By Shazleena Binti Kasirin, Physiotherapist — OZHealth Think Tank

Short answer: Studies on Asian populations consistently show flat foot prevalence of 25–45% — significantly higher than Western populations (estimated 10–20%). For Malaysia specifically, contributing factors include genetic predisposition in Southeast Asian foot anatomy, childhood footwear habits, extended time barefoot on hard floors, high humidity climate, and dietary factors affecting joint laxity. Understanding these factors is essential for effective prevention and treatment.

Genetic Factors in Southeast Asian Foot Anatomy

Research on foot morphology across ethnic groups consistently shows that East and Southeast Asian populations tend to have wider, flatter feet compared to European populations. A 2017 study in the Journal of Orthopaedic Research found that Asian subjects had significantly lower arch indices than European subjects matched for height and weight. This appears to be partly genetic — related to differences in foot bone morphology and ligament laxity.

Malaysia's multiethnic population (Malay, Chinese, Indian) shows variations within this pattern. Malay and Chinese populations tend toward flatter arch profiles; Indian Malaysians show more variable distribution. All, however, have higher flat foot prevalence than Caucasian populations.

Childhood Footwear Habits

The arch develops between ages 3–7 through the mechanical stress of walking. Children who walk predominantly barefoot or in flat sandals during this critical window receive insufficient arch stimulation, and the arch may not develop fully. In Malaysia, it is culturally common for children to go barefoot at home and wear flat rubber sandals or school shoes with minimal arch support from early school age. This differs from Western countries where supportive children's shoes are the norm.

This does not mean children need rigid orthotic shoes — natural barefoot walking on varied terrain (grass, sand) actually promotes healthy arch development. The problem is flat rigid surfaces (tiles, concrete) where the arch receives no proprioceptive stimulation and the foot is never challenged in the ways that build arch strength.

The Malaysian Home Environment

Malaysian homes predominantly have hard ceramic tile floors. The cultural practice of removing shoes at the door means most Malaysians spend 4–6 hours daily barefoot on hard, unforgiving surfaces. Unlike natural ground (soil, grass), tiles provide no shock absorption and no proprioceptive feedback to the foot muscles. Over years, this contributes to intrinsic foot muscle weakness and arch collapse.

Wearing orthotic sandals at home — rather than going completely barefoot — provides continuous arch support during these hours and partially offsets the effects of hard floors. This is a practical Malaysian-specific recommendation that differs from Western clinical guidance.

Climate and Joint Laxity

High ambient temperatures (Malaysia averages 27–32°C year-round) increase tissue laxity — the flexibility of tendons and ligaments. Greater ligamentous laxity means the ligaments supporting the arch are less taut, making arch collapse more likely under weight-bearing. This is a physiological reality in tropical climates and partly explains why tropical and subtropical populations tend toward higher flat foot prevalence.

Diet and Footwear as Modifiable Factors

Malaysian dietary patterns (high refined carbohydrate intake, increasing obesity rates) contribute to higher body weight, which directly increases plantar pressure and arch stress. Footwear habits — widespread use of budget flat sandals and flip-flops — remove the supportive layer that could partially compensate for genetic and environmental predispositions. These are the modifiable risk factors that can be addressed through public health education and better footwear choices.