inward too much, stays in that position too long, or doesn't become stable when it needs to. That's what we call overpronation. When the foot rolls inward too much or doesn't become stable when it should, the forces traveling through the foot change. Over time, that can put extra stress on certain joints, tendons, ligaments, and muscles.

  • Rigid Flat Foot

    A rigid flat foot is different.

    The arch remains flat whether you're sitting or standing, and the joints don't move as freely.

    Instead of having too much motion, a rigid flat foot may have too little motion. The foot can't adapt to the ground or absorb forces as well as it should, so other areas may have to compensate. That can also lead to pain and other foot problems.

    So both flexible and rigid flat feet can cause problems—but for very different reasons.

• Tight Calf Muscles. One thing I check in almost every patient with painful flat feet is their calf tightness. If you have very loose calf muscles, you’re much less likely to have pain due to flat feet. On the other hand, if you have tight calf muscles your ankle can't move through its full range of motion. Your body has to compensate somewhere. For many people, that compensation happens in the foot. Instead of the ankle moving properly, the foot rolls inward more than it should. That places even more stress on the plantar fascia, the Achilles tendon, and the tendons supporting your arch. It's one of the reasons I spend so much time encouraging patients to stretch their calf muscles. Sometimes improving ankle flexibility can dramatically reduce the stress placed on the foot with every step. Learn more about how to relieve tight calf muscles here!

Why Do People Have Flat Feet?

Genetics

For many people, genetics plays a major role. I often see parents bring in children who have the same type of feet they do. That's because foot structure is often inherited. But what you inherit isn't necessarily just a low arch.

Develop Later in Life Due to A Variety of Factors

• Aging
• Injuries
• Arthritis
• Diabetes
• Weight changes
• Weakening of the tendons that support the arch can also cause feet to flatten.

In Summary

To sum up if you have flat feet, 3 factors can influence the type of foot condition you develop or whether you develop one at all.

1. Whether you have a flexible or rigid flatfoot
2. How much you overpronate.
3. The tightness of your calf muscles.

Conditions Caused by Flat Feet and Other Factors 

Plantar Fasciitis

Let's start with one of the most common—plantar fasciitis.

The plantar fascia is a strong band of tissue that runs along the bottom of your foot and helps support your arch. When the foot moves excessively and you have tight calf muscles, the plantar fascia can be repeatedly stretched and overloaded. Over time, that can contribute to plantar fasciitis.

So if you've been treating your heel pain but haven't looked at how your foot is functioning or your tight calf muscles, you may be missing an important part of the problem.

And if you're a runner with flat feet and heel pain, check out the video below.

Bunions

Now let's talk about bunions, because this connection surprises a lot of people. Bunions often run in families, so genetics certainly matter. But you're not simply inheriting the bump. You're often inheriting a type of foot structure and the way that foot functions.

When the foot is unstable and rolls inward excessively (overpronation), it can change the forces going through the big toe joint. Over many years, those abnormal forces can contribute to the big toe drifting toward the smaller toes and the bunion becoming progressively larger.

So when I evaluate a bunion, I'm not just looking at the bump. I'm looking at the entire foot and asking why the bunion developed in the first place?

Achilles Tendonitis

Excessive motion can also affect the tendons around the foot and ankle. One of those is the Achilles tendon. If the foot is moving excessively underneath it, the Achilles may be subjected to abnormal stress with every step and cause Achilles tendonitis.

Posterior Tibial Tendonitis

One of the most important structures is the posterior tibial tendon, which helps support your arch. If that tendon weakens or becomes damaged, a once normal arch can gradually begin to collapse, leading to a condition called Posterior Tibial Tendonitis. If one of your feet seems to be getting flatter, particularly if you have pain or swelling along the inside of the ankle, have it evaluated.

Flat Feet in Children

Young children naturally tend to have flatter-looking feet. As they grow and develop, their feet change and an arch often becomes more noticeable.

Many children also have flexible flat feet.

If a child is active, isn't having pain, and can comfortably participate in normal activities, a flat-looking foot doesn't automatically mean something is wrong.

There are situations, however, when a child's flat feet should be evaluated—especially if there's pain, difficulty with activities, unusual stiffness, or a noticeable difference between the two feet.

Check out the video below.

Other Problems Associated With Flat Feet

Flat feet and excessive motion can contribute to other problems as well.

They can also lead to:

• Shin splints
• Hammertoes
• Ball-of-foot pain
• Neuromas
• Ankle instability or repeated ankle sprains
• General aching or tired feet
• Knee, hip, and back pain

Does that mean every person with one of these conditions has flat feet? Absolutely not. And it doesn't mean flat feet are always the only cause. Usually, several factors are involved. That's why it's important to look at the whole foot rather than simply treating the spot that hurts.

How Flat Feet Can Cause Pain in the Hips, Knees, and Back

Flat feet can contribute to problems further up the body. Why? When your foot rolls inward excessively, the lower leg can rotate with it. That can influence the way your knee moves. Changes at the knee can influence the hip, and your body may continue compensating all the way up through your pelvis and lower back.

That doesn't mean your flat feet are necessarily causing your knee, hip, or back pain. There are many possible causes of pain in those areas. But foot mechanics can sometimes be one piece of the puzzle, which is why it's important to look at how the entire lower extremity functions.

If you’re currently experiencing any of these foot or musculoskeletal conditions, we can alleviate your pain and prevent your condition from getting worse.