Pes Planus

Pes Planus (Flat Insoles) Pes planus is a postural deformity characterized by the collapse of the internal arch of the foot (medial longitudinal arch). This condition, which is common in both children and adults, can affect gait, posture, and overall function. Foot Arches and Supporting Structures There are three main arches in the foot: Medial arch (inner side) Lateral arch (outer side) Transverse arch (anterior part of the foot sole) The primary structures protecting these arches are: Tibialis posterior muscle Peroneus longus muscle Plantar fascia When these structures weaken or relax, the arch collapses and pes planus occurs. Causes (Etiology) Congenital ligament laxity Muscle weakness (especially tibialis posterior) Excessive pronation and improper shoe wear Obesity or prolonged standing Trauma or neuromuscular diseases Clinical findings Loss of the inner arch of the foot Heel valgus and excessive pronation Fatigue, pain, and ankle instability Kinetic chain effects such as knee and low back pain Classification Flexible Pes Planus: The arch collapses under load but is normal when sitting. Rigid Pes Planus: The arch is collapsed or reduced in all positions. Acquired Flatfoot: Develops in adults as a result of posterior tibial tendon insufficiency.

Diagnosis and Evaluation Clinical observation and postural analysis Navicular drop test and wet footprint test Radiographic measurements if necessary Ankle muscle strength and range of motion assessment Physiotherapeutic approach Muscle strengthening: Tibialis posterior and intrinsic foot muscles Stretching: Gastrosoleus and peroneal muscles Balance and proprioception exercises Manual therapy and taping techniques Use of appropriate insoles (orthotics) Exercise examples Raising the arch of the foot (Short Foot) Marble pick-up: Picking up marbles with the toes Towel curl: Curling a towel with the toes Achilles and plantar fascia stretching Balance training on one leg Prevention and Patient Education Proper shoe selection (with back support and orthopedic sole) Regular stretching and muscle strengthening program Avoiding excessive weight gain Taking breaks when standing for long periods

References:

• American Orthopaedic Foot & Ankle Society (AOFAS). Flatfoot (Pes Planus). 2023.

• Saltzman CL, et al. Adult flatfoot deformity: evaluation and treatment. J Bone Joint Surg Am. 2005;87:2122–2138.

• Kelikian AS. Foot and Ankle Anatomy and Biomechanics. 3rd ed. Philadelphia: Saunders; 2011.

• Easley ME, Trnka HJ. Current concepts review: adult acquired flatfoot deformity. Foot Ankle Int. 2007;28:1045–1059.

• Kulig K, et al. Rehabilitation of pes planus: strengthening and orthotics. Phys Ther. 2009;89:108–119.