Definition

Collapse of the internal longitudinal and transverse arches of the foot. Eversion of the foot is associated in many cases.


Symptoms

A sensation of weakness and strain on the medial (inner) side of the foot. Pain and aching at night, which is increased on weight bearing. The pain usually centers on the inner border, or at the metatarsal heads. Referred pain to the calf, knee, hip, or low back is common. Loss of “spring” in step, with awkwardness. Feet tire easily, numbness, cramping.


Etiologic Considerations

• Excess weight-bearing (carrying heavy weights, obesity, pregnancy) • Weak muscles • Prolonged standing • Improper foot wear • Previous strain, sprain, or fracture • Knock-knees • Poor body mechanics-weight-bearing center incorrect • External rotation of leg • Heredity • Congenital (abnormal talus bone) • Shortening of Achilles tendon • Improper walking habits • Arthritis, rickets, or calcium deficiency • Walking with foot everted • Claw toe walking • Muscle paralysis or weakness-due to disease such as polio or muscular dystrophy • Spinal lesions


Discussion

The foot is a very complicated functional unit, composed of 26 articulating bones. It is supported by an internal longitudinal ligament (spring ligament), external longitudinal ligament, and anterior and posterior transverse ligaments. It is not the function of the ligaments, however, to withstand prolonged weight bearing. It is the muscles that provide the foot with its real support.

In the weight-bearing position, there is a natural tendency of the foot to evert (turn outward), which is counteracted by the muscles of the feet. If these muscles weaken and eversion becomes chronic, the weight distribution on the foot becomes severely altered. Instead of a balanced distribution of weight through all the ligaments of the foot, the whole weight is thrown onto the internal spring ligament, which is not designed to handle such stress.

In the normal step, weight is first carried by the heel (calcaneus), passed down the outer border of the foot to the five metatarsal bones in the front of the foot, with a final push-off from the big toe. If the muscles become weak, the ligaments are overburdened, and they begin to stretch. This leads to bone displacement and, finally, permanent bone changes. In specific medical terms, what occurs is a movement of the talus bone forward and medially (toward the midline). This can then be found displaced toward the inner side of the foot. The navicular bone is depressed and the heel (calcaneus) rotates posteriorly downward and everts, so that walking is done more on the inner border. With these actions, the entire foot can be seen to evert in the typical flat-footed position, the foot then widens, as the transverse arch collapses and the forefoot abducts or moves away from the midline.

These foot changes may further affect muscular balance in the calf, leg, hip, and low back, causing tiredness, pain, rotation of the fibulae, and sacroiliac or lumbar spinal lesions.

The most detrimental influences causing flat feet are a combination of excess weight bearing, weak muscles, calcium deficiency, and poor body mechanics.

The most obvious cause of excess weight bearing is obesity. Occupations that require repeated or prolonged lifting also may be a factor. Muscles may become weakened by lack of general muscular tone, excess burden, nutritional deficiency (especially calcium deficiency), spinal lesions upsetting nutritional and nervous supply to muscles, trauma or previous strain, or poor spinal mechanics causing muscle imbalances and weakness.

Poor spinal mechanics may also be a factor in several other ways. Habitual walking with the foot everted places the weight burden on the weaker inner spring ligament, straining the arch and overburdening the muscles, which then weaken, allowing the ligaments to stretch. The big toe is then forced to push off in a position of adduction, creating the complication of hallux valgus, in which the toe rotates and then crosses over its neighbor. The increased lumbar curve caused by wearing high heels throws the weight center forward onto the front part of the foot. The same situation occurs with the condition called visceroptosis, where the abdomen sags due to weak abdominal muscles, obesity, or spinal lesions, causing the center of gravity to alter, affecting the feet. The muscles between the toes (lumbricals and interossei) then weaken, due to the excess burden. The toes may also begin to “claw,” favoring a collapse of the anterior transverse arch, which is associated with the condition called metatarsalgia.


Treatment

Normally the arches only begin to form when the child has been walking for a year or so. This means that it is normal for a toddler to show some degree of flat feet, and normally it is no cause for alarm. In some cases, however, arches do not form due to congenital causes and special shoes are required.

Three degrees of flat feet are recognized:

First-degree flat foot is a postural deformity with alteration in the muscles and ligaments but only minor displacement of bone or pain. Complete correction is possible with proper treatment.

Second-degree flat foot shows slight bone change and muscle damage. Complete correction is no longer possible, but stabilization and strengthening will relieve the symptoms of pain and weakness to a large degree.

Third-degree flat foot shows permanent bone changes, with some arthritis and rigidity. No cure is possible.

As you can see, it is very important to treat flat feet in the earliest stages to prevent permanent bone deformity.

Diet

It is essential that the diet contain a large amount of readily absorbable minerals, especially calcium. Contrary to popular belief, dairy products are not the most desirable source of calcium. A far better source is raw green vegetables taken with a slightly acidic salad dressing containing apple cider vinegar or lemon juice. Salads or cooked vegetables should be eaten in large quantities with both lunch and supper. Dairy products, in most cases, should be reduced if a large portion of the diet has been concentrated on this source in the past. Less red meat and more fish or vegetarian proteins are also suggested. Soy milk contains more 2. times the amount of bioavailable calcium as dairy milk does.

Physiotherapy

The main part of therapy lies in physical therapies. These must be done daily for any real results.

Exercises — Standing
  • Spring up*: Stand on hard floor, rise gently onto toes and then “spring up” (hop on your toes). This should be done in the morning before shoes go on, and repeated fifteen to thirty times. Repeat again in evening.
  • Rise and sink*: Stand on forefoot with hands over the head and slowly rise onto toes. Lower arms in front of body and gradually sink down to the flat foot and heel. Repeat ten to twenty times two times per day.
  • Heel-to-toe-rock*: Stand on the flat feet and rock heel to toe for 2 to 3 minutes two times per day.
  • Scrunch*: With shoes on, scrunch the toes up against the bottom of the shoe so that the foot arches. Do this six to ten times and repeat up to ten times per day.
  • Pick up*: Pick up a ping-pong ball or a large marble with the toes. Make this into a game.
  • Bean bag game*: Make 3-inch-square or round beanbags. Pick up bags with toes and then toss them into a target such as a small wastebasket or hat.
  • Ostrich step*: Walk in a straight line with weight on the outer borders of the foot and toes curled downward and inward. Raise each foot so that it is opposite the other knee before placing it down to the ground.
  • Incline board walk*: Nail two boards (8- to 10-feet long and 8- to 12-inches wide) together along their long edges to make an equilateral triangle with the ground. Walk along the boards with one foot on each board. Repeat ten to twenty times two times per day.
  • Hip Rotation*: Stand with feet 2 to 3 in. apart. Contract gluteal muscles (seat) and rotate the hips outward while keeping the toes, outer foot, and heels firmly on the ground.
  • Push Out*: Stand with the feet 2 in. apart and attempt to force them apart, thus putting weight and stress on the outer portions of the foot, but do not move the feet. Slowly relax and repeat ten to twenty times.
  • Toe Rise*: Rise onto the toes and slowly tilt the weight onto the outer borders of the ball of the foot. Repeat ten to twenty times two times per day.
  • Outer Foot Stand*: Knees are held parallel and then slowly rolled outward so that the weight is placed on the outer borders of the foot.
  • Outer Border Walk*: Walk on outer borders of foot.
Exercises — Sitting
  • Heel raising and lowering.
  • Sit with feet crossed resting on outer borders.
  • Sit cross-legged.
  • Press toes against ground, but do not raise any part of foot off ground.
  • Place thin book under toes and flex forefoot, rising up onto forefoot, keeping toes straight. This is a very important exercise.
Local Therapy
  • Postural and muscular reeducation and exercises: With special work on Achilles tendon, calves, quadriceps, gluteals, para-vertebral lumbar muscles, and abdominals.
  • Deep muscle massage to plantar fascia, entire foot and lower limbs with: peanut oil, 8 oz; witch hazel, 2 oz; rubbing alcohol, 4 oz; oil of sassafras (possibly toxic; use with supervision), 3 to 10 drops; tincture of capsicum, 2 drops. Mix well and repeat massage two times per day.
  • Tannic acid foot and lower leg baths: Made by boiling old coffee grounds and water for 10 minutes. Apply hot and massage feet and lower legs while soaking, 20 minutes per day.
  • Alternate hot and cold footbaths.
  • Spinal therapy (to specific lesions).
  • Local manipulation: General joint mobilization. Treat talus, which has rotated anteriorly and medially; navicular, which is depressed; and calcaneus, which is everted.
  • Footwear: The front of the shoe should not compress toes and should have a straight inner border from heel to big toe. Soft, resilient arch supports are useful. In later stages of the disorder an inner wedge heel lift of 0.5 cm may be needed. This raises the inner border of the heel to counteract its tendency to evert.

Therapeutic Agents

Vitamins and Minerals

Calcium*: 400 to 800 mg per day.

Vitamin C*: 500 to 3,000 mg per day or more.

Vitamin A: 4,000 to 25,000 IU two times per day. Use any dose of vitamin A over 50,000 IU per day with medical supervision only.

Vitamin B: 25 to 50 mg two times per day.

Multiminerals, e.g., Celtic salt

Magnesium: 200 to 400 mg per day.

Silica

Botanicals

Horsetail (Equisetum arvense)

Therapeutic Suggestions

Exercise, Exercise, Exercise!

Suitable Treatments
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Excerpts from Better Health Through Natural Healing 3rd Edition

First published in 1985, Better Health through Natural Healing has become one of the most successful and authoritative resources of its type, with more than 1.5 million copies sold worldwide. Since the original publication of this comprehensive guide, alternative therapies have become more and more accepted by the mainstream, and patients and practitioners of the wider medical community are embracing complementary medicine as an effective treatment option for a range of medical conditions.

The book is available at the West End clinic, exclusively in Australia.


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