Last week, while getting a pedicure, my nail technician casually remarked that I had flat feet. At first, I didn’t quite understand what she meant because most of the people around me seemed to have feet shaped like mine. But then she removed her own shoe and pointed to the distinct arch at the centre of her foot. I didn’t have such an arch.
“You know you can’t become the next Kipchoge or even join the army with flat feet?” she continued before advising me to seek medical intervention to fix my flat feet.
Curious, I contacted Dr Sally Kariuki, a podiatrist to find out whether I needed to be concerned.
In her office, Dr Kariuki started by explaining that flat feet are characterised by a reduced or absent arch, meaning the entire sole of the foot has contact with the ground.
“You can have a rigid flat foot, which doesn’t move at all,” she said, “or a mobile flat foot, where an arch appears when the foot is lifted off the ground but disappears when standing.”
Is flat foot inherited?
“There’s a genetic predisposition,” Dr Kariuki explained. “However, in children, you typically won’t be able to tell whether they have flat feet until they’re around five or six years old, as the feet are still developing.”
Certain medical conditions can also cause flat feet. “Rheumatoid arthritis, which causes joint destruction, is one of them,” she said. “So are diabetes and syphilis, which are conditions that interfere with nerve function.”
Other contributors include Ehlers-Danlos syndrome (EDS), injuries that damage foot muscles, pregnancy, and excessive weight gain.
Myths
Flat feet have long been stigmatised. It’s widely believed that people with this foot type can’t join the military, become models, or compete in elite sports. But Dr Kariuki said the reality is far more nuanced.
“Usain Bolt has flat feet, and he’s the fastest man on earth,” she noted. “Having flat feet doesn’t mean you’re doomed athletically, it just means your strengths may lie in some areas more than others.”
For instance, people in gymnastics or martial arts may benefit from flat feet, as they tend to land more evenly compared to those with high arches.
Importantly, not everyone with flat feet requires treatment. “Roughly 80 percent of people with flat feet live completely normal lives,” Dr Kariuki said. “We don’t intervene unless there’s pain or discomfort.”
So, when should you see a podiatrist?
According to Dr Kariuki, you should consider seeing a foot specialist if you begin experiencing pain in the inner ankle, arch, or knee.
“Often, the real issue comes from wearing the wrong type of shoes for your foot structure,” she explained. “In many cases, the solution is as simple as finding the correct footwear. If they don't like those sorts of shoes, then we make for them an inner sole to transform their bad shoes into good shoes.”
Another visual indicator of flat feet is the position of the Achilles tendon. “When viewed from behind, the tendon should run straight down. If it curves inward, that’s a sign of flat feet,” she said.
Treatment options
Surgery is rarely the first option. “We start with orthotics, which are custom insoles designed to realign the foot,” Dr Kariuki said. “These push the foot back into a more neutral position.”
But in severe cases where the flat foot is rigid, painful, and unresponsive to conservative treatment, surgery may be considered.
Whether flat feet can be reversed depends on the underlying cause. “If it’s genetic, that’s your God-given foot,” she said. “It’s not something that can be reversed.”
There are surgical procedures to create an arch, but Dr Kariuki advises caution. “Some patients who undergo surgery for cosmetic reasons end up in worse pain. It’s not always successful, and it’s not a decision to rush into.”
I was curious to find out who her youngest and oldest patients were.
“I’ve seen children brought in as soon as they start standing,” she said. “But in most cases, I simply recommend specific shoes and monitor their development yearly.”
She once made orthotics for an 18-month-old who kept tripping and falling.
“The oldest can be quite old because I see all patients, from babies to 100-year-olds. For the elderly, most foot deformities are due to arthritis."
