FLAT FOOT Pes Planus

Patients with flat feet often present to the Physical Therapist with problems that are indirectly caused by their foot structure. Knees, hips and lower back may be the primary source of discomfort

Flatfoot is a common condition, it is defined as an abnormal depression of the medial longitudinal arch.

These feet appear collapsed with excessive turning out of the heel, and the inside of the foot contacting the ground. Flatfoot is usually bilateral and apparent at an early age. It may be initially asymptomatic, but often becomes progressively symptomatic with age.  Some flat feet never become bothersome.

Weakness or paralysis of leg muscles can also create a flatfoot deformity. The medial arch is unstable in flexible flatfoot, this creates stress on the surrounding soft-tissues and joints creating tired, sore arches. The instability of the foot can create abnormal stress up the kinetic chain - resulting in pain in the legs, knees, hips and lower back. Flatfeet suffer from inadequate support of the bones and joints, and abnormal joint motion during gait. 

Fortunately, foot orthotic devices can correct these problems and reduce the occurrence of painful symptoms..  Generally, custom-made rigid functional posted orthotics are most effective for this foot type.  These devices are prescribed based on a thorough biomechanical examination by a qualified Physical Therapist. Over-the-counter arch supports may be helpful for mild cases, but often prove ineffective to relive symptoms associated with flatfoot.

Symptoms                                                                                                                                         Flat Foot
Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot
There may be associated discomfort within and near the ankle joint
The knees, hips, and lower back may be the primary source of discomfort
Feet may often feel tired and achy
Painful shin splints may develop with activity
Gait may be awkward

Causes
Genetic predisposition
Faulty foot mechanics, e.g. excessive pronation
Abnormal bony architecture
Laxity of ligaments
Neuro-muscular disease
Trauma to the leg muscles or major tendons
Inflammatory diseases of the joints e.g. Rheumatoid arthritis
Surgical procedures on the leg and ankle
Limb length inequality                                                                                                                              
Tight Achilles tendon

What you can do
Wear shoes with a good fit in the arch
Keep active and fit to strengthen leg and foot musculature
Control body weight to decrease load on the feet                 
Avoid prolonged periods weight bearing with bare feet
 

What the Physical Therapist may do
Apply orthopedic taping to support strained ligaments and joints
Prescribe physical therapy modalities
Prescribe functional foot orthotic devices to stabilize the foot and control motion
Prescribe an ankle-foot orthosis when greater control is required

Complications of Flat Foot
Severe heel pain from plantar fasciitis and Achilles tendonitis
Chronic strain and pain in the arch and lateral side of the mid-foot
Metatarsal stress fracture 
Early degenerative joint disease (osteoarthritis) of lower extremity joints
Flatfeet are more prone to conditions such as bunions, hammer-toes, and Morton's neuroma
Painful corns and calluses
Structural changes may create areas of abnormal pressure resulting in chromic ulcers of the foot
Chronic foot pain may lead to inactivity and diminished well-being