The human foot is a complicated thing. It is made up of 26 bones that are connected by 33 joints and 107 ligaments, with 19 muscles and tendons that help to control movement and provide stability. Feet come in many shapes and sizes and the shape and posture changes with age. The posture of an adult foot in standing is often described as being either pronated, neutral or supinated. These three foot types relate to the position of the heel bone and to the arch or instep. When a foot is said to be supinated, the arch appears to be very high. At the other end of the spectrum is the pronated or flat foot, where there is either a very low arch or none at all. Both of these foot posture extremes have been linked to foot pain conditions and also to problems higher up, including the shins, knees, hips and back. However, it has been the flat foot posture which has historically received most bad press, despite the fact that many people with flat feet never experience problems.

Flat feet only need attention if a clear link can be identified with a specific pain condition. In such cases, the use of well fitting shoes or corrective insoles may help. However, simply correcting a faulty foot posture may not sort out the problem. Even if the complaint is localised to the foot, It is important to fully assess the rest of the body, as there are frequently other issues that need to be addressed. A commonly associated factor with flat feet is tightness of the calf muscles or of ankle stiffness. In such cases, the foot adopts a flattened posture to compensate for the restriction of movement at the ankle. Weak muscles may also play a part in causing the foot arch to drop, by allowing the thigh and knee to drift excessively inwards when walking or running, with the result being too much inward and downward pressure through the foot, causing it to flatten. Weakness of the foot muscles is also a common feature of painful flat feet. Simply using insoles to correct a flat or over pronating foot, could make this weakness worse as the weak muscles aren’t encouraged to work. Rather than being the cause of a painful condition, many flat or over pronated feet are often the result of other factors such as restricted mobility and reduced muscle control and strength.