Flat feet or tendon problems: When should you be concerned?
When it comes to foot biomechanics or posterior tibial tendon dysfunction, there are a lot of conflicting opinions online. The height of the foot arch is often at the center of the debate: is it responsible for the development of our pain?
As with any scientific question, the answer is more complex than a simple “yes” or “no.”
Is there really such a thing as “bad” foot posture?
When a professional assesses the function of the foot and lower limb, they observe both its appearance and how it moves. Many people tend to blame the shape of the foot (the ideal “scapegoat”) or the way it supports the body as the cause of pain.
However, it is crucial to distinguish between natural morphological variation and a true pathology. The latter leads to changes or progressive weakening, including a collapse of the arch.
- The Case of Flat Feet : Although a low arch can sometimes be associated with a progressive condition called “Posterior Tibial Tendon Dysfunction” (also known as PTTD), it is essential to note that the majority of people with flat feet will never develop this condition.
- Natural variation : Similarly, a low or high arch may sometimes be associated with certain symptoms. These symptoms can be attributed, in particular, to prolonged stress on certain structures or age-related changes in tissue, such as a decrease in shock-absorbing capacity. However, a structural or functional variation does not automatically guarantee the onset of symptoms.
- Adaptability : The natural variability in foot shape, combined with the foot’s ability to remain strong and adaptable in the face of daily stresses (such as walking, standing, or physical activity), makes it impossible to make any universal statements or recommendations in biomechanics.
That is why regular check-ups with a qualified professional can help ensure that no treatment is needed and allow for early detection if any changes or deterioration occur.
The short answer : A low arch isn’t necessarily a problem.
What is the PTTD?
Posterior Tibial Tendon Dysfunction (increasingly referred to as Progressive Flatfoot Deformity) is a condition in which the tendon, along with other supporting structures, becomes irritated and weakens. This process gradually alters the way the foot bears weight during walking.
Signs and symptoms to watch for:
- Pain along the inner side of the ankle and under the arch of the foot.
- Noticeable collapse of the arch when standing or walking.
- The heel tilts inward when standing.
- The forefoot turns outward when standing or walking.
- Difficulty rising onto the toes with control.
- Sharp pain upon palpation of the posterior tibial tendon.
Progress and prognosis :
Clinically, DTTP is classified into stages. Early stages are often reversible and treatable. More advanced stages, which involve greater stiffness, are generally managed to stabilize symptoms and prevent further deterioration.
Without appropriate intervention, the loss of arch height often becomes difficult to restore. That said, the tissues can be strengthened to better tolerate weight-bearing, thereby creating a “new normal” for the foot and lower limb.
If the posterior tibial tendon were to fail completely, movements such as standing on tiptoes with control could be seriously compromised, affecting foot stability, the foot’s ability to act as a stable lever during the push-off phase, and weight transfer while walking.
In some cases, surgical reconstruction may be necessary to restore control of the hindfoot.
What you can check at home
These simple screening tests can help you determine whether you need to see a professional:
1. Bilateral heel raises : Stand on your tiptoes while holding onto a wall, and assess how smooth the movement is. If this is difficult, try repeating the test on one foot at a time to compare the sides.
2. Single-leg raise : Try standing on one foot at a time. Note if one side feels weaker, less controlled, or more painful than the other.
Please keep in mind, however, that these tests do not provide a diagnosis but serve as an indicator of whether you should seek medical advice.
The Benefits of Manual Therapy and Interdisciplinary Care
It’s important to clarify that manual therapy does not “put things back in place,” contrary to some claims you might find online. It acts as a lever to help muscles and tissues function better and to reduce the perception of pain. This can make movements more fluid, reduce the “knotted” sensation you may be experiencing, and facilitate your participation in the rehabilitation process.
As osteopaths, we can collaborate through interdisciplinary approaches, particularly to:
- Modulate the “intensity” of pain to facilitate rehabilitation.
- Improve the fluidity of movement and tissue mobility.
- Strengthen tissues so that the foot can better tolerate weight-bearing.
When should you see a professional?
It is generally recommended that you see a qualified professional as soon as possible. Seek medical advice if you experience:
- A sudden loss of function or strength.
- Persistent swelling.
- Severe pain or weakness that does not improve after about 2 weeks.
- Discomfort that limits your ability to perform daily activities.
Conclusion
A low arch, in and of itself, does not automatically mean that a condition is developing or that treatment is necessary. However, it may potentially indicate TTPD if other signs and symptoms are present. A structured treatment plan can improve the majority of mild to moderate TTPD cases. The key is to remain attentive to changes and to encourage movement.
Working with an osteopath can help reduce symptoms and restore movement, facilitating a safe return to your daily activities. Don’t hesitate to consult our practitioners to relieve your symptoms.