Can physiotherapy (physical therapy) help with flat feet?

Physiotherapy Interventions for Flat Feet

Yes, physiotherapy can effectively help with flat feet through targeted exercises, orthotic interventions, and education. 1

Assessment and Understanding Flat Feet

• Flat feet (pes planus) occur when there is an imbalance between arch-flattening forces and arch-supporting structures, leading to collapse of the medial longitudinal arch 2
• Contributing factors include excessive tension in the triceps surae, obesity, posterior tibial tendon dysfunction, or ligamentous laxity in supporting structures 2

Effective Physiotherapy Interventions

Exercise Therapy

• Short foot exercises are highly effective for improving the medial longitudinal arch and should be performed for at least 6 weeks to see significant improvements 3, 4
• Tibialis posterior strengthening exercises combined with short foot exercises (3 days/week for 6 weeks) significantly improve foot posture and arch height 5
• Regular calf-muscle and anterior compartment stretching can reduce tension on the foot structures 1
• Eccentric strength training can promote tendon healing if tendinopathy is present 1

Orthotic Management

• Custom or prefabricated foot orthoses effectively redistribute plantar pressure and support the medial longitudinal arch 1, 6
• Orthotic insoles have been shown to significantly decrease maximum force and arch index under different walking conditions, preventing further deformation 6
• Heel lifts may be beneficial to unload tension on affected tendons 1

Combined Approach

• A combination of short foot exercises and arch support insoles provides superior outcomes compared to either intervention alone 5
• The combined approach improves not only foot posture but also dynamic balance and limits of stability 5

Implementation Timeline and Progression

• Short-term (0-6 weeks): Begin with short foot exercises and appropriate orthotic modifications 3, 5
• Medium-term (6-12 weeks): Continue exercises with progressive intensity and monitor orthotic effectiveness 4, 5
• Long-term (>12 weeks): Maintain exercise regimen and adjust orthotics as needed 6

Common Pitfalls to Avoid

• Inadequate exercise duration - short foot exercises need to be performed for at least 6 weeks to show significant improvement 4
• Inappropriate footwear - continuing to use tight or unsupportive shoes will perpetuate symptoms 1
• Premature return to high-impact activities before adequate arch strength is developed 1
• Relying solely on orthotics without addressing muscle weakness - both interventions work best when combined 5

When to Refer for Further Assessment

• If no improvement occurs after 6-8 weeks of consistent physiotherapy intervention 1
• If pain persists despite appropriate exercise and orthotic management 1
• If there are signs of rigid flat foot or significant structural abnormalities that may require surgical intervention 1