Running myths and realities – What to do with flat feet for running?

You may have been told that your flat feet are the cause of your running injuries. A salesperson may have recommended shoes with arch support, and a professional may have prescribed “corrective” orthotics. You’re wondering if the shape of your feet dooms you to injury. This concern is understandable when you’ve been hearing this for years.

A flat foot has a low arch, meaning there is little curvature under the inner side of the foot. An arch support provides support for this area inside the shoe. An orthotic insole is an insert placed inside the shoe; it can be custom-made or pre-molded. Pronation refers to the inward movement of the foot. The foot’s posture when standing and its movement while running are not the same thing.

Having flat feet does not necessarily mean you’ll get injured. In a study of 246 young military personnel, those with the flattest feet were not the ones who were injured most often. Another study, conducted over 10 weeks with 59 beginner runners, found no clear difference between pronated feet—those that turn inward—and neutral feet, which do not have a marked inward or outward tilt. However, the small number of participants limits the certainty of the results. ^{1, 2}

A review of studies that tracked participants over time found a weak link between an inward-turned foot posture and tibial periostitis, a condition characterized by pain along the bone on the front of the leg. A weak link to pain around the patella—the bone at the front of the knee—is also possible, but the evidence is much less certain. ³

Achilles tendinopathy affects the tendon that connects the calf to the heel, at the back of the ankle. Not all studies measure the same thing. In a study of beginner runners followed for 10 weeks, certain distributions of forces under the foot were associated with this injury. The force was directed more toward the outer part of the forefoot and moved less toward the front ⁴. A 2024 study, on the other hand, compared the standing posture of people who already had the condition to that of people without these injuries. Postures that were more or less turned inward were more common in those with Achilles tendinopathy ⁵.

Plantar fasciitis causes pain under the heel, near where the strong band of tissue that supports the bottom of the foot attaches. A study compared 80 people with persistent pain under the heel to 80 people without this pain. A more inward-turned stance was associated with the pain. The odds ratio was 3.7: this measure compares the presence of this foot alignment in the two groups. It does not mean that the future risk of pain is 3.7 times higher ⁶. An association does not prove that the posture caused the pain, nor that altering the arch will make it go away.

For tibial periostitis, foot posture can therefore be part of the evaluation, along with other factors. The review of studies on this posture does not directly test the effectiveness of a shoe or insole in preventing injuries. ³

• Foot posture is one of several factors contributing to certain injuries, including tibial periostitis ³
• Flat feet that don't cause pain don't automatically require treatment
• Choosing a shoe based solely on arch height did not reduce injuries in military trials. This does not prove that all pronation-control shoes are ^{useless.⁷, ⁸}
• The shape of the foot alone is not enough to determine the appropriate treatment: symptoms and difficulties with walking or running also matter

Flat feet should therefore be evaluated based on your symptoms, without automatically assuming a correction is needed. To choose the right shoes, check out our guide to running shoes.

What Should You Do If You Have Flat Feet While Running?

Painless flat feet do not automatically require correction for running. If you’re experiencing pain, have the issue evaluated rather than attributing it solely to your arch. Our guides on Achilles tendinopathy and plantar fasciitis explain the symptoms and treatments specific to these conditions.

Plantar fasciitis can affect people with both low and high arches. A 2004 clinical review describes these two situations and offers mechanical explanations. This model does not demonstrate that foot shape alone causes the pain. ⁹ The 2024 study also found an association between plantar fasciitis and foot positions that are more or less turned inward. The association is stronger for feet that are more turned inward. Foot position was measured while standing; it does not correspond simply to arch height or foot movement while running. ⁵

Votre type de pied peut être présent depuis longtemps et bien toléré. Un pied plat peut aussi apparaître plus tard. Consultez un médecin si l’arche s’affaisse récemment, si un seul de vos pieds est plat, ou si vous avez de la douleur, de la raideur, une faiblesse ou un engourdissement. Des blessures répétées du pied ou de la cheville, une difficulté à marcher ou un problème d’équilibre justifient aussi une consultation¹⁰.

Une chaussure à contrôle de pronation comporte des éléments destinés à limiter le mouvement du pied vers l’intérieur. Son effet varie selon le modèle et les personnes. Dans un essai de six mois auprès de 372 coureurs récréatifs, 17,6 % des participants avec le modèle à contrôle du mouvement se sont blessés, contre 32,4 % avec la version standard. Une comparaison supplémentaire, faite selon la posture du pied, suggérait un bénéfice surtout chez les 94 coureurs aux pieds pronés. Ce résultat favorable concerne le modèle testé; il ne garantit pas le même effet avec toutes les chaussures¹¹.

However, the 2022 Cochrane review considers the overall effect of motion-control shoes compared to neutral shoes—which have no specific features to limit pronation—to be highly uncertain. Military trials do not show any advantage to prescribing shoes based solely on arch height. The choice of a shoe can therefore take into account a potential benefit, without making this type of shoe mandatory for all people with flat feet.

Les blessures liées à des efforts répétés ne s’expliquent pas toutes par la pronation. Une revue clinique de 2009 ne trouvait pas de lien définitif entre des mouvements inhabituels du pied et les blessures de course. Cette limite n’annule pas les associations plus précises trouvées dans d’autres études.¹²

Une orthèse peut aider les symptômes sans changer la forme du pied. Un essai auprès de 135 personnes avec fasciite plantaire a comparé une semelle préfabriquée, une orthèse sur mesure et une semelle de comparaison en mousse mince. À trois mois, les deux types d’orthèses amélioraient modestement les activités quotidiennes : environ 8 points de plus sur une échelle de 100. L’avantage sur la douleur était moins certain. À 12 mois, les groupes ne différaient plus clairement. Cela ne signifie pas que les participants avaient tous perdu leur amélioration.¹³

Un autre essai a réparti 236 personnes avec fasciite plantaire entre cinq groupes. Tous faisaient des étirements du mollet, du tendon d’Achille et du dessous du pied. Après huit semaines, les groupes qui ajoutaient un support déjà fabriqué dans leur chaussure rapportaient une amélioration plus souvent que les groupes avec étirements seuls ou avec orthèse sur mesure. Selon le support testé, 81 à 95 % allaient mieux, contre 72 % avec les étirements seuls et 68 % avec l’orthèse sur mesure. Ces résultats concernent les supports étudiés, combinés aux étirements. Ils ne prouvent pas qu’une orthèse sur mesure est toujours inutile.¹⁴

Where can I learn more about running?

The podcast “Parle-moi de santé” features running tips in its first episode. Alexis Gougeon hosts Blaise Dubois to discuss injury prevention and treatment.

Episode #1: Prevention and treatment of running injuries.

Écouter l'épisode 1 de Parle-moi de santé sur la course à pied, sur YouTube et Écouter l'épisode 1 de Parle-moi de santé sur la course à pied, sur Podbean.

Source

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2. Ramskov D, Jensen ML, Obling K, Nielsen RO, Parner ET, Rasmussen S. No association between q-angle and foot posture with running-related injuries: a 10 week prospective follow-up study. Int J Sports Phys Ther. 2013;8(4):407-15. ↩ Retour au texte
3. Neal BS, Griffiths IB, Dowling GJ, Murley GS, Munteanu SE, Franettovich Smith MM, et al. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res. 2014;7(1):55. ↩ Retour au texte : 1re, 2e, 3e mentions
4. Van Ginckel A, Thijs Y, Hesar NG, Mahieu N, De Clercq D, Roosen P, et al. Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture. 2009;29(3):387-91. ↩ Retour au texte
5. Johannsen FE, Rydahl JP, Jacobsen AS, Brahe CCH, Magnusson PS. Foot Posture and Ankle Dorsiflexion as Risk Factors for Developing Achilles Tendinopathy and Plantar Fasciitis: A Case-Control Study. Foot Ankle Int. 2024;45(12):1380-1389. ↩ Retour au texte : 1re, 2e mentions
6. Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study. BMC Musculoskelet Disord. 2007;8:41. ↩ Retour au texte
7. Relph N, Greaves H, Armstrong R, Prior TD, Spencer S, Griffiths IB, et al. Running shoes for preventing lower limb running injuries in adults. Cochrane Database Syst Rev. 2022;8(8):CD013368. ↩ Retour au texte
8. Knapik JJ, Trone DW, Tchandja J, Jones BH. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014;44(10):805-12. ↩ Retour au texte
9. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004;39(1):77-82. ↩ Retour au texte
10. National Health Service (NHS), Royaume-Uni. Flat feet. ↩ Retour au texte
11. Malisoux L, Chambon N, Delattre N, Gueguen N, Urhausen A, Theisen D. Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. Br J Sports Med. 2016;50(8):481-7. ↩ Retour au texte
12. Ferber R, Hreljac A, Kendall KD. Suspected mechanisms in the cause of overuse running injuries: a clinical review. Sports Health. 2009;1(3):242-6. ↩ Retour au texte
13. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-10. ↩ Retour au texte
14. Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999;20(4):214-21. ↩ Retour au texte

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.