What are Flat Feet?

Adult feet typically have an upward curvature in the middle, which may be seen from the inside. We refer to this as an arch or medial arch of the foot. The arch is formed by tendons, which are tight bands that join at the heel and foot bones. The arches of your feet are formed by a combination of tendons in your foot and lower leg. Your foot produces a moderate to normal arch when all of the tendons are pulling in the right direction. There will be little to no arch if tendons do not draw together appropriately. This condition is characterized as flat feet, commonly referred to as fallen arch or pes planus.

Flat feet in children:

At birth, all infants have flat feet. By age 6, arches often begin to emerge. As adults, about two out of every ten children still have flat feet. Adults can get collapsed arches as a result of age-related stresses due to wear-and-tear or injuries.

The alignment of the body whether a person is standing, walking, or running might be impacted by flat feet. Therefore, having flat feet can raise your risk of experiencing pain in your foot, ankle, knees, hips, and even your back and neck. Before any symptoms of flat feet would appear, appropriate rehabilitation should be started to prevent any complaint. Treatments can be helpful if flat feet are the source of pain or other issues.

The biomechanics of the lower leg and the structure of the foot’s arch is functionally related. Most of the stresses experienced during weight bearing on the foot can be dissipated before the force reaches the long bones of the leg and thigh thanks to the arch, which offers an elastic, springy link between the forefoot and the rear foot.

The talus bone’s head is medially and distally displaced from the navicular bone in the pes planus. A person with pes planus loses the function of the medial longitudinal arch as a result of over-stretching the Plantar calcaneonavicular ligament (spring ligament) and the tendon of the tibialis posterior muscle.

Types of Flat feet:

Flexible:

The most typical flat feet are flexible. When you are sitting, you can see the foot arches. As soon as you put weight on your feet like in standing, the arches vanish. Early childhood or adolescence is when flexible flatfoot first appears. Both of the feet are affected, and it steadily grows worse with age. The tendons and ligaments of the foot arches are prone to swelling, stretching, and tearing.

Rigid:

When a person is sitting or standing and bearing weight on their feet, their feet do not have arches. This condition frequently starts around adolescence and gets worse as people age. Your feet can be in pain. Flexing the feet upwards or downwards or moving them side to side might be challenging. A rigid flat foot can occur on one or both feet.

Adult-acquired:

An adult-developed flat foot is characterized by an abrupt decline or collapse of the foot’s arch. The foot turns outward due to the falling arch, which can be painful. It can occur in one or both feet. The leg tendon that supports the arch, the posterior tibial tendon, is the most frequent site of inflammation or a tear.

Vertical talus:

A birth defect known as vertical talus prevents arches from developing in some infants. Incorrect position of the talus bone in the ankle. The foot’s bottom has a rocking chair-like appearance. The term rocker-bottom foot also applies to the vertical talus.

Causes:

Flat feet could run in your genes. The feet develop arches as children become older. Some people’s arches are high, while others are flat or almost so, resulting in flat feet.

 Your risk of flat feet is increased by a number of issues, such as:

• Achille’s tendon injuries.
• Tight Achilles tendons.
• Foot injury Injury.
• Tear or weakness of foot’s tendons.
• Damage or inflammation of the posterior tibial tendon.
• Broken bones.
• Cerebral palsy.
• Diabetes.
• Down syndrome.
• High blood pressure.
• Obesity.
• Pregnancy.
• Rheumatoid arthritis.

Symptoms:

• The loss or absence of foot arches is one of the most noticeable signs and symptoms of flat feet (especially when weight-bearing).
• Pain in the outside of the foot, ankle, heel, or arch.
• Leg cramps.
• Leg or foot muscle pain or fatigue.
• foot pain after prolonged walking or standing.
• The toes and the front portion of the foot point outward.
• Back, hip, and knee pain are possible symptoms of severe flat feet.

Diagnosis:

A physiotherapist can diagnose you by examining your symptoms and the appearance of your arches while you sit, stand, and walk. To examine the bone structure, you could have X-rays taken.

The doctor will assess your ankle strength and identify the primary source of your pain. He will also check Your shoes’ wear pattern, as it may also provide details about your feet.

Checking for falling arches or flat feet is a simple self-test that you may perform. Utilize these three main steps:

1. wet your feet into the water.
2. Stand on a level area where you can easily see your footprint.
3. Take a step back and examine the prints. You probably have flat feet if the bottoms of your feet leave entire imprints on the ground. Typically, the flatter the foot, the more of an imprint the sole of the foot leaves.

Treatment:

There are conservative treatments for flat feet. Rarely do individuals require surgery to correct rigid flat feet or issues with their bones or tendons. Treatment consists of:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Physical therapies.
• Supportive devices like foot orthotics, foot or leg braces, and custom-made shoes or insoles.
• Surgeries. Surgery is the last resort only if all other options have failed and the foot damage is serious. A few examples of procedures are as follows:

1. 1. Arthrodesis.
   2. Excision.
   3. Osteotomy.
   4. Tendon transfer.
   5. Bone grafting.

Physiotherapy Treatment:

The primary goals of the physiotherapy treatment are- Pain relief, Increase foot and ankle flexibility, Strengthen weak muscles, Train proprioception, and Realign the foot and ankle. To achieve these goals treatment include:

Cryotherapy:

Thermal treatment can ease your pain, and also provide you relief to do the following exercises.

Stretchings:

Heel cord stretching

• The Achilles tendon will roll inward if it is tight. Stretching the heel cord aims to lengthen the posterior calf muscles and the Achilles tendon.

Soft Tissue Release:

The golf ball roll

• Place your feet firmly on the floor and take a seat on the chair. To stretch the plantar fascia ligament, place the golf ball under the foot and roll it back and forth for two minutes under the arch of the foot.

Strengthening exercises:

• Standing Arch lift exercises.
• Calf raise exercises.
• On stair Arch raise exercises.
• Towel Toe curl exercises.
• Toe raises.
• Tibialis posterior muscle training.
  • Tibialis posterior muscle strengthening exercises should be done with a proper supportive arch. As while barefoot, subjects activated additional lower-leg muscles to complete an exercise that resisted foot adduction.

Proprioception Exercises:

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.
• toe extension and toe fanning/spreading.

Manual techniques:

• Ankle joint mobilization and manipulation.
• Kinesio taping.
• Cupping treatment.

Therapeutic modalities:

• combo therapy for pain relief.
  • 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.
• SIS.

Remember that it can take a few weeks of performing these exercises before you start to feel better. Be constant in your approach and keep performing the exercises even as you progress.