Flat Feet: Can Yoga Help?

by Ram

Walking Woman by Martiros Sarian

A year ago, an individual I will call Maria to protect her privacy sent me a mail asking if I could suggest a suitable Ayurvedic intervention program to correct her flat feet. Maria mentioned that she had been suffering from painful feet, including foot and leg discomfort and pain and inflammation on the bottom of the feet. When she approached a wellness practitioner, he suggested that she do something about her flat feet and strengthen her feet. At that time, I was not aware of any health concerns associated with flat feet. Additionally, Ayurveda did not discuss about flat feet in general. But in the yoga section of the Ayurvedic texts, I found some interesting information about flat feet. So, I browsed through other journals, books, and websites to understand more about this condition. Based on the knowledge I acquired, I wrote to the individual and suggested yoga therapy to help her with the condition. 

Flat feet are extremely common. In fact, flat feet start out at infancy. The structures (muscles, tendons, ligaments) that are responsible to create the arches in the feet are not fully formed at birth. As we grow and use our feet for locomotion, these structures mature and fully develop, and the arches begin to appear. The arches provide optimal support to the foot during movement, help to distribute body weight across the feet and legs, and stabilize the foot on a variety of surfaces. However, in some individuals these structures develop poorly, resulting in a low arch or no arch. Having a fairly low arch or no arch at all can result in the entire soles of the feet touching the ground. Flat feet may also be associated with overpronation, a condition where the ankle bone leans inward more toward the center line resulting in the foot rolling to the inner side during standing and walking. Overpronation puts a lot of strain on the big and second toes and creates instability in the foot. The excessive rotation of the foot leads to more rotation of the lower tibia and stress on the ligaments and tendons of the foot, resulting in shin splints and knee pain. An increased risk of injury and heel pain may also arise from overpronation. 

Flat feet are common and many people with flat feet normally will not experience any symptoms. If the foot flattens out when you stand and is not painful, treatment is not required. However, if the flat feet are rigid and not flexible, this can be painful and also result in imbalance from prolonged foot and leg discomfort. If this persists, it can lead to other problems, including pain (especially in the lower back), inflammation on the bottom of the feet, tendonitis, or bone spurs. Generally, rigid flat feet are also linked with less movement, sedentary lifestyle, and increased body weight. Clinicians and qualified healthcare practitioners can diagnose the condition by examining the feet and observing the client when they stand and walk. The health care professional may suggest motion control shoes, insoles, ankle brace, or orthotics to stabilize the foot and correct the motion in overpronation. The American Academy of Orthopedic Surgeons (AAOS) recommends various exercises to improve strength and flexibility in the feet and ankles. My publication search revealed one scientific study that focused on certain foot-specific exercises and barefoot weight bearing to achieve sufficient changes in foot function. This study confirmed that proper training methods specific to the foot, heel, and calf muscles will alleviate foot problems in participants with flat feet.

Yoga with its repertoire of asanas that strengthen the calf muscles, heel, or the arch area may improve foot structure and function in people with flat feet. Alternatively, in some cases it may even strengthen the feet by increasing the foot arch. Even though I did not find any specific article on yoga asanas and flat feet, based on research and anecdotal experiences, I suggested the following asanas to Maria:

1. Sun Salutations with emphasis on Downward-Facing Dog pose (Adho Mukha Svanasana), Powerful pose (Utkatasana) and Plank poses (high plank=Kumbhakasana and low plank=Chaturanga Dandasana) to release the tightness in the heels and strengthen the ligaments and tendons in the feet.
2. Warrior 1 (Virabhadrasana 1), Intense Side Stretch pose (Parsvottansana), Triangle pose (Uthitha Trikonasana) and Bound Angle pose (Baddhakonasana). These asanas were suggested to strengthen and stabilize the muscles of the feet and knees, to stretch the calf muscles, and to create an inner arch lift.
3. For standing poses I suggested that she keeps the ball of the foot on the floor but lift all the toes up to strengthen the tendons and ligaments. 
4. I also suggested simple squats and squatting yoga postures, such as Garland pose (Malasana, and sitting poses that stretch the top of the foot and strengthen the arches, such as Hero pose (Virasana).

There are other asanas that may also help in releasing the tension in the tendons, strengthen the muscles, and stimulate the arches of the feet to appear. But I did not wish to see Maria rushing into a long series of postures and hurting herself more in the process. Fortunately, Maria judiciously did all the asanas that I had suggested, holding each pose for about 15 seconds, repeating the poses at least 3 times. As she practiced, she went to edge in some of the poses but was mindful at the same time. Four months into the practice, Maria noticed that the radiating pain had subsided! Her energy was back, the stiffness in the ankle and heel had eased, and she did not have any problems while standing behind the cash counter at her work place. She described her life to be normal and productive devoid of any physical pains. It is now eight months since Maria incorporated those asanas in her daily lifestyle. A week ago, she had one more interesting piece of information to share: she noticed a slight arch in both feet. Maria was thrilled and promised that yoga would now be a part and parcel of her daily lifestyle. I, too, was amazed. This is one anecdotal example is encouraging enough to warrant a full-scale scientific study. But for those of us who are already on the yoga path, we don't need a research study to prove the benefits, we are already experiencing them! 

For additional foot-related information, check the following on this blog.

In All About Your Feet, Baxter provides an overview of all the information we have on the blog about the feet.

In Video of the Week: Anatomy of the Feet Baxter provides an introduction to the anatomy of the feet, including basic structures, landmarks, and functions.

In Video of the Week: Anatomy of the Toes Baxter discusses how the toes move, their functions, and some common toe problems.

In Friday Q&A: Flat Feet Baxter discusses flat feet.

In Friday Q&A: Morton's Neuroma Baxter discusses a condition of the ball of the foot and how yoga helps to heal it. 

In Friday Q&A: Feet and Comments Shari and Baxter suggest ways to practice yoga if you wear orthotics in your shoes.

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