Are your headaches caused by flat feet? Doctors say countless suffer from the problem
Country walks or strolling through Central London used to be Rachel Smith’s favourite way of relaxing at weekends.
But then the 37-year-old began to suffer ‘wild headaches’ that forced her to go home and lie down in a darkened room.
‘The headaches would come on almost every weekend,’ says Rachel, a senior local government manager. ‘I’d take painkillers, but usually the only thing that helped was to lie down.
‘It was very frustrating. I’m young and active, but all I could do was go to bed and wait for the pain to ease.’
It was only when she sought help for a back problem that the unexpected source of both her back pain and headaches was identified: Rachel’s feet.
Like one in five adults in the UK, Rachel has flat feet. While most sufferers experience no real problems, Rachel is one of the many thousands who suffer headaches and other problems as a result of the effect that flat feet have on your posture.
‘With every step we take, we load our body weight through our feet,’ explains Rina Bimbashi, a podiatrist at the London Foot & Ankle Centre.
‘If you have flat feet, you are likely to be rolling in with each step, so your muscles are working harder and longer to keep your body stable.
‘This can set off a chain reaction, from the calf muscles up the leg to the knee and thigh, through to the abdomen and lower back. Consequently, you have poor posture and very tight, over-worked muscles.’
Poor posture is linked to approximately one in four severe headaches, says Dr Mark Weatherall, a neurologist at the Princess Mary Migraine Clinic at Charing Cross Hospital, a leading specialist centre.
‘Our feet are what ground us, so if someone has severely flat feet then the whole body is likely to become out of kilter.
‘Severe posture-related headaches or migraines are triggered when the brain is unable to process all the signals it is being sent.
‘For some people, the trigger may be an overload of sensory signals from lights. For others, it may be connected to poor posture.
‘The muscles in all parts of the body are constantly sending information to the brain about what they are doing, and signals from overloaded muscles can disturb the brain.
The brain then releases chemicals which cause blood vessels around it to expand and become inflamed – and it is this process that causes the throbbing pain.’
Dr Weatherall says that as many as 170,000 Britons will be suffering a severe headache on any single day, with many of them posture-related.
In fact, headaches are not the only problem caused by the structure of the feet, says Rina Bimbashi. other problems include ‘mystery’ back, knee and pelvic pain.
‘Many patients have seen a succession of health professionals who have focused on the particular area where the pain is felt, rather than the mechanics of the whole body,’ she adds.
Martin Klinke, consultant orthopaedic surgeon at the London Foot & Ankle Centre, explains: ‘there are three characteristics of flat feet. the obvious feature is that the arch is very low, or there is no arch at all. the heel also rolls inwards, while the top the foot rotates outwards.
‘People may have one, two or all three of these features of flat foot, with different degrees of severity.’
For many people, flat feet run in the family and the condition is obvious from childhood. others may be born with lax ligaments, causing the foot increasingly to roll inwards, so that over time a flat foot develops.
Whatever the cause, it seems it’s those who have a small degree of flat feet who are particularly at risk of headaches.
‘This is because they are continually loading their weight in the wrong part of their foot, putting pressure on the tendon which runs down the side of the ankle and along the centre of the foot,’ says Mr Klinke.
This tendon plays an important supporting role for the foot, and if it weakens the arch will fall and the heel tilts inwards.
‘They are then more likely to suffer headaches and back or knee pain as the tendon gets progressively weaker.
By contrast, many people born with flat feet simply have a foot structure which stays the same throughout their life and doesn’t cause them any difficulties.
Rachel had been diagnosed with flat feet by a podiatrist when she was 14, after her mother noticed her feet were unusually wide (another common characteristic, caused by laxity in the joints).
Rachel was warned this made her prone to bunions, because as her foot rolls inwards, pressure builds on the area around the big toe, squashing the joint.
‘I was prescribed some special orthotics [custom-made insoles] to wear in my shoes, to improve the position of my feet,’ recalls rachel.
‘But by 17 I didn’t want to wear sensible shoes with orthotics. I wore stupid shoes, just like my friends. So by 20 I had developed bunions on both feet.’
But it wasn’t until she was 25 and moved to London from her home in Australia that Rachel noticed how bad her foot problems had become.
‘I was walking around more than I did in Australia and my bunions were becoming increasingly painful. It was hard to find shoes which were wide enough to fit properly.
‘I knew that at some point I would probably need foot surgery, but it was something I tried to keep at the back of my mind.
‘The headaches started when I was about 27. If I had been walking for a while, pain would start at the base of my neck then work upwards into a wild, throbbing headache. the only thing which gave me relief was to lie down.
‘I would get dreadful headaches most weekends, but I didn’t think anything could be done about it.’ Then Rachel developed a ‘nasty ache’ in her lower back every few weeks.
‘I thought it was due to an old injury, but when I saw an osteopath he looked straight at my flat feet and explained they were the cause of both my back problems and headaches.’
For many people, orthotics to give extra cushioning on the inside of the foot to prevent the foot from rolling inwards are sufficient, but a small minority will need surgery. Rachel had surgery to correct both her bunions and flat feet.
People with flat feet develop very tight calf muscles from the strain of the heel rolling inwards, so Rachel’s operation involved first cutting the muscle.
Her heel bone was then moved about 1cm into line with her knees, and pinned in place with surgical screws.
A small mid-foot joint was also fused together to provide greater stability because Rachel had lax ligaments, making her foot prone to rolling inwards.
Rachel had one foot treated at a time. An operation on her right foot was carried out at London Bridge Hospital in February 2007, and the second operation was a year later. Rachel faced a long recovery. ‘It was a big undertaking psychologically and physically,’ she recalls.
‘You can’t put any weight on your foot for a full six weeks after surgery, and even after that you have to take it very slowly.
‘It took a year after both operations before I was fully recovered. But I haven’t had a single headache since – which feels like magic!’
By Jenny Hudson