Pes planus, commonly referred to as a fallen arch or flatfoot, is a postural deformity where the arch of the foot collapses, causing the entire sole to make complete or near-complete contact with the ground when standing. This loss of the medial longitudinal arch means the foot lacks its natural curve, which normally provides an elastic, springy connection between the forefoot and hindfoot for shock absorption. The condition can be congenital, or acquired later in life due to factors like injury, illness, or the weakening of the posterior tibial tendon. When the arch collapses, it can disrupt the biomechanics of the lower limb, sometimes leading to pain in the feet, ankles, knees, or lower back.
Strengthening Exercises and Stretches
Active rehabilitation focuses on strengthening the intrinsic muscles of the foot and the supporting structures, particularly the tibialis posterior tendon, which is a major dynamic stabilizer of the arch. Consistent exercise helps build muscular support to compensate for the foot’s structural instability. An effective technique is the arch lift, also known as “foot doming,” where a person contracts the foot muscles to raise the arch without scrunching the toes, keeping the heel and toes grounded.
Exercises targeting the tibialis posterior muscle are important because its deficiency is a common cause of acquired flatfoot. One method involves sitting with the knee flexed and using a resistance band looped around the forefoot, then sliding the foot inward (adduction) against the band’s resistance while maintaining contact with the floor. This movement can be progressed to resisted heel raises, which engage the tendon as it assists in locking the midfoot and turning the heel inward during elevation. Another technique for engaging the small foot muscles is the marble pickup, which involves using the toes to grasp and lift small objects.
Stretching the calf muscles and Achilles tendon is equally important, as tightness in the triceps surae group can increase the likelihood of arch collapse. Calf stretches, performed with the knee straight and then bent, help improve flexibility and reduce the excessive tension that can contribute to the deformity. Foot rolling, often done with a tennis ball or similar small object, can also help relieve tension in the plantar fascia and improve flexibility in the sole of the foot. Consistency in performing these movements helps improve foot functionality and reduce related symptoms.
Selecting Supportive Footwear and Orthotics
Supportive footwear helps maintain proper foot alignment and cushioning, complementing muscle strengthening. Shoes designed for flat feet should feature a firm heel counter to limit excessive inward rolling (overpronation) and improve rearfoot stability. A shoe’s midsole should be firm and structured, rather than overly soft, to provide stability and resist twisting, which prevents the arch from collapsing further.
The shoe should also incorporate built-in arch support, which helps evenly distribute body weight across the foot and reduces strain on tendons. A wide toe box allows the toes to spread naturally, providing a broader base for weight distribution and better stability. Stability running shoes, for example, are engineered with motion control features and structured medial support to counteract overpronation.
Orthotics, or arch supports, are medical devices placed inside footwear to support the foot’s arch and correct biomechanical imbalances.
Over-the-Counter vs. Custom Orthotics
Over-the-counter (OTC) arch supports provide general relief by offering cushioning and basic arch reinforcement. Custom-made orthotics are prescribed by a specialist and fabricated based on a precise mold or scan of the foot to correct specific alignment issues and redistribute pressure more effectively. Custom orthotics are used when OTC options fail to provide adequate pain relief or when a specific biomechanical issue needs targeted correction.
When to Seek Professional Medical Guidance
While self-guided exercises and supportive footwear can manage many cases of flexible flatfoot, certain signs indicate the need for a professional medical evaluation from a podiatrist or orthopedist. A doctor’s visit is warranted if a person experiences persistent or worsening pain that interferes with daily activities, especially if the pain radiates up the leg to the knee or hip. Swelling around the inside of the ankle, difficulty standing on tiptoes, or a sudden, noticeable change in the foot’s shape in adulthood suggest posterior tibial tendon dysfunction. If conservative management fails to improve symptoms after several weeks, a specialist can provide a structured treatment plan.
A medical professional may prescribe structured physical therapy to focus on specific muscle weaknesses and gait abnormalities. They may also use imaging, such as X-rays or MRI scans, to assess the severity of the arch collapse and determine if the flatfoot is flexible or rigid, which dictates the course of treatment. In rare cases of rigid flatfoot, or when conservative care fails to relieve severe pain and progressive deformity, surgical options may be considered. These procedures can range from heel realignment (osteotomies) and tendon transfers to restore alignment, to more complex fusions of foot joints for fixed deformities.