Pes Planus Flat Feet
Pes Planus Flat Feet
What are Flat Feet?
Pes planus or flat feet is a postural deformity relating to the collapse or flattening of the medial longitudinal arch. It can also be referred to as hyperpronation or overpronation. As seen in the image, pes planus results in the midfoot region pronating towards the ground, and in some cases touching the ground completely. Although there are varying degrees of collapse, people are still able to live completely pain-free with flat feet.
What Causes Flat Feet?
This condition can be congenital (e.g. from birth) or acquired (e.g. adults, increased exposure to weight-bearing).
Congenital flat feet occur when someone is born with or predisposed to having a more flexible midfoot region resulting in pronation or collapsing of the arch. Ethnicity is an important factor surrounding flat feet, with the condition being more likely in certain indigenous cultures.
How Do Flat Feet Progress?
Flat feet progress slowly as you increase your feet’s exposure to weight-bearing activities. The two most common progressions from flat feet are foot deformities and bony stress injuries.
In the active person, hyperpronation alters the load transference up through the leg and can cause stress responses such as shin splints and in the worst case, stress fractures.
At the opposite end, the bones through your foot are also exposed to altered loads potentially causing a bunion. As seen in the image, the midfoot pronation and collapse of the arch change the line of force to the outside of the first metatarsal (from green to red), creating the bony protrusion. As the head of the metatarsal is forced out, the rest of the big toe is forced inwards further accentuating the bunion.
Tibialis Posterior Tendinopathy
Medial Tibial Stress Syndrome or “Shin Splints” ÂDue to the excessive pronation can cause the tibialis posterior or soleus muscle to apply altered stress to the inside aspect of the tibia. This can result in medial tibial stress.
Patellofemoral Pain Syndrome
Excessive or overpronation of the midfoot can cause a cascade effect through the ankle, knee and hip via inducing changes of tibial and femoral rotation and altering the normal dynamic control of these joints. These changes, although sometimes subtle, can predispose your knee and hip joints to increased instability and an increased likelihood of acute trauma.
How are Flat Feet Diagnosed?
The Foot Posture Index (FPI) is an observational tool which constitutes 6 items to analyse your static standing posture from 3 different angles. The FPI can assist your physiotherapist to diagnose flat feet or pes planus. However, your diagnosis should not rely entirely on this one index.
Due to problems most commonly arising in weight-bearing activities, your physiotherapist will also observe you conducting numerous single leg tasks in order to investigate your overall dynamic control, from your foot and ankle to your hips. This will include activities that challenge your strength, endurance, proprioception, and balance. Integrated into the entire kinetic chain, the main focus will be identifying any active insufficiencies through your arch and it’s respective stabilizers.
Flat Feet Treatment
Restore Intrinsic Muscle Control and Foot Arch Biomechanics
Dynamic Foot Posture Exercises
Passive Arch Support / Orthotics
Restore Normal Calf & Leg Muscle Control
Improve Your Running and Landing Technique
If your flat feet or compounding problems of the ankle or leg are exacerbated by sport or running, which place enormous forces through these areas, a good physiotherapist will be able to analyse your running and landing technique.
Return to Sport or Work
Depending on the demands of your chosen sport or your job, you may require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment. While flat feet itself can be pain-free, for some people, the pain it causes can hamper their working and active life. Specific focus will be applied to controlling your foot arch through specific activities that are causing you discomfort.
Sometimes it is poorly designed footwear that can predispose you to acquire flat feet or an associated injury. If you do suffer pain or discomfort that is impacting your active lifestyle, you should seek the professional advice of your healthcare practitioner to assist your ability to determine the best footwear for your feet.