Rethinking Flat Feet: Debunking Myths and Shifting Perspectives on Musculoskeletal Health

The historical belief that flat feet lead to higher risks of musculoskeletal injuries during sports and daily activities was revived in the 20th century by Merton Root, a podiatrist, and colleagues who published a report “Normal and abnormal function of the foot” in 1977. They proposed an “ideal feet” concept, asserting that feet deviating from specific criteria were prone to injury due to biomechanical compensations. This notion became a foundation in health education but has been challenged by more recent research.

An editorial by Gabriel Moisan and colleagues from Canada published in British Journal of Sport Medicine in August 2023 challenged this view.

Contrary to the “ideal feet” theory, meta-analyses have found weak links between flat feet and certain injuries like medial tibial stress syndrome and patellofemoral pain syndrome, but not many other conditions. Some systematic reviews and analyses even indicate that flat feet aren’t linked to running-related injuries. Despite these findings, there’s a persisting belief in the medical community that flat feet are significant risk factors for various musculoskeletal disorders, driving unnecessary treatments even for asymptomatic cases.

The issue of overdiagnosis in healthcare is crucial, as it leads to unnecessary physical, psychological, and financial harm. To combat this, healthcare professionals must differentiate between benign anatomical variations and harmful conditions, reducing overtreatment of asymptomatic flat feet. While foot morphology assessment remains relevant in certain cases (e.g., advanced stages of posterior tibial tendon dysfunction), a more comprehensive approach, considering factors like tissue capacity, load, psychological aspects, and the kinetic chain, is necessary to understand and prevent musculoskeletal injuries effectively.

In conclusion, the authors wrote that asymptomatic flat feet are typically not problematic and do not require attention from healthcare professionals. The outdated belief that flat feet are inherently risky for injuries should be abandoned, and flat feet should be seen as natural anatomical variations. A shift in perspective is needed to appreciate the diversity of flat feet within the broader context of foot health.