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Flat Feet

Dec 11, 2014

Ask the Doc………

“Can my flat feet be related to the arthritis of my knees and hips?”

Because many remain without symptoms for years, they are unaware of the real significance of their flat feet. Some even joke about the fact that when their feet are wet no arch can be seen at all. Others feel that since they have a high arch when sitting that they don’t have a problem either. When symptoms do occur…and occur they will….they simply attribute them to aging. Indeed, most of the serious problems seen in the feet as well as those joints that the feet support…the ankles, knees, hips and back… can be attributed specifically to feet that flatten when standing, which is called pronation.

Infants often have a natural fat pad on the bottom of their feet making them look flat. But that is very different than a foot that collapses when standing. While the child will grow out of that fat pad, a foot that collapses is one that will grow into a permanent, often painful deformity… most often preventable.

What’s most important is not how flat a foot is but rather how much it flattens; i.e., the difference in the foot when sitting compared to standing. Compare this to a vehicle you might be driving. More important than how low or high it sits, is how much lower it gets when people get in it. If it lowers a great deal, you have a problem with the supporting framework of that vehicle. Well that’s exactly what happens to a foot that flattens; its supportive framework is problematic. And just like that car or truck, your tires (bones) will wear prematurely and unevenly, and your ride (the way you walk and function) will suffer, and eventually your parts (joints) will wear out.

There has been much research done that validates the true importance of a foot that flattens and its significance to arthritis. One such study included 1900 adults in their 50’s or older and found that those with the flattest feet were 31% more likely to have knee pain and 43% more likely to show actual damage to their cartilage on the inside of their knee, proven on X-rays. Yet this only relates to those with the flattest feet. In my experience of almost 50 years, I have in many instances seen very significant problems even in those whose feet only flatten a little.

Stand up in front of a mirror and collapse the arch on your right foot by rolling (leaning) it inward towards your left foot. Notice how your right knee follows and now faces more inward also. This is exactly why many people develop arthritic changes in their knees…abnormal foot positioning… and not simply age or weight. These are factors that become very important…..but secondarily to poor alignment.

Osteoarthritis is therefore preventable in many cases and can often be successfully treated by controlling the position of one’s foot, often with custom foot orthotics. But make no mistake; to prevent problems and eliminate symptoms, this must be done precisely with the same specificity of corrective eyeglasses. To be clear, this does not mean simply getting a pair of arch supports

at your local outlet or drugstore or getting so called custom orthotics that are really anything


When thinking about your health and checking your teeth, cholesterol, blood pressure, breasts or prostate, you may just want to pay a little more attention to those two “orphan appendages” we call our feet, that will carry you an estimated 75,000 miles in your lifetime!

A former reconstructive foot and ankle surgeon, past Clinical Instructor of Medicine at Emory, and Fellow of the American College of Rheumatology, Dr. Pack practices in Greensboro and Atlanta. He treats athletes at all levels and works with patients who have arthritis and want to remain active. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions). For further information please contact him directly at 770-335-9201, via email at, or see his website at His new book, The Arthritis Revolution, Latest Research on Staying Active Without Pain Medication or Surgery, is available on or


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