REHABILITATION.
FLAT FOOT /PES PLANUS is loss of medial longitudinal arch of foot.
The medial longitudinal arch (MLA) plays an important role in shock absorbance and energy transfer during walking.
Biomechanically Flat-arched feet, causes altered foot function, i.e. prolonged calcaneal eversion, increased tibial internal rotation, increased forefoot abduction, reduced efficiency of gait, and reduced shock absorption.
People with flat feet show altered movement biomechanics than normal people, for example, when walking; these people have more pronation in the back of their feet, more plantar flexion in the ankle joint, and more flexion in the knee joint.
In flat foot ,entire lower limb biomechanical alterations happen which causes knee joint valgum ,leading to knock knees and tight hip adductor muscles and weakened hip abductor muscles.
This causes musculoskeletal problems like Achilles tendinitis, iliotibial band syndrome, knee pain, and low back pain . Previous research has shown that 77% of adults with flatfoot have back or lower extremity pain.
A person with moderate or severe pes planus typically is unable to dissipate loads throughout the foot, Hence intrinsic and extrinsic short foot muscles have to work more to compensate for the lack of tension produced in overstretched or weakened foot ligaments and fascia.
Increased muscular activity is needed even during quiet standing, which causes fatigue and various overuse symptoms, including : —
Pain, “shin splints,” bone spurs, and a thickened and inflamed plantar fascia(plantar fascitis).
The good news is that , A variety of therapeutic and clinical interventions is available to treat flat feet, such as the use of orthotics, orthopedic surgery, and the use of special short foot muscle (SFM)exercises.
Rehabilitation of flat foot includes therapeutic exercises of foot _
- Short Foot Muscle Exercises (SFM)
EXERCISE 1- RAISE MEDIAL ARCH
EXERCISE 2: PERONEAL MS STRETCHING.
EXERCISE 3: STANDING SUPINATION
EXERCISE 4: WEIGHT BEARING SUPINATION
EXERCISE 5: NON WEIGHT BEARING SUPINATION
EXERCISE 6: TOWEL CURLS
EXERCISE 7: THERABAND EXERCISES- 10–15 reps * 3 sets.
EXERCISE 7- TIBIALIS POSTERIOR STRENGTHENING:
EXERCISES TO CORRECT KNEE AND HIP JOINT PROBLEMS OCCURING DUE TO FLAT FOOT:
KNEE JOINT:
- EXERCISE 1 — VMO STRENGTHENING
2. EXERCISE 2 — STRETCHING ILIOTIBIAL BAND.
HIP JOINT:
EXERCISE 1- HIP ABDUCTOR STRENGTHENING
EXERCISE 2: HIP ADDUCTOR STRETCHING
ORTHOSIS USED IN FLAT FOOT:
In a study conducted by Jun Na Zhai et al (2016), it was found that wearing foot insoles in flatfoot persons for upto 3 month significantly reduced plantar pressures by increasing the arch height of foot and distributing the weight from midfoot to forefoot and heel, thus causing less production of fot pain in people with flat feet.
Hence insoles adjust the aligngment of altered bones in flat foot.
In Summary to the recent advances of treatment for flat foot, rehabilitation , in a study conducted by S. Hara et al. / The effects of short foot exercises to treat flat foot deformity: A systematic review, found that —Five weeks of continuous short foot exercises (SFE) for flat feet may improve morphology and proprioception in the Intrincsic Foot Muscles and improve the Medial longitudinal Arch (MLA).
Also SFEs have been shown to be more effective than functional orthotic therapy in improving the MLA.