What is “Flat Foot” Actually ?

Flat foot is a foot deformity in which there is loss of medial longitudinal arch. It is also termed as
pes planus. Pes planus may be lifelong, or acquired through time. In this condition the entire sole
of the foot is in contact or near contact with the ground while standing.
flat foot is normal in infants and toddlers, because the foot’s arch hasn’t yet developed. Most
people’s arches develop throughout childhood, but some people never develop arches. This is a
normal variation in foot type, and people without arches may or may not have problems.
Some children have flexible flatfoot, in which the arch is visible when the child is sitting or
standing on tiptoes, but disappears when the child stands. Most children outgrow flexible
flatfoot without problems. Arches can also fall over time. Years of wear and tear can weaken the
tendon that runs along the inside of your ankle and helps support your arch.
Infants & children
Flat feet are common in children and are often caused by:
2)Laxity of ligaments
3)Tight Achilles tendon
4)Lack of foot exercise
Typically a child’s arches begin developing in infancy and progress to normal arches in line with
normal growth patterns.
Adults can develop flat feet through injury, tight Achilles tendon, abnormal joint formation,
continued stresses on the foot and its arch, or simply as they age.
Some of the most common causes of flat feet in adults are:
1)Achilles Equinus contracture
2)Coalition of rearfoot joints
3)Failed or injured tendons
5)Marfan syndrome
9)Overuse & strain
10)Injury & fractures
The most identifiable symptoms and characteristics of flat feet are the decrease or lack of
arches in your feet (especially when weight bearing) and pain / fatigue along the inner side of
your feet and arches.Some issues caused by flat feet include:
1)Inflammation of soft tissue
2)Foot, arch, and leg fatigue
3)Heel, foot, and ankle pain
4)Knee, hip, and lower back pain
5)Rolled-in ankles
6)Abnormal walking patterns
7)Shin splints
11)Plantar fasciitis

Management of flat foot treatment
Treatment of flat feet will be started when you will start feeling pain or other foot, ankle
abnormality .
For children
At Advanced Foot & Ankle our podiatric specialists will conduct both a clinical exam and an
X-ray study to determine the type and cause of most flatfoot deformity.
Most cases of flat feet in children are genetic. However their feet are flexible in nature and can
be treated with:
1)Custom made insoles
3)Appropriate footwear
5)Surgery – often the best treatment for preventing major developmental complications in the
For Adults
Non-surgical treatment options for deterring the development of flat feet and its symptoms are:
1)Custom orthotics
2)Bracing & supports
3)Supportive footwear
5)Physical Therapy
6)Weight loss
7)Daily activity modifications
Physiotherapy management will help to regain mobility of the foot, Strengthen the surrounding
muscles .Regain foot and ankle control Provide initial relief of pain by using ice pack wrapped
in a damp towel and placed on the foot or area of pain for 10-15 minute can help to reduce
soreness. Some patients prefer moist heat for pain relief.
1)Modalities : Heat and cold therapy is applied to enhance relaxation and reduces pain. Ultra
sound and pulsed electrical stimulation can also be used to relieve the pain. Electric stimulation
will helps to improve the blood circulation, thus enhancing the healing process and reducing any
swelling or discomfort.
2) Exercises: toe clawing exercises, arch muscle strengthening exercises, heel cord stretching,
calf and hammstring stretching, toe spreading exercises, toe walking, ankle ROM, Dorsiflexion
and plantar flexion of foot, gripping exercises. Releasing manually any tight muscles will also
develop arches and will bring the foot in shape. Kinesio taping to support and to avoid any
unwanted movement of muscle.
Advance techniques like dry needling on tendon and on trigger points will ease the pain .
If conservative treatment won’t help much in treating flat foot sign and symptoms then another
choice of treatment will be surgical.
Surgical interventions includes
1) tendon transfer
2) osteotomies
3) Arthrodesis.



Squatting is one of the best exercise to gain strength and muscle mass in the leg.

Full squatting involves nearly all the muscles in the body as it is the basic human movement pattern. Daily activities such as picking up stuff off the floor, toileting or sitting in chair or low sitting box involves squatting.

Exercise science says squats are excellent for building strength, power, mobility and muscle mass. Researches shown that squatting creates more growth hormone compared to leg press exercise. Growth hormone is important aspect for muscle mass.

 But question arises here, are you squatting correctly?

Improper squatting can be result of less stability and mobility of spine or any of the joint problem (hip, knee, ankle, foot).

How to squat properly?

 Let’s talk about positioning –

Head – To be held straight in line with the shoulders

Thoracic spine – To be slightly extended or neutral

Lumbar spine – Neutral stable throughout the movement

Hip joints – Stable, no outwards or inwards movement (medio-lateral)

No drooping (drop down of hips) should stay aligned with knees.

Knees – Aligned with hips and feet, stable, no excessive movement inside or outside, forward or back

Feet & ankle – Flat feet and stable, heels in contact with the ground at all the times.

These are few basic steps to follow while you squat.

So after knowing these, what will be the key requirements to do squat properly?

             Balance , stability and mobility

             Keep hips mobile

             Knee follow toes

Does squats hurts or bad for knees or it is a myth?

It’s a myth, while you do full squatting, forces on the connective tissue increases which will not produce any injury. Full depth squatting in fact increases knee joint ligament stability.

This can turn out to be bad only when there is loss of strength of certain muscles, any injury to ligament or meniscus, or unstable joint. Then you need to seek advice from physiotherapist in particular.

Other major factors which can lead to injury are:

             Fatigue (tiredness of muscles)

             Poor technique

             Faster repetition speed

             More resistance ( over load)

What improper squat can lead to?

             Low back pain

             Upper & middle back pain

             Ligaments sprain ( knee and ankle)

             Muscle strains

Injuries can come suddenly or can take a period of time to indicate you such as sprains and strains can come suddenly but low back pain due to abnormal bio-mechanics can take few days or months to show pain.

How to prevent these injuries?

“Prevention is better than cure”

There is increased risk of injuries when there is lack of knowledge among trainers or those who do exercises watching videos online which do not always justify exercise physiology and movement patterns.

Right thing is to consult sports or musculoskeletal physiotherapist for correcting movement patterns and exercise. Physiotherapist evaluates all the muscles, joints and mechanics of the body. Physio can recognize the faulty patterns or weak links in the body.

What is best to do if any injury or pain occurs during squatting exercise?

             Initially if something happen you should stop doing exercise.

             For sudden injury, apply ice with compression and take rest

             Avoid any vigorous activity

             Do not massage over the strained part of the body

*Best option is to consult either Sports physio or Musculoskeletal physio.

We “Pain Free Zone” has witnessed many cases like these in the past many years. Faulty mechanics was the primary reason for body aches such as low back pain, upper – mid back pain etc.

It is needful that a physio should assess gym going clients by movement pattern analysis.

Squatting movement at different angles, faulty mechanics to be under stood and analyzing muscle function.

Solved over hundreds of cases, we concentrate on the faulty root which is causing pain instead of looking at pain only and treating that part.

Is there any problem or anomaly which can be diagnosed mistakenly in place of faulty mechanics?

Yes of course, one of the example is low back pain – after doing MRI, disc bulge is seen and any medical professional can blame disc to be reason which is not always true.

Faulty mechanics such as increased low back arch (lordosis curvature increased) during squatting can over stress back musculature, or butt wink or SI joint dysfunction.

Fact – Disc bulge can be seen in most of the gym going people no need to be worry always.

For any pain with or without any injury, for correcting exercise pattern, kindly visit “PAIN FREE ZONE” once. We will assess you the way it should be. We will describe in detail what is causing discomfort to you.

You can visit us at www.physiotherapistindelhi.com or can visit pain free zone fb page.

All the advance physiotherapy treatment is carried out here in PFZ such as

Dry needling



Manual therapy

Exercise program

Deep tissue release/ Sports massage

*Exercise program can turn your wrong way of doing squat into right way.

*Deep tissue release will transform your tight – tensioned muscle into much more relaxed state and helps in doing movement and exercises fluently.