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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All About Your Feet

by Baxter 

Feet by Vincent van Gogh

One of the most frequent requests that I receive from our readers is for information about conditions related to the feet, and one of your all-time favorite posts is one I did about bunions. And the importance of healthy feet really came home for me when I read Atul Gawande’s powerful book on issues of aging Being Mortal, and I noted the emphasis gerontologists place on assessing foot health in the older patients as a predictor of future function. 

On a personal level, I have noticed as I am getting older that the health of my feet is vitally important for independence and my continued participation in activities that are important to me, including my asana practice, my new-found love of tennis, desire to travel, and walking and hiking. In fact, over the past few months, I have experienced an unusual periodic tender swelling around the ball of my right foot that lingers for up to a week and definitely interferes with my regular activities when it shows up. Fortunately—even though I am not yet clear on why—a modified approach to my asana practice including practicing non-weight bearing poses and lots of Legs Up the Wall pose seems to help resolve my symptoms. 

A 2014 survey by the American Podiatric Medical Association of 1000 adults aged 18 and older noted that 77 percent had experienced foot pain. And as people age, there is an increase in complaints of foot pain! The presence of foot pain is also associated with an increase chance of indoor falls in older adults, and a 2011 Australian study showed that a foot care program, consisting of foot exercises, inexpensive orthotics, and shoe advice, reduced falls in older adults with foot pain by 36% over a one year period. So, addressing various causes of foot pain with yoga could not only decrease pain and improve function, but could hopefully even reduce falls due to foot pain. 

After receiving yet another inquiry recently on a condition of the feet (see Friday Q&A: Sesamoiditis and Yoga), I was curious to review the past posts we have done here on the feet and consolidate them so our readers would have a single place you could refer to when searching for foot-related information on the blog. I hope this will be useful for you as yoga practitioners and for those of you that are also yoga teachers. 

I've divided the posts into three categories: basic information about the feet

Basic Information about the Feet

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

In Video of the Week Anatomy of the Feet, Part 2 I focus on the movements you make with your feet and ankles and how these movements related to some yoga poses.

In Video of the Week: Anatomy of the Toes along with basic toe anatomy, I discuss how your toes move, what their functions are, what which kinds of common problems they can have.  

In Getting to Know Your Ankles I focus on the basic anatomy of the ankles. 

In Parallel or Not: Aligning Your Feet I share my recommendations for how to position your feet in standing poses.

In Your Feet On My Mind I identify some of the basic variations there are among different people's feet. 

Importance of Healthy Feet for Healthy Aging

In Want to Improve Your Balance? Take Off Your Shoes! Nina writes about the importance of practicing yoga with bare feet and going barefoot in preventing falls.

In The Importance of Preventing Falls, inspired by the book Being Mortal, I describe why maintaining foot health is so important as you age.

Specific Foot Problems 

In Friday Q&A: Flat Feet I discuss what flat feet are and how to work with them in your yoga practice.

In New Tricks for Old Dogs: Working with Bunions I discuss how to use your yoga practice to improve your bunions.

In Friday Q&A: Bunions, a Can, and a Rubberband I recommend a simple practice you can try to improve your bunions.

In Friday Q&A: Foot Cramps I discuss what foot cramps are, how to practice when you're having them, and how to avoid future cramps.

In Friday Q&A: Plantar Fascitis I discuss what plantar fascitis is, how you can practice when you have it, and how you might use yoga to help the condition.

In Friday Q&A: Morton's Neuroma I discuss what Morton's neuroma, a condition of the ball of the foot, entails and how you can use yoga to help you heal. 

In Friday Q&A: Difficulty Standing on the Balls of the Feet I discuss how to practice when there is difficulty standing on the balls of feet after surgery for Morton’s neuroma.

In Friday Q&A: Sesamoiditis and Yoga I discuss what sesamoiditis (a condition of the toes) is and how to practice yoga as you are healing form it.

In Friday Q&A: Hammertoes I discuss what hammertoes are and provide a sequence to practice for those who have the condition.

In Friday Q&A: Big Toe Stiffness (Hallux Limitus) I discuss hallux limitus, which causes big toe stiffness, and provide tips for how to practice for those with the condition.

In Friday Q&A: Feet and Comments Shari and I both weigh in about how to practice yoga if you wear orthotics in your shoes.

In Yoga for Foot Pain I discuss how to practice yoga after a traumatic foot injury.

In Ankle Sprains  I recommend how to practice yoga after an ankle sprain. 

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

Follow Baxter Bell, MD on YouTube, Facebook, and Instagram. For upcoming workshops and retreats see Baxter's Workshops and for info on Baxter see baxterbell.com.