Flat Foot medically known as Pes planus, is a medical condition in which the medial longitudinal arch (MLA) which runs the length of the foot is flattened out or lowered. Flatfoot may affect one or both feet, and not only increases the load acting on the foot structure, but also interferes with the normal foot function. Therefore, individuals with flat feet experience discomfort while standing for long periods of time and exhibit a distinctive flat-footed gait.
Typical flatfoot symptoms include a tenderness of the plantar fascia, a laxity of the ligaments, a rapid tiring of the foot, pain under stress, and instability of the medial side foot structure. Over time, the mechanical overloading resulting from the flattened MLA is transferred to proximal areas such as the knees, hips and lower back, and thus flatfoot is recognized as a contributory factor in a wide variety of medical conditions, including lower limb musculoskeletal pathologies such as plantar fasciitis Achilles tendonitis, and patello-femoral joint pain.
Flatfoot deformities are commonly treated using some form of orthotic device. Such devices are designed to provide stability and to realign the foot arch, and have a demonstrable success in alleviating patients’ symptoms.
Anatomy
Flatfeet are an anatomical alteration which can occur in one foot or in both feet. The most common structural difference in flatfeet is found to be rear-foot varus which in turn causes excessive pronation of the foot.
In addition, deepened navicular cup, widened talus articular surface, proximally faced talus, and higher positioned navicular articular surface can be seen. These alterations cause the MLA to collapse resulting in a loss of arch height. When this loss of arch height is observable in both non-weight bearing and weight bearing positions, it is termed as rigid flatfeet.
Contrarily, when a normal MLA height is present in non-weight bearing condition and collapses with weight bearing is identified as flexible flatfeet.
Symptoms
The most identifiable symptoms and characteristics of flat feet are the decrease or lack of arches in the feet (especially when weight bearing) and pain / fatigue along the inner side of the feet and arches.
Some issues caused by flat feet include:
- Inflammation of soft tissue
- Foot, arch, and leg fatigue
- Heel, foot, and ankle pain
- Knee, hip, and lower back pain
- Rolled-in ankles
- Abnormal walking patterns
- Shin splints
- Bunions
- Hammertoe
- Arthritis
- Plantar fasciitis
- Posterior tibial tendon dysfunction (PTTD)
Causes
Flatfeet is not unusual in infants and toddlers, because the foot’s arch hasn’t yet developed. Most people’s arches develop throughout childhood, but some people never develop arches. People without arches may or may not have problems.
Some children have flexible flatfeet, often called flexible flatfoot, in which the arch is visible when the child is sitting or standing on tiptoes but disappears when the child stands. Most children outgrow flexible flatfeet without problems.
People without flatfeet can also develop the condition. Arches can collapse abruptly after an injury. Or the collapse can happen over years of wear and tear. Over time, the tendon that runs along the inside of the ankle and helps support the arch can get weakened or tear. As the severity increases, arthritis may develop in the foot.
Diagnosis
The observation of the feet mechanics from the front and back and also toes stand. The strength test in the ankles and locate the main area of pain. The wear pattern on the shoes also may reveal information about the feet.
Imaging tests that can be helpful in diagnosing the cause of foot pain may include:
- X-rays. A simple X-ray uses a small amount of radiation to produce images of the bones and joints in the feet. It’s particularly useful in evaluating alignment and detecting arthritis.
- CT scan. This test takes X-rays of the foot from different angles and provides much more detail than a standard X-ray.
- Ultrasound may be used when a tendon injury is suspected. Ultrasound uses sound waves to produce detailed images of soft tissues within the body.
- Using radio waves and a strong magnet, MRIs provide excellent detail of both bone and soft tissues.
Treatment
Many people with flat feet don’t have significant problems or need treatment. However, if foot pain, stiffness or other issues occur health provider might recommend nonsurgical treatments. Rarely, people need surgery to fix rigid flat feet or problems with bones or tendons.
Treatments include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), rest and ice to ease inflammation and pain.
- Physical therapies to stretch and strengthen tight tendons and muscles, improving flexibility and mobility.
- Supportive devices like foot orthotics, foot or leg braces and custom-made shoes.
Exercises
- Toes elevations: Start by standing with your feet shoulder-width apart and flat on the ground. Slowly raise your toes off the ground as high as you can, while keeping your heels on the ground. Hold this position for a few seconds, then lower your toes back down to the ground. Repeat for several repetitions.
- Toes scrunches: Begin by sitting in a chair with your feet flat on the ground. Scrunch your toes together as tightly as you can, then relax them. Repeat for several repetitions.
- Double/Single leg raises: Start by lying on your back with your legs straight out in front of you. For double leg raises, raise both legs off the ground at the same time, keeping them straight. For single leg raises, raise one leg off the ground while keeping the other leg straight and on the ground. Hold the raised leg in the air for a few seconds, then lower it back down to the ground. Repeat for several repetitions on each leg.
- Standing single leg balance: Stand on one foot with your knee slightly bent. Hold this position for as long as you can, up to 30 seconds, then switch to the other foot. For a greater challenge, close your eyes or stand on a pillow or unstable surface.
- Toes walks: Start by standing with your feet flat on the ground. Slowly walk forward on your toes, keeping your heels off the ground. Walk for a few steps, then lower your heels back down to the ground. Repeat for several repetitions.
- Heel walks: Begin by standing with your feet flat on the ground. Slowly walk forward on your heels, keeping your toes off the ground. Walk for a few steps, then lower your toes back down to the ground. Repeat for several repetitions.
- Calf muscle stretch: Start by standing facing a wall with your hands on the wall at shoulder height. Take one step back with one foot, keeping your heel on the ground. Bend your front knee, keeping your back leg straight, until you feel a stretch in your calf muscle. Hold this position for 15-30 seconds, then switch legs and repeat.
Prevention
Flat feet can be hereditary and hereditary causes can’t be prevented. However, to prevent the condition from worsening and causing excessive pain by taking precautions such as wearing shoes that fit well and providing the necessary foot support.
How we can help
Massage therapy and sports therapy can be effective treatment options for individuals with flat feet. These therapies aim to address imbalances in the muscles and connective tissues of the feet and lower legs, which can contribute to the development of flat feet or exacerbate existing flat foot symptoms.
Massage therapy involves the manual manipulation of soft tissues, such as muscles and fascia, to promote relaxation, improve circulation, and reduce tension and pain. A massage therapist can work on the feet and lower legs to release tension in muscles and connective tissues that may be contributing to flat foot symptoms. They may also use techniques such as trigger point therapy or myofascial release to address specific areas of tension or pain.
Sports therapy, on the other hand, focuses on improving strength, flexibility, and function in the muscles and joints of the feet and lower legs. A sports therapist can develop a personalized exercise program to help strengthen weak muscles, improve flexibility, and correct imbalances in the feet and legs that may be contributing to flat feet. They may also use techniques such as kinesiology taping or orthotics to support the arch of the foot and promote proper alignment.
Together, massage therapy and sports therapy can help alleviate pain, improve function, and prevent further complications associated with flat feet. If you are experiencing flat foot symptoms or have been diagnosed with flat feet, consult with a qualified massage therapist or sports therapist to develop a personalized treatment plan that can help you achieve optimal foot health.