From the Guidelines
The most effective treatment for pes planus associated tendonitis involves the use of orthotics and braces to correct biomechanical problems, such as excessive foot pronation or pes planus deformity, as recommended by the American Family Physician in 2005 1. The treatment approach should prioritize conservative management, including rest, ice, and activity modification to reduce inflammation and pain.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation for 1-2 weeks.
- Physical therapy focusing on stretching and strengthening exercises for the posterior tibial tendon, Achilles tendon, and intrinsic foot muscles should be performed 3-4 times weekly for 6-8 weeks.
- Custom orthotic inserts with medial arch support are crucial for correcting biomechanical issues and reducing tendon strain during daily activities, as they can help correct overpronation or pes planus problems, and many patients will benefit from heel lift orthotics to unload the tendon for pain relief 1. The use of orthotics and braces is a valuable adjunct to these therapies, as they are safe, widely used, and often helpful in correcting biomechanical problems, such as excessive foot pronation or pes planus deformity 1.
- Immobilization with a walking boot or ankle brace may be necessary for 2-4 weeks in more severe cases.
- Corticosteroid injections should be used cautiously due to potential tendon weakening. For cases resistant to conservative treatment after 3-6 months, surgical options including tendon repair, osteotomy, or arthrodesis may be considered. Proper footwear with good arch support and stability features is also important for long-term management, as it can help reduce the risk of further injury and promote healing.
From the Research
Treatment Options for Pes Planus Associated Tendonitis
- The treatment of pes planus associated tendonitis can be managed conservatively or surgically, depending on the severity and stage of the condition 2, 3.
- Conservative treatment options include support for the medial longitudinal arch, physical therapy focusing on eccentric exercises, and orthotics 3, 4.
- Surgical treatment is considered for patients who do not respond to nonoperative treatments after three to six months and is based on the specific stage of tendinopathy 3.
- Posterior tibial tendinopathy, a common cause of pes planus, can be treated with nonoperative options such as immobilization, physical therapy, and orthotics, while surgical debridement can be considered if nonoperative treatment is ineffective 3.
Etiology and Diagnosis
- Pes planus can be caused by various factors, including posterior tibial tendon dysfunction, and can be diagnosed through clinical and x-ray evaluation 2.
- The condition can be classified as flexible or rigid pes planus, with flexible pes planus being more common in children and often resolving with age 2.
- A thorough assessment and diagnosis are essential to guide treatment decisions and prevent further complications 2, 4.
Treatment Outcomes
- While there is limited evidence on the efficacy of specific treatments for pes planus associated tendonitis, studies suggest that conservative management can be effective in reducing pain and improving function 3, 4.
- Local corticosteroid injection, platelet-rich plasma injection, and extracorporeal shockwave therapy have been compared as treatment options for pes anserine bursitis, with local corticosteroid injection showing significant improvement in pain and function 5.