The long-held belief that low arches inevitably lead to injury is being challenged by research that prioritizes foot strength as a key protective factor. While traditional studies often found that individuals with extremely low or high arches were more prone to injuries like stress fractures or ankle sprains, newer data suggests that strong feet can significantly mitigate these risks. In fact, one study showed that runners with extremely flat feet were 20 times more likely to be injured, but those who engaged in foot-strengthening exercises saw a 240% decrease in injury rates.

The sources advocate for a shift from purely structural assessments to performance-based clinical evaluations. Weakness in the intrinsic muscles, such as the flexor digitorum longus, is a better predictor of pain than arch height alone. Furthermore, while orthotics are a common treatment, the best clinical results are achieved when they are coupled with specific foot-strengthening interventions. For patients with low arches, these exercises can lead to significant improvements in running speed and power. Ultimately, by focusing on the "foot core," chiropractors can help patients prevent injury and improve athletic performance regardless of their anatomical arch type.