Flat feet (pes planus) and physiotherapy intervention


The pes planus, commonly referred to as a “flat foot”, is a relatively common deformity of the leg and is defined as a result of a loss of the mid longitudinal arch of the foot where it touches or almost touches the ground. The arch of the foot is a supple and elastic connection of the ligaments, tendons, and cornea between the fore and hind feet. Intra-heel ligament, tibial plateau of the delta ligament, soles of the foot ligament and mid-heel slug ligament. Archs act as an adaptive and flexible basis for the entire body. It has the function of dissipating the forces of a heavy body and has the effect of storing mechanical energy in the elastic ligaments that are stretched during the gait cycle. Disorders of the arch complex, especially involving flexible flat feet, are often asymptomatic, but can alter the biomechanics of the lower extremities and lumbar spine, increasing the risk of pain and injury. . Pes planus usually goes away spontaneously during the first decade of life, or sometimes progresses to a stiff form of pain that causes significant disability. All babies at birth have flat feet and noticeable arches seen at around 3 years of age.

Flat feet come in two forms; flexible pes planus and rigid flat legs. When the arch stays in place when lifting the heel and does not bear force but disappears when standing upright on one leg, it is called a rigid pes planus while the rigid pes planus is when the arch is not present at the lift. heel and bearing.

flat-leg x-ray

Figure 1: A lateral X-ray of the left leg depicts the pes planus as evidence of reduced heel angle


Previous studies have shown that the incidence of flat feet is between 1% and 28% in certain age groups. Pes planus is more common in children and women are more likely to have the condition than men in adulthood. About 20-30% of children have some form of flat foot.

Pita-Fernandez and plus the reported a 26.62% rate in randomized samples. Older adults and those with a high body mass index (BMI) were also found to have a significant effect on flat feet.


The etiology of flat feet has many factors involved. Depending on the etiology that pes planus can be divided into categories, namely congenital and acquired. These factors are:

  • Malformed horse feet, ligament ligaments, tiptic deformities, tibial rotations, presence of accessory whites, congenital upright slug bones and foot bones.
  • Diabetes and obesity are also possible pes planus related factors.
  • Foot and ankle injury such as rupture or dysfunction of the posterior tibial tendon.
  • Hereditary deformities such as Down syndrome and Marfan syndrome.
  • Family factors.
  • Arched weakness due to overuse and certain types of foot condition or injury.
  • Some medical conditions include arthritis, spina bifida / spina bifida, cerebral palsy, stiffness, and muscular dystrophy.
  • Flat feet can also happen as a result of pregnancy.
  • Factors caused by examination or treatment such as posterior tibial tendon displacement.


Heel bones, kneons, slug bones, first three wedge bones and first three knuckles form the middle longitudinal arch. This arch is supported by the posterior tibial tendon, the heel-toe ligament, the delta ligament, the fascia, the elongated flexor, and the big toe flexor. Dysfunction or injury to any of these structures can cause acquired pes planus. Excessive tension in the triceps, obesity, spasticity of the Achilles tendon or calf muscles, ligament of the soles of the feet, the fascia, or other foot support ligaments may also cause flat legs caught.

middle vertical arch structure

Figure 2: the middle longitudinal arch is made up of the heel bone, the snail bone, the whip bone, the first three wedge bones, and the first three scapula.

Flat legs are rare but usually begin in childhood; adhesions of the feet, accessory, congenital vertical slug, or other forms of posterior foot disease are often the underlying factors.


  • The main symptom of flat feet is leg pain caused by tension in the muscles and connective tissues; pain along the posterior tibial plateau, inability or pain when attempting to perform monolabial lifting.
  • Some people with flat feet have ankles pointing inward with most of the load on the foot deviating in the middle.
  • A skewed weight load can lead to abnormal biomechanics in the lower extremities, which in turn can cause pain in the arches of the feet, calves, knees, hips, lower back and lower legs.
  • There may be edema in the middle of the legs.
  • Hard one or both arches of the legs.
  • Spasticity of the feet and ankle muscles in the lateral cavity.
  • Uneven distribution of body weight with the result that wearing the shoe misaligned to the inner edge of the foot leads to further injury.
  • Difficulty in walking.


Co-occurrence of many diseases includes, but is not limited to, neurological conditions such as cerebral palsy; genetics such as Down syndrome, Marfan syndrome or Ehlers Danos; charcot joint disease; posterior tibial muscle disorder; fat; diseases of the joints; Shprintzen-Goldberg syndrome.


Children rarely require treatment for pes planus. Orthotics are indicated for secondary leg pain caused by pes planus alone or by pes planus associated with leg, knee and back pain.

In adults, treatment is based on etiology. Orthopedic appliances and nonsteroidal anti-inflammatory drugs (NSAIDS) are sufficient for pain.

Surgery is required only for flattened feet and in resistant cases to relieve symptoms. Most surgical procedures are aimed at rearranging the shape and mechanics of the foot. These surgeries can be tendon displacement, osteotomy, joint stiffening surgery and where other surgeries fail, tricyclic stiffening is performed.


The goals of physical therapy are to minimize pain, increase foot flexibility, strengthen weakened muscles, train position perception, and educate and reassure the patient.

Pain management includes rest, activity regulation, cold therapy, massage, and nonsteroidal anti-inflammatory drugs. Ultrasound and electrical stimulation can also be used for pain relief. Electrical stimulation aids blood circulation, promotes recovery, and reduces discomfort and edema.

Flexibility exercises are passive range of the ankle and all joints of the foot; stretching of the calf twin muscle complex – short heel and lateral lacer muscles to reduce internal scoliosis and leg pressure; Stretch Achilles tendons and calf muscles to relieve tendon tension.

Strength exercises:

Strengthening exercises are provided for the anterior and posterior tibial muscles, the big toe flexors, the intrinsic muscles of the feet, the soles of the feet, and the big toe muscles to prevent scoliosis and flattening of the front arch.

Strength exercises for the arch muscles with the therapeutic cord

Figure 3: Arched Leg Strength Exercise with Theraband: Sit down and cross the affected leg across the other leg thigh. Wrapping therapy around the foot. Raise your feet with your hands. Slowly lower your legs back to the original position, resisting the cord’s pull. 3 sets per day, 10-15 pieces each.

Activate all the muscles that are known to support the medial arch and curvature with or without drag.

Stand bearing on one leg.

For the perception of position (proprioception), walking on toes and on heels, bearing a foot and going down an inclined surface are exercises that can be assigned.

Walk on heels

Figure 4: Walk on heels

walking on toes

Figure 5: Walk on toes

Alternatively, swiping your toes on towels and cobblestones, standing with your toes on stairs, toe stretching, toe spread, and heel walking are all good exercises to maintain arches of your feet.

leg scrubbing exercises

Figure 6: Foot-on towel exercise: Toes fully folded; Hold that position, then relax and stretch your toes as far as possible. Do 3 sets per day, 10-15 pieces each.

Stand on the ladder with your front foot

Figure 7: Stand on a ladder, place only the front leg on it. Lower your heels until you feel the tension in your calves. Hold the position, then relax. Every day 3 innings, each half 10-15 times

spread toe exercises

Figure 8: Toe spread exercise: toes spread out fully; Hold that position, then relax. Every day 3 innings, each half 10-15 times

toe stretching exercises

Figure 9: (A) Stretch your toes as much as possible. (B) Flex all the toes to form punches, practice 3 sets a day, 10-15 times each

Proper shoe consultation, introduction of shoe control movements, orthotics and bracing are also needed. Orthotics such as shoelaces are used to support arches for secondary leg pain caused by pes planus alone or by pes planus associated with lower leg, knee and back pain.

Overweight and obese individuals should be consulted for weight loss through exercise and diet; Patients can be referred to a registered dietitian for an appropriate view.

Other comorbidities suitable for physical therapy may also be treated after examination and treatment planning.

Reference source:




Luong Nguyen Minh Phuong


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