Tabassum Ali, DC, CCSP, CCCN
A flat foot, also known as pes planus, is found on the medial aspect of the foot when the arch fails to develop and touches the floor. The condition normally presents in infants and toddlers; it only becomes an issue in adulthood if the arch does not eventually develop. Most adults with flat feet will not have any complaints, but to experience pain or achy feet is not unusual. Flat feet is associated with the following symptoms:
Pain on the medial aspect of the foot, in the arch
Achy and tired feet at the end of a day or after long periods of standing on feet
Tight calves (Achilles Tendon)
Numbness from compression of the tibial nerve
Arthritis of the lateral ankle from compression
Associated knee pain
The pain with flat feet can be attributed to weakness in the tendons leading to failure of arch formation. When palpating the foot, you may also notice swelling on the medial ankle due to the constant compression.
Flat feet are often differentially diagnosed with tarsal tunnel syndrome and plantar fasciitis, or heel spurs, because of similar symptoms. To confirm that the flat feet are not flexible, have the patient stand on their toes and observe for the formation of an arch. If an arch is formed, that is indicative that the flat feet are flexible and there is no major underlying condition. If the arch does not appear when standing on the toes, further imaging may be necessary to confirm there is no other underlying condition causing the deformation of the foot such as tarsal coalition. With plantar fasciitis, the patient may be able to pin point the sharp pain on the heel of the foot and will be exacerbated by putting any weight on the foot or excessive duration of exercise. A good way to diagnose tarsal tunnel syndrome is, Tinel’s test; you can tap the tarsal tunnel where the nerve passes through, and if the symptoms are reproduced then it is highly probable.
Treatment of flat feet can vary depending on how chronic the condition is. In rare cases surgery to fuse the tarsals can be performed to decrease the pressure on the arch and vasculature. If you're considering foot surgery, discuss the benefits and risks with your doctor. Other invasive options include surgery of the tendons to repair the area. Conservative treatment is preferred, and can have lasting results if managed properly. Icing the area for no more than 20 minutes every 2 hours can help with the inflammation. Some sources recommend an orthotic to provide support for the medial arch and to relieve pressure on the nerve. The most effective form of treatment would be to address the scar tissue that has built up over time from overuse and adjust any subluxations of the foot and ankle. Once the symptoms have subsided and the scar tissue has healed, the next phase of treatment would be to keep stretching the muscles of the plantar fascia and medial arch of the foot and to strengthen them to prevent future injury.
Warm up of the muscles is important and can be done with simple arch stretching and continued on with the strengthening program. With flat feet, it is common to find tight calves. A good stretch for the calves is downward facing dog yoga pose. This pose serves dual purpose for flat feet, in that it stretches the tight calves and is exercising the tendons with weight on the balls of the feet. Exercises to strengthen the tendons associated with flat feet will include proprioceptive activity with one-legged stances and diagonal reaches. Approximately 6-8 weeks of treatment will be needed to decrease the pain and strengthen the muscles.
At Lone Star Sport & Spine, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. We examine the patient and determine the most efficient and quickest treatment plan for them. Our goal is not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance. We address the scar tissue that is built up from micro tears in the tissue due to overuse or previous injuries and develop a program to strengthen and train the muscles to be used functionally. Most all of our patients find results within a few treatments with decreased pain, and increased range of motion, strength, and balance. We then move into the second phase of treatment with strength and training which is the most important aspect of the treatment, to prevent future injuries.
In summary, to address flat feet:
Address the scar tissue in primary involved muscle, and any associated muscle
Adjust any subluxations in the ankle and foot
Strengthen and train the medial arch to prevent future injury (sport specific functional training)
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Ma, C. Benjamin. "Flat Feet: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, 17 Jan. 2013. Web. 11 Apr. 2013. <>.