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If one Googles the web on flexible flatfeet, the intervention often suggested is an orthotic incorporating a medial longitudinal arch. I am adamantly and decisively against this type of intervention.

In over 50 years of clinical and research studies I have demonstrated (via gait studies and KBTs) that arch supports should not be used when treating the Flexible Flatfoot. In fact, arch supports increase the flat footedness when used in orthotics.

In lieu of using arch supports, I advocate using a plantar stimulation underneath the first metatarsal and hallux, which I contend will decrease the collapse of the medial longitudinal arch without supporting it.

 

I had the opportunity to run force plate studies using medial column wedges on patients diagnosed with the Primus Metatarsus Supinatus foot deformity. Most of these patients demonstrated a certain degree of flexible flatfeet (mild to moderate). What I recorded was a decrease in the maximum forces (N/kg) along the medial longitudinal arch using the proprioceptive insoles, vs. a higher N/kg along the MLA without insoles. I then ran the same tests using the proprioceptive insoles vs. prefabricated arch supports. Here I noted an increase in the N/kg along the MLA using the off the shelf orthotics vs. the insoles fabricated specifically to treat the PMS foot structure.

These recordings substantiated my clinical observations that a medial forefoot wedge decreases the collapse of the ILA without using an arch support.

I still find it incredible that pedorthists and some Podiatrists still use arch supports in their orthotics. Arch supports, IMO, should only be used with the severe Flexible Flatfeet (PreClinical Clubfoot Deformity) where a supportive type orthotic is required to alleviate symptoms.

 

Moderate to Severe Flexible Flatfeet have been increasingly referred to as a Progressive Collapsing Foot Deformity (PCFD) in the European Orthopedic Community. For the mild to moderate collapse, orthotics with arch supports is used. Severe collapse is stabilized surgically.

Renaming Flexible Flatfeet as a PCFD does not change the fact that you are naming a symptom, not the primary pathology. Before any type of intervention is recommended, the diagnosis must be secured: e.g., PreClinical Clubfoot Deformity, Rupture of the Posterior Tibial Tendon, Coalition of the Talarnavicular Articulation, etc. Once the diagnosis is determined, the appropriate intervention can be instituted.

Unfortunately, in too many cases, rigid orthotics incorporating an arch support is dispensed based only on a visual inspection of the ILA. IMO, this is a gross misfeasance, if not borderline malpractice.

 

Over the past 15 years, I have expressed my concern over the improper and too frequently used arch supports. Arch supports weaken the feet by attenuating the need to engage the intrinsic foot muscles in a closed kinetic state (standing/walking).

Attached is an animated file that demonstrates this point vividly.

• This patient was diagnosed as having a Grade 3 Primus Metatarsus Supinatus Foot Deformity (Grade 3 RFS).
• Rigid orthotics were dispensed which incorporated hard arch supports based on the practitioner's visual inspection only.
• Notice the deterioration in the structural stability of the ILA after 5 months of use!

Is there anyone on this forum who wishes to support this protocol (dispensing rigid orthotics in flexible flatfeet based on visual inspection only)?

 

Photos were taken at different angles. Are there patients with before and after diagnostic imaging?

 

These photos were taken: the first before supportive type insoles (with arch supports) were dispensed, the second was taken after the supportive type insoles were dispensed and worn.

The slightly different angles at which these two photos were taken does not diminish the impact arch supports have on weakening the muscles in the foot and leg.