Leveling with flat feet – foot related injuries

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Twelve years ago, the U.S. Navy’s physical therapists took one look at Milo Prodanovich’s feet and concluded it was impossible for him to run. Given his incredibly flat feet and the prevailing wisdom at the time, their appraisal was understandable. Flat feet were viewed as the scourge of able-bodied folk, and no feet were flatter than Prodanovich’s.

“My feet are so flat,” says Prodanovich, “that they leave suction-cup marks on the road when I walk.”

By the time the navy told Prodanovich he shouldn’t be running, he had already been doing so for 13 years, logging between 30 and 50 miles a week. Prodanovich ran through his stint with the navy, and is still at it, feet as flat as ever.

Moral of the story: Flat feet don’t necessarily preclude you from running. But they can cause you some trouble if you’re not careful.

“You can’t just look at a flat-footed person and say, Gee, you’re going to have problems running,’ ” says Lloyd Smith, D.P.M., a Newton, Mass., sports podiatrist and past president of the American Academy of Podiatric Sports Medicine. “A lot of people who run, and run very successfully, have flat feet. Yet we do know that people with flat feet have a greater chance of getting injured than people with normal-arched feet.”

How can you tell if you have a genuinely flat foot?

Try taking the Wet Test. Wet your feet and then stand on a flat, dry surface that will leave an imprint of your foot. When you look at the imprint, you should find that you have one of the following foot types.

The flat foot

Description: Flat feet have a low arch and leave a nearly complete imprint; there’s little inward curve where the arch should be.

Foot characteristics: This imprint usually indicates an overpronated foot that strikes on the outside of the heel and rolls inward excessively. Over time, this can cause many different kinds of overuse injuries. Runners with flat feet often need motion-control or stability shoes.

The normal foot

Description: Normal feet have a normal-sized arch and leave an imprint that has a flare but shows the forefoot and heel connected by a wide band.

Foot characteristics: A normal foot lands on the outside of the heel, then rolls inward (pronates) slightly to absorb shock. Runners with a normal foot and normal weight are usually considered biomechanically efficient and don’t require motion-control shoes.

The high-arched foot

Description: High-arched feet leave an imprint showing a very narrow band connecting the forefoot and heel.

Foot characteristics: A curved, high-arched foot is generally termed a supinated or underpronated foot. This type of foot usually doesn’t pronate enough, so it’s not an effective shock absorber. Runners with high-arched feet often need shoes with superior cushioning

Fortunately, genuine flat feet, such as those beauties sported by Prodanovich, are actually quite rare. “Most runners who think they have flat feet actually have low-arched feet,” says Richard Schuster, D.P.M., a semi-retired podiatrist living in Florida. “Their arches may be very low, but there is an arch there.” The good news is that having low-arched feet is not necessarily a handicap, either.

Schuster estimates that one-third of the populace have flat feet or low-arched feet, one-third have normal-arched feet, and one-third have high-arched feet. Given a choice between low and high arches, Schuster would choose low-arched feet every time. Why? Low-arched feet are more flexible; rigid, high arches are more likely to produce muscle strains and pulls. Low-arched feet also absorb the shock of running better than high-arched feet, simply because more of the foot spreads across the ground.

“Runners with low-arched feet generally don’t have to worry,” says Schuster. “The runner with high-arched feet is usually the one with more problems. This is a highly complex situation, but generally a low-arched foot is a fairly strong foot. A lot of runners probably have low-arched feet and don’t even know it.”

The possibility of injury

Many running injuries begin with the feet no surprise, since they are the first part of your body to absorb running’s shock.

Running on true flat feet is akin to running on Jell-O. Flat feet tend to overpronate. This often causes the legs to collapse inward with each footfall. Left unchecked, this can lead to overuse injuries ranging from shin splints to aches and pains in the ankles, knees, hips and lower back.

“If your foot is flat and you don’t have proper support, all the problems that occur can be the result of your feet,” says Joe Ellis, D.P.M., coauthor of Running Injury-Free (Rodale Press, Inc., 1994). “It’s hard to be specific about the type of injuries flat feet cause because they can cause all sorts of things.”

Preventing injury

Low arch or no arch, there are certain precautions you can take to lessen the risk of injury:

Buy appropriate running shoes (this alone can help keep you injury-free). The best shoes for flat-footed runners are motion-control or stability shoes with firm midsoles and features such as a medial post to reduce pronation. Do not wear shoes with lots of cushioning and little support; this allows too much pronation.

Avoid uneven running surfaces. Golf courses and trails may sound soothing to aching ankles and knees, but uneven ground can accentuate your pronation problem and make matters worse.

If your aches and pains persist despite these precautions, see a sports podiatrist.

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