In Step

Here, we take a look at flat feet, also called pes planus or fallen arches, and what you can do to help.

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How to recognize flatfeet in clients and what you can do to help.

Have you noticed during a pedicure that your client’s arches on one or both feet are less pronounced than they used to be? If so, she likely has flatfeet, also called pes planus or fallen arches. What’s more, many of your clients may fall into the typical flatfoot patient profile: the average person with flatfeet is a woman in her 40s to 50s, notes Matthews Roberts, MD, chief of foot and ankle service at Hospital for Special Surgery in New York. Here, we take a look at this condition and what you can do to help.

Cause and Effect

Flatfoot, most commonly caused by genetics, is usually noticeable from early on in life and may not lead to problems. Those with flatfeet can be asymptomatic, says Dr. Roberts, meaning that no ill effects are felt from the low arch that characterizes this condition. However, if flatfoot develops as a person ages, health issues may also arise.

“When feet flatten over time, it can be attributed to the tendon wearing out or not functioning properly, which is a problem,” Dr. Roberts explains. For example, one foot losing its arch can indicate a lack of strength to push off or accommodate uneven surfaces. This condition is called adult or acquired flatfoot, and can be triggered by a variety of factors.

“Adult flatfoot can be caused by trauma, injury, accident, or being overweight or pregnant,” notes Jacqueline Sutera, DPM, who specializes in women’s foot care at City Podiatry in New York. “These events can rupture tendons and ligaments that hold the foot in its neutral position.” As weight-related changes may cause the foot to flatten, widen or overpronate (i.e., roll inward to a greater degree than usual), the effects can be temporary or permanent.

Regardless of its cause or course of development, flatfoot universally becomes troublesome when other symptoms crop up, especially pain in the arch, leg, back or hip. In these cases, experts recommend a doctor’s visit, because once pain manifests, the problem can go from bad to worse. Sutera relates that a host of problems may be caused by unchecked flatfeet, including heel pain, bunions, arthritis and hammertoes. “Some signs to look for: The middle of the foot (the instep or arch) flattens when you stand up, fleshy parts on the outside of your heel/midfoot spread out when standing, the outsides of the heels of your shoes wear out, you have pain on the bottom or back of the heel, or you notice a wide foot imprint when standing on wet sand at the beach.” Roberts adds that pain on the inside of the ankle can be an early sign of flatfoot. The bottom line: Pain isn’t normal; get it checked by a doctor.

Treatment Options

Because genetics often dictate the condition, there isn’t a surefire way to prevent flatfeet from occurring, but Dr. Roberts notes that staying fit can help keep adult flatfoot in check. Many patients with acquired flatfoot are overweight. If flatfoot has already developed significantly, there isn’t much that can undo it. But when caught early, certain steps can prevent the problem from getting worse. “If a deformity hasn’t yet occurred, we can put the patient in a cast, boot or brace, keeping the foot stable while it recovers from the inflammation or tear,” he explains. After four to six weeks, physical therapy and future orthotics or arch supports can ensure control of the issue. Best of all, diagnosis of flatfoot is quick and painless. The doctor will simply have the patient stand up so she can observe alignment (see where the heel is in relation to the foot).

Sutera pinpoints another common culprit that intensifies the symptoms of flatfeet: insensible shoes, including flip-flops, ballet flats and high heels. If your client has flatfeet, steer her toward more supportive shoes. “Sensible shoes have three criteria: arch support, thicker soles and some stabilizing straps to help protect the foot. Even wedges are better than traditional high heels because weight is distributed across a greater surface area,” she adds. However, for longer periods of walking or standing, Sutera recommends choosing a more appropriate shoe. Flatfeet can also be helped with custom-molded orthotics, quality prefabricated shoe inserts or “motion-control sneakers, which help limit pronationof the foot of flattening ofthe arch.”

Even in advanced cases of flatfoot, surgery is a last resort and typically occurs only when pain is severe and the patient has not responded to other noninvasive methods of treatment. Fortunately, complex surgeries are necessary in only a small percentage of cases.

Chances are, your client with flatfoot hasn’t developed these more severe issues. If she hasn’t, you can actually relieve some of her discomfort right at your station. “When nail techs notice flatfeet, they should work to make these clients feel better,” suggests Johanna Youner, DPM, FACFAS, founder, medical director and head physician at Park Avenue Podiatry Center in New York. “No changes need to be made when working with these clients, but they’re great candidates for foot massage because their arches are usually tired. Focusing on these overstressed areas will be helpful, and clients will appreciate it.” Sutera agrees that extra care during massage—focusing on the bottom of the heel and the arch, as well as the back of the heel by the Achilles tendon—can help relieve some of the client’s symptoms temporarily. Add a couple of minutes to your regular massage, and you may find that you’ve landed a client for life.

Part of your job as a nail tech is to evaluate the overall condition of your client. In addition to asking for information on intake forms (always a good idea for new clients—and for updates on repeat clients), you should be using your powers of observation to make sure that you’re providing the safest and most comfortable service possible. If you notice that a client has flatfoot, ask her if she’s aware of the condition, refer her to her doctor if she’s experiencing pain and use the healing powers of touch to make sure that your services become a flat-out must-have in her future.

Tracy Morin is a freelance writer and editor based in Oxford, MS.

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