Flat Foot Rehabilitation

What Is Flat Foot (Pes Planus)? Distinguishing Flexible from Rigid Flat Foot

Flat foot is a condition in which the longitudinal arch that should be present on the inner side of the foot (the medial longitudinal arch) collapses or fails to develop at all. This causes the foot to make full contact with the ground. Flat foot is basically divided into two main types:

1. Flexible Flat Foot (Flexible Pes Planus): This is the most common type. The arch becomes visible when the foot is not bearing weight (for example, when sitting or rising onto the toes), but disappears when the foot bears full weight on the ground. It is generally considered a normal condition in childhood and often resolves spontaneously with age. It can also occur in adults, and may be asymptomatic or become painful over time.
2. Rigid Flat Foot (Rigid Pes Planus): This is less common. The arch never forms, whether or not the foot bears weight. It is usually an indicator of a more serious underlying condition, such as a bony abnormality (for example, tarsal coalition – an abnormal fusion between the foot bones), a neurological problem, or advanced arthritis.

Causes of Flat Foot and Who Is Affected?

The causes of flat foot vary according to age and type:

• In children:
  
  • Most often it is a normal developmental stage (especially up to age 6).
  • General ligament laxity.
  • Genetic predisposition.
• In adults:
  
  • Posterior Tibial Tendon Dysfunction (PTTD): This is the most common cause of flat foot that develops later in adulthood. This tendon is one of the most important structures supporting the arch of the foot, and its weakening or tearing leads to collapse of the arch.
  • Genetic factors, ligament laxity.
  • Excess weight (obesity).
  • Aging.
  • Inflammatory joint diseases such as rheumatoid arthritis.
  • Trauma (foot or ankle injuries).
  • Diabetes (complications such as Charcot neuroarthropathy).
  • Occupations that require standing for long periods or walking on hard surfaces.
  • Wearing unsuitable footwear.
  • Neuromuscular diseases.
  • Tarsal coalition (usually becomes symptomatic in adolescence).

Symptoms of Flat Foot: When Should You See a Specialist?

Not every case of flat foot produces symptoms. However, it is important to see an orthopedic specialist in the following situations:

• Pain in the sole of the foot, the heel, or the inner part of the ankle.
• Quick fatigue, cramping, or a feeling of heaviness in the feet and legs.
• Difficulty standing or walking for long periods.
• Swelling on the inner side of the ankle (especially in PTTD).
• Knee, hip, or low back pain (may be related to biomechanical changes caused by flat foot).
• Faster wear on the inner parts of shoes.
• In children, pain during activity, frequent falling, or reluctance to participate in play.
• Heels that appear to shift outward when viewed from behind (the “too many toes” sign – seeing too many toes).
• Suspicion of rigid flat foot.

How Is Flat Foot Diagnosed? (Prof. Dr. Bozkurt’s Diagnostic Approach)

At his clinic in Ankara, Prof. Dr. Murat Bozkurt performs a comprehensive evaluation when diagnosing flat foot:

• Patient History (Anamnesis): Details such as when and how the complaints began, the character of the pain, whether there is a family history of similar problems, the patient’s activity level, and the footwear used are thoroughly reviewed.
• Physical Examination:
  
  • Observation: Examining the feet both while standing (weight-bearing) and while sitting (non-weight-bearing). The presence of the arch, the position of the heels, and the “too many toes” sign are assessed.
  • Jack Test (Toe-Raise Test): The arch is checked for reformation when the big toe is passively lifted upward (helpful in distinguishing flexible from rigid flat foot).
  • Single-Leg Heel Rise Test: Important for assessing the strength of the posterior tibial tendon.
  • Range of Motion Examination: Ankle and subtalar joint movements are checked. These movements may be restricted in rigid flat foot.
  • Muscle Strength Examination: The strength of the posterior tibial tendon and other foot-ankle muscles is specifically tested.
  • Gait Analysis: The patient’s walking pattern is examined.
• Imaging Methods:
  
  • X-ray: Weight-bearing X-rays are requested to assess bone alignment, arch height, and possible findings of arthritis or tarsal coalition.
  • Ultrasonography (USG) or Magnetic Resonance Imaging (MRI): May be needed to assess the condition of soft tissues such as the posterior tibial tendon, or when other pathologies are suspected.
  • Computed Tomography (CT): Rarely requested for detailed examination of bony pathologies such as tarsal coalition.

Main Goals of Flat Foot Rehabilitation

In symptomatic cases of flat foot, the main goals of the rehabilitation program are:

• Reducing pain and discomfort.
• Strengthening the muscles of the foot and ankle (especially the arch-supporting muscles).
• Stretching tight muscles and tendons (especially the Achilles tendon).
• Improving balance and proprioception (the body’s ability to sense its position).
• Establishing correct walking mechanics and weight-bearing habits.
• Improving foot function and increasing participation in daily activities.
• Preventing secondary problems (such as knee, hip, and low back pain) that may develop in the long term.

Rehabilitation Methods: Step by Step Toward Health

In Ankara, Prof. Dr. Murat Bozkurt creates a personalized flat foot rehabilitation program based on the patient’s age, the type of flat foot, the severity of symptoms, and the underlying causes.

• Stretching Exercises:
  
  • Achilles Tendon and Calf Muscle Stretching: Very important for correcting the Achilles tendon tightness frequently seen in flat foot.
  • Stretching exercises for other tight muscle groups.
• Strengthening Exercises:
  
  • Intrinsic Foot Muscle Strengthening: Exercises such as towel curls, picking up marbles with the toes, and the “short foot” exercise strengthen the small muscles of the sole of the foot.
  • Posterior Tibial Tendon Strengthening: Exercises such as resistance-band inversion (turning the foot inward) and heel raises (especially with weight shifted inward).
  • Peroneal Muscle Strengthening: Eversion (turning the foot outward) exercises for ankle stability.
  • Leg and Hip Muscle Strengthening: Hip abductors, extensors, and core muscles are also trained to improve overall lower-extremity biomechanics.
• Balance and Proprioception Exercises: Single-leg standing, exercises performed on a balance board or soft surface.
• Gait Training and Biomechanical Corrections: Re-teaching correct weight-bearing and walking patterns.
• Use of Orthotic Insoles and Footwear Selection:
  
  • Insoles: When deemed necessary, Prof. Dr. Murat Bozkurt may recommend custom-made or ready-made supportive insoles. Insoles reduce pain, correct biomechanics, and prevent fatigue by supporting the arch of the foot.
  • Footwear Selection: Supportive shoes with good arch support, a firm heel counter, and a good fit should be preferred. Going barefoot or wearing very flat, unsupportive shoes should be avoided (except in certain special situations and exercises).
• Activity Modification: During painful periods, temporarily avoiding or reducing activities that increase symptoms (such as prolonged standing or running) may be recommended.

Rehabilitation Approaches According to Different Types of Flat Foot

• Flexible Flat Foot and Follow-Up in Children: Asymptomatic flexible flat foot generally does not require treatment; follow-up alone is usually sufficient. Parents are given information about appropriate footwear selection and general foot health. Gentle exercises and supportive insoles may be recommended in painful cases.
• Rehabilitation of Symptomatic Flexible Flat Foot in Adults: The comprehensive rehabilitation program described above (stretching, strengthening, balance, insoles, footwear modification) is applied.
• Rehabilitation of Adult-Acquired Flat Foot (Posterior Tibial Tendon Dysfunction – PTTD): The treatment plan varies according to the stage of PTTD. Successful results can be achieved with rehabilitation and orthoses (insoles, AFO – ankle-foot orthosis) in the early stages, while surgical treatment followed by intensive rehabilitation may be required in advanced stages.
• Post-Surgical Rehabilitation: For patients who undergo surgical treatment for rigid flat foot, advanced PTTD, or other structural problems, a staged rehabilitation program specifically planned by Prof. Dr. Murat Bozkurt is vital to optimizing postoperative recovery and restoring joint motion and strength.

Flat Foot Rehabilitation in Ankara: Individualized Solutions with Prof. Dr. Murat Bozkurt

Prof. Dr. Murat Bozkurt has extensive experience in Ankara accurately diagnosing and creating personalized treatment plans for children and adult patients presenting with flat foot complaints. His approach includes:

• Detailed evaluation of the patient and accurate identification of the type of flat foot.
• Use of advanced imaging methods when necessary.
• Designing individualized rehabilitation programs and managing them in collaboration with experienced physiotherapists in Ankara.
• Consultation on appropriate insole and footwear selection.
• Evaluation and application of surgical treatment options when conservative treatment is insufficient or a structural problem is present.
• Careful follow-up of the post-surgical rehabilitation process.

Flat Foot and Daily Life: Prevention and Management Tips

• Maintain your ideal weight as much as possible.
• Wear supportive shoes that fit your feet well.
• Avoid walking or running barefoot for long periods, especially on hard surfaces.
• Do regular exercises that will strengthen and stretch your foot and leg muscles.
• Take a break from your activities when you feel pain, and do not push through it.