Flat Feet Massage

Pes Planus or Flat Foot is a decreased medial longitudinal arch and a pronated hind foot (aka “flat foot”).

Causes of Flat Feet:

• hyper mobility
• poor biomechanics of subtler joint and metatarsal joint
• shortened gastrocs, soleus, or Achilles
• weakness in tibialis posterior
• congenital bony abnormalities in foot
• congenital bony abnormalities in leg and thigh
• poor posture
• nerve lesions causing paralysis or muscle weakness
• trauma
• poor footwear  flat feet massage flat foot massage for flat feet 

Flat Feet Massage: SIGNS & SYMPTOMS

• hypermobility of medial arch and pronated foot
• pain may be present in plantar surface, usually with overuse and fatigue
• short peroneus longus, peroneus brevis, peroneus tertius, gastrocnemius, and soleus muscles
• lengthened and weak tibialis posterior, tibialis anterior, long toe flexors, and intrinsic muscles of the foot
• other conditions present (plantar fasciitis, shin splints, and iliotibial band contracture)

 Flat Feet Massage: CONTRAINDICATIONS

• mobilizing hypermobile joints is contraindicated
• do not stretch tibialis anterior and posterior. Allows increased pronation of foot
• avoid heat on plantar surface when fasciitis is present
• friction massage technique when client is on anti-inflammatory medication is contraindicated

 Flat Feet Massage: ASSESSMENT

OBSERVATION:

• pronation occurs throughout entire gait cycle
• mild pes planus: 4-6 degrees hind foot valgus
• moderate pes planus: 6-10 degrees hind foot valgus
• severe pes planus: 10-15+ degrees hind foot valgus
• Achilles tendon= valgus
• internal tibial torsion possible
• valgus at knees
• internal rotation at hip possible
• medial arch is flat; foot pronated
• talar head bulges medially. Redness or callus where shoe rubs talar head
• valgus at first metatarsal joint
• forefoot abduction
• mortons foot
• Second metatarsal longer than the first

PALPATION:

• tenderness at spring ligament, navicular, calcaneus attachment of the long plantar ligament and plantar fascia, first and second metatarsal head and first metatarsophalangeal joint.
• heat local to first metatarsophalangeal joint with bunions and on plantar surface if plantar fasciitis is present
• thick, rough texture of skin over talar head and the first and second metatarsal heads
• hypertonic and lengthened intrinsic foot muscles, tibialis anterior, tibialis posterior, and long toe flexors
• shortened and hypertonic gastrocs, soleus, peroneus longus, peroneus brevis, and peroneus tertius
• trigger points present in peroneus longus and brevis

ROM:

Active Free:

• Eversion in non-weight bearing calcaneus greater than 10 degrees
• Dorsiflexion of ankle limited with severe pes planus
• Increased internal rotation with femoral ante version

Passive Relaxed:

• Tarsal joints and other joints of medial longitudinal arch are hypermobile
• Plantarflexion and dorsiflexion reduced with restricted ankle joint capsule
• Pain when passive eversion of calcaneus, supination of the foot and extension of toes with low grade inflammation of ligaments or plantar fascia
• Hypomobility in pronated superior tibiofibular joint
• Increased internal rotation of hip with femoral anterversion
• External rotation of hip decreased

Active Resisted:

• Reduced strength of tibialis anterior, tibialis posterior, and extensor hallucis longus

SPECIAL / ORTHOPEDIC TESTING:

• test for structural or functional Pes Planus
• morton’s neuroma

 Flat Feet Massage: Treatment Goals

• decrease SNS firing, fascial restrictions, pain, HT, TP’s, adhesions
• massage compensating structures
• treat other conditions, if any
• stretch shortened muscles
• increase circulation, esp. to weak, taut structures
• mobilize hypomobile joints

Flat Feet Massage Therapy Treatment:

PRONE:

• gastrocs/soleus:
• MFR, DMS, Effleurage, Petrissage
• . Stretch (+peroneals)
• foot: Repetitive effleurage

SUPINE:

• joint play  tibiofibular joint/ankle
• Use Stimulating Techniques: Tibialis anterior/posterior, Toe flexors intrinsic foot muscles (medial arch)
• Passive Stretch: gastrocs/soleus and peroneals
• Circulatory massage techniques to the whole leg

 Flat Feet Massage: Homecare

hydrotherapy:

• contrast foot baths after prolonged stress
• apply ice local to inflammation

strengthen:

• tibialis anterior/posterior
• intrinsic foot muscles

stretch:

• gastrocs/soleus
• peroneus longus, brevis, and tertius

other:

• avoid activities that stress medial longitudinal arch
• arch support
• self massage leg, foot, and ankle