Are you worried about the Flat foot in your Children?  What should parents know?
History of Human Feet:

The human foot is a fantastic structure that helps in weight-bearing and locomotion. That means it must take care of stability as well as mobility. Each foot is controlled by 13 extrinsic muscles and 21 intrinsic muscles. With 26 bones and 33 joints, the human foot is a complex structure yet robust. While standing and walking, the entire body weight must fall on the foot, so evolution has made the human foot very strong. Stone age humans never used footwear, and there were no concrete surfaces to walk on those days. To meet the demands of extreme terrains, the foot evolved to form an arch. Even 200 years before, humans hardly used footwear and walked barefoot, close to 10000 steps every day in uneven fields. Our foot is designed to walk barefoot. Or maybe, the foot would be more functional, barefooted, than with footwear. Since our civilization and after the more recent modernization, we have not used the foot the way we used it 100 years back. Humans are the only species on Earth that uses footwear. Think about what happens when all animals start to wear shoes and sandals. Strange. Biologically animals and we are the same. When animals don’t need footwear, humans, too, don’t need it. But our environment and lifestyle obligate us to use them. And we can’t be an odd man out.

Overarching Arches:

Humans are among the few bipedal vertebrates that have foot arches. Medial longitudinal arch, lateral longitudinal arch, and transverse arch are present in each foot. These arches are combined with bones, ligaments, muscles, and fascia. As per the fossil studies, these arches in the foot developed 3.5 million years back. These Arches improve the foot’s stability and help absorb and transmit the forces appropriately to the bones and joints so that no area is too stressed. The foot performs its best when the arches are present. However, it will be shabby when the arches are collapsed. As the arch collapses, the weight-bearing point and the gravity line change, predisposing many injuries and impairments.

The Problems With The  Modern Day Foot

The foot and the ankle complex are supposedly the most robust joint-segment in our body. It is less affected by musculoskeletal issues than other areas like the neck or the back. But nowadays, there is a rising incidence of foot and ankle issues, even in the young population. This is good enough to keep podiatrists and orthotists busy in their job. In amazon, you can see how many products pertinent to heel pain, toe pain, arch support, etc., are available for sale and how many people have bought them. There is a big industry for foot and ankle pain. Seldom were these products used 100 years back. That means there is a problem going on with the modern-day’s foot. More and more people suffer from flat foot, plantar fasciitis, bunion, metatarsalgia, retrocalcaneal bursitis, and tendinitis.

The Problems With The  Modern Day Foot

We could list these factors contributing to ankle and foot problems when we dwell on urban dwellers.

The present urban-dwelling population:

  • Barely walk Barefooted
  • Hardly walk on uneven terrains
  • Lack of variety and novelty of Physical Activities
  • Mostly overweight or Obese
  • Lazy and less motivated to go out or move around


With all the above risk factors, the foot muscle strength would reduce, the ligaments become lax, the joints would be unstable, and the inherent stimulus to maintain the arch would be lost. In the modern day, some feet are underutilized and hence underdeveloped, so it loses their capacity to absorb and transmit the load. It is primarily due to the lack of development of arches in the foot. Nearly 40% of adolescents in western countries have flat feet. This is quite a concerning figure, and with these statistics believed to the correct, then in another 50 years, nearly all people in those countries are likely to have a flat foot.

The Development of Arches in Children:

Neonates are born without any arches. These arches develop over the years as the child grows. The stimulus for arch development essentially starts as the child begins to walk and rapidly develops between the ages of 7 and 12. It is the most active stage and the golden period for the arch building. The genetic software program intrinsically helps develop the arches in the foot, but there must be a stimulus for that. That stimulus includes walking barefoot, on uneven terrains, and on various terrain ranging from rocks, hills, sandy beaches, and muddy roads.

If these children stay in the comfort of their homes and always use fancy footwear, the stimulus will disappear, and the arch won’t be formed. So, these children grow as an adult with their arch missing. Later, they say that “I have got a flat foot.” But the fact is, “they never developed any arch.”

Most people who have flat feet might get away without any problem. This is because the body tries to accommodate and adapt even with such flat feet. But this capacity is not eternal for some people. Somebody at some point, a patient would experience pain and or develop deformities.

Pathomechanical changes in flat foot
  • Abnormal tensile stress over the long and short plantar ligaments
  • Poor length-tension relationship in the intrinsic and extrinsic foot muscles
  • Altered alignment of the subtalar and intertarsal joints
  • Inefficient movement economy for running or jogging. 
  • Predisposition to plantar fasciitis, Achilles tendinitis, Heel Pain syndromes, Bunions, Tibialis Posterior tendinitis, etc.
  • Change in the line of gravity alters the stress lines over the knee joint, hip, and lower back.
How to deal with a Flat Foot?

The best way to deal with that is simply to prevent getting a flat foot. Foot Arches don’t develop overnight. It takes at least 3-5 years to get the entire arch, even for normal kids. The growth period between 7- 12 years is critical to building the arch. During this time, the parents must be keen on educating and encouraging their children to play barefoot. Forget about getting infected or injured. They become more robust with that. Let your kids play barefoot and walk them on uneven and varied terrains. Create an environment for this to happen. Take them for a trek, beach, or at least a park. Get them to play varieties of games. Join them at a sports club or a sports coaching class. All Kids must have compulsory playtime of 30-40 mins outdoors daily. Rope skipping, jumping, hopping, running, stair climbing, heel walking, and toe walking are easy ways to engage the intrinsic and extrinsic foot muscles. Remember, all the above activities must be done barefoot.

Fun games like walking on the outer border of the foot, walking on toes, painting with the foot, writing letters on the floor using the foot and toes, and gathering scattered pellets using the foot are the other enjoyable sporty ways to build the arches. Stay consistent with these activities because the arch won’t develop if the child is physically inactive and always walking with shoes on a concrete surface. Lack of arch is a lifelong liability.

So, let us ensure this new generation of kids is not Flat-Footed but Good Arched.  

Dr. Rajkannan. P
APTER Institute

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