Flat Feet AKA Pes Planus

Pes Planus

The foot is comprised of the ankle, forefoot (metatarsals)  and the joints of the five digit or toes. There are 26 bones and 30 joints in the foot. All joints are connected by supportive ligaments. Various muscle at the back, top and bottom of the foot function as the joint movers. Geometrically the bones articulate and form three archest he three arches are called the medial and lateral longitudinal arches and an anterior transverse arch.

The feet support all one’s body weight. Functionally the arches behave like springs and shock absorbers of an individual’s weight during standing, and during walking or running. When functioning properly these anatomic structures allow for human locomotion- and are pain free. 

In Children Flat feet occurs when the arches are not properly developed during growth. Flat feet also result from injury to the tendons, muscles,  bones or from certain conditions such as, rheumatoid arthritis, diabetes or obesity.  Flat feet are most often pain free. Most common symptoms include pain in the arches or heel after walking, swelling of the feet or even back pain. When pain occurs and does not respond to self care measures it is recommended one see a doctor either a chiropractor or podiatrist. Conservative care should always be a first consideration.

Treatment May Include

1. Joint mobilization and Physical therapy. Specially trained doctors of chiropractic provide joint mobilization methods to improve function. Video and gait analysis provides information to allow for walking and running style “retraining”   Flatfeet may contribute to overuse injuries in some runners.  Trained Therapists evaluate gait mechanics and may offer specific exercises. Exercise for the toes and calf muscles e. g. Achilles’ stretching are recommended. 

2. Stretching exercises.  Proper stretching helps restore foot joint mechanics and muscle control. Some people with flatfeet also have a shortened Achilles tendon. Exercises to stretch this tendon may help. Toe curling exercises are also helpful.  Also proprioception function can be improved with balance exercises.  Consider T’ai Chi for example or balance board as part of a complete work out.

3. Arch supports AKA orthotics. Arch supports or shoe inserts or orthotic insoles serve as a cushion, assist to normalize function or alleviate pain from these conditions. Studies have shown that arch support for children produce positive results including pain reduction and improved function,   Low cost over the counter supports have been to shown to help. In more serious cases professional made orthotics, often from molds to fit shape of the foot to provide relief on plantar pressure.  Inserts allow for better proprioception and help restore proper gait mechanism. See abstracts below.

4. Proper Fitting Footwear: Orthopedic or custom made shoes.  For athletes proper fitting sports shoes are a must requirement. . Avoid wearing sandals, flip-flops or hight heels. For severe conditions special custom shoes may become a viable treatment option.

5. Surgery:  For people with serious chronic flat-foot disorder surgery may become an option of last resort. Surgeries vary with age of the patient with  recovery from 3 to 6 months depending on severity of the condition.

Research: 

Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial.  By Hsieh RL^1,2, Peng HL³, Lee WC⁴.

Conclusion:

Children with flexible flatfoot who wore customized arch support insoles for 12 weeks exhibited significantly improved pain/comfort, physical health, stair ascent time, upper extremity and physical function, and transfer and basic mobility. These variables belong to the domains of body functions and structures and activity and participation in the ICF framework…, additional studies with larger sample sizes should be conducted.

J Phys Ther Sci. 2016 Nov;28(11):3078-3083. Epub 2016 Nov 29.

Effects of orthotic insoles on adults with flexible flatfoot under different walking conditions.  By Zhai JN¹, Qiu YS¹, Wang J¹.

Conclusion : Orthotic insoles could effectively improve the plantar pressure of flatfoot under different walking conditions. In addition, the arches of both normal foot and flatfoot were obviously influenced when walking downstairs. It is therefore necessary to wear orthotic insoles for flexible flatfoot to prevent further deformation.

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