Pes Planus (Flat Foot): Physiotherapy Treatment

A Pes planus is also known as a flat foot when there is no medial longitudinal arch in the foot. An arch of the foot has fallen, causing the whole foot to make contact with the ground. Pes planus can progress into a painful rigid form which causes significant disability.

Pes planus is of two forms; Flexible pes planus and rigid pes planus. When the arch of the foot is intact on non-weight-bearing but disappears on full standing on the foot, it is termed flexible pes planus. While rigid pes planus is when the arch is not present in both non-weight-bearing and weight-bearing.

Pes Planus (Flat Foot)

Causes of Pes planus:

• Sometimes pes planus is congenital.
• Obesity.
• Foot and ankle injury.
• Ligamentous laxity,
• Genetic malformation such as  Down syndrome and Marfan syndrome.
• The arches may weaken due to overuse and certain foot conditions or injuries
• Also, Spina bifida, cerebral palsy, and muscular dystrophy are some medical conditions.
• Due to pregnancy.

Clinical presentation of Pes planus:

• Foot pain.
• An attempt to perform a single-leg heel rise aggravates the pain.
• Inward turned ankles.
• Possible edema at the medial side of the foot.
• stiffness of arches of the feet.
• Contracture of feet and ankle muscles at the lateral side.
• Difficulty in walking.

Medical management:

Treatment is based on cause and symptoms. and NSAIDs are used for pain.

Surgery is required in rigid pes planus. Tendon transfers, realignment osteotomies, and arthrodesis are some of the surgeries that may be necessary, as well as triple arthrodesis in the event that other surgeries fail.

Physiotherapy Management:

The aim of physiotherapy is to minimize pain, increase foot flexibility, strengthen weak muscles, and train proprioception.

Pain management includes:

• Rest,
• Activity modification,
• Cryotherapy,
• Heat therapy,
• Soft tissue massage,
• Combo therapy,
• Combo therapy is the combination of ultrasound and pulsed electrical stimulation and along with pain relief, it also improves blood circulation, promoting the healing process, and diminishing discomfort and edema.

Flexibility training includes:

• Firstly, Passive range of motion exercises of the ankle and all foot joints,
• Stretching of gastrocnemius and soleus,
• Stretching of peroneus brevis muscles,
• Achilles tendon stretching,
• In addition heel stretch: Keep one leg extended behind you while the other leg forward. Press both heels firmly into the floor. Keep your spine straight, bend your front leg, and push yourself into the wall or support, feeling a stretch in your back leg and Achilles tendon. (Hold this position for 30 seconds. Do each side 4 times).
• Also, Tennis/golf ball roll: Sit on a chair with tennis or golf under your right foot. While rolling the ball under the foot Maintain a straight spine, focusing on the arch. (Do this for 2–3 minutes).

Strengthening exercises:

To prevent valgus and flattening of the anterior arch, muscles such as the anterior and posterior tibialis muscles, the flexor hallucis longus, the intrinsic, the interosseus plantaris, and the abductor hallucis are strengthened.

• Firstly, Arch muscles strengthening with theraband,
• Single leg weight-bearing,
• Toe walking,
• Eccentric gastrocnemius strengthening.
• Squatting while maintaining proper foot and leg alignment, as well as arch control,
• Arch Lift: Stand with your toes in contact with the floor the entire time, roll your weight to the outer edges of your feet as you lift your arches up as far as you can. Then relaxes your feet back down. (Do 2–3 sets of 10–15 repetitions),
• Calf raises:  Stand and take support of chair or wall, lift your heels as high as you can.  Hold this position for five seconds, and then come down. Do 2–3 sets of 15–20 repetitions. Then while at the upper position, pulse up and down for 30 seconds,
• Stair arch raises: Stand on stairs with your one foot 1 step higher than your other foot. Use your upper foot for balance as you lower your other foot down so your heel hangs lower than the step. Slowly lift your lower heel as high as you can. Turn your arch inward while rotating your knee and calf to the side so that it becomes higher. Slowly come back to the initial position. (Do 2-3 sets of 10-15 repetitions on both sides),
• Towel curls,Also, 
• Toe raises.

For proprioception:

Proprioception exercises can be performed on foam, rocker board, or Bosu ball.

• Toe and heel walking,
• Single leg weight-bearing,
• Toe clawing of towel and pebbles,
• forefoot standing on a stair,
• Also, toe extension and toe fanning/spreading,

Specialized techniques and manual therapies such as:

• Kinesio taping,
• Ankle joint mobilization and manipulation,
• Static or dynamic Cupping therapy.

Lifestyle modification;

• Footwear modification: wear footwear that has proper arch support as well as extra cushion and additional side foot support.
• orthotics and braces.
• Also, weight loss through exercise and dieting.