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• Specifically, having flat feet was believed to predispose individuals to future pain and other musculoskeletal problems (i.e.
• Flat feet were believed to be a kind of time bomb.
• We demonstrate that the theory that having flat feet inevitably leads to pain or other musculoskeletal problems, is unfounded.

Where does this theory come from?

• This theory became central to the educational programs of health professionals.
• In fact, science has never validated the theory: it has remained at the hypothesis stage.
• Nevertheless, over the years up until the present, many health professionals have continued to support the theory that flat feet pose a major risk for developing musculoskeletal disorders.

Do flat feet cause musculoskeletal injuries?

• Furthermore, a systematic review and a meta-analysis concluded that runners with flat feet are no more at risk of injury than those with regular feet.
• These analyses call into question the idea that people with flat feet have a substantial risk of developing musculoskeletal disorders.
• Unfortunately, this frequently results in people having unnecessary interventions, such as using orthopaedic shoes or custom-made foot orthoses for asymptomatic flat feet.

Setting the record straight

• Based on current scientific knowledge, assessing whether a person has flat feet to determine their risk of injury is ineffective and counterproductive.
• While it is possible for a person with flat feet to develop a musculoskeletal injury, this does not necessarily mean that flat feet caused the injury.
• It is quite possible for two variables to be present at the same time without there being a causal link.
• A cause-and-effect relationship implies that a change in one variable (the cause) leads to a change in another variable (the effect).

Reducing overdiagnosis in health care

• Reducing overdiagnosis in health care has become crucial.
• Since overdiagnosis often leads to overtreatment, avoiding unnecessary treatments will help to alleviate patients’ concerns about their flat feet.
• It’s time to change our perspective and our approach to the significance of flat feet and to recognize their natural diversity in the context of overall foot health.

Gabriel Moisan is a member of the Ordre des Podiatres du Québec (College of Podiatrists Québec). He has received funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), the War Amps of Canada and the Réseau provincial de recherche en adaptation-réadaptation (REPAR).