Relationship Between Pes Planus, Plantar Fasciitis, and Scoliosis
There is no direct evidence that pes planus or plantar fasciitis causes scoliosis, though they may coexist in certain conditions and biomechanical abnormalities in the foot can potentially contribute to postural changes.
Biomechanical Relationship
Pes planus (flat feet) and plantar fasciitis are common foot conditions that affect the lower extremity biomechanics, but current guidelines do not establish them as direct causes of scoliosis 1, 2.
While these conditions frequently coexist, particularly in certain genetic and developmental disorders, the relationship appears to be associative rather than causative:
- In cardio-facio-cutaneous syndrome, both pes planus and scoliosis are common findings, with scoliosis occurring in approximately 33% of individuals and pes planus in about two-thirds 1.
- In 22q11.2 deletion syndrome, scoliosis (usually adolescent idiopathic type) is common, and patients may also experience nonspecific lower leg/foot pains associated with pes planovalgus 1.
Clinical Considerations
Pes Planus
- Pes planus is typically physiologic in children and often resolves by adolescence 3.
- It can be classified as:
- Flexible: normal arch during non-weight-bearing or tiptoeing, with flattening on standing
- Rigid: arch remains collapsed regardless of weight-bearing status 4
- While pes planus may cause biomechanical changes in the lower extremity, there is no established direct pathway to scoliosis development 3, 4.
Plantar Fasciitis
- Plantar fasciitis is associated with biomechanical abnormalities including pes planus 5, 6.
- It results from a degenerative process at the origin of the plantar fascia at the calcaneus 5.
- While it can cause altered gait mechanics due to pain, there is no evidence in the guidelines that it directly leads to scoliosis 5, 6.
Scoliosis
- Scoliosis is primarily classified as:
- Idiopathic (75-80% of cases)
- Associated with genetic conditions (Marfan syndrome, Ehlers-Danlos syndrome)
- Secondary to neurological conditions (Chiari malformation, syringomyelia) 2
- The current guidelines for scoliosis management do not list foot conditions as primary etiological factors 2.
Management Implications
For patients presenting with both foot conditions and scoliosis:
- Address each condition appropriately according to its severity and symptomatology
- For symptomatic pes planus, orthotics may provide relief 1, 4
- For plantar fasciitis, conservative management including stretching, NSAIDs, and physical therapy is typically effective 5, 6
- For scoliosis, management depends on curve severity, with observation for mild curves, bracing for moderate curves, and surgery for severe curves 2
Routine scoliosis screening is recommended for patients with genetic conditions that predispose to both foot abnormalities and spinal deformities 1.
Important Caveats
When evaluating patients with both foot conditions and scoliosis, consider:
- Underlying genetic or neuromuscular conditions that may cause both issues
- The possibility that altered gait mechanics from foot pain might exacerbate existing spinal imbalances
- The need for comprehensive orthopedic evaluation when both conditions are present and symptomatic
Avoid assuming a direct causative relationship between foot conditions and scoliosis without considering other potential etiologies for the spinal curvature.