Some people have flat feet, while others may have a high arch. Neither condition needs treatment unless it becomes painful or effecting function. People are more susceptible to certain conditions based on the type of foot they have. A high arched foot is a poor shock absorber whereas a flat foot can be unstable. A person with flat feet needs a shoe with arch support and may also benefit from shoe inserts. PT intervention can help pain that relates to common flat foot conditions include tendonitis, nerve entrapment, plantar fasciitis, metatarsalgia (pain in the forefoot), and pain in the big toe region (bunion). The focus of PT intervention is to help the foot become more stable. This goal may be achieved through the use of strengthening exercises to the muscles in the foot and calf. In addition, the exercises will focus on promoting muscle activation of the arch of the foot.
Pes cavus (high arched foot) is not as common as a flat foot. Pain related to this condition relates to the foot being too stiff or rigid. During the gait cycle (walking), the foot does not absorb pressure or shock efficiently and that will lead to pain. Common problems include metatarsalgia (pain in the forefoot), pain under the big toe, toe problems (hammer toes), plantar fasciitis, ankle arthritis, and achilles tedonitis. PT intervention focuses on improving the foot and ankle mobility with joint mobilization (hands on stretching) and exercises to stretch tight muscles and strengthen weak muscles. The correct shoe for this type of foot would provide a lot of cushioning and the sole of the shoe would be very flexible.
Heel pain or plantar fascitiis has been associated with obesity, poor shoe shock absorption, decreased ankle mobility, and running. Common descriptions include heel pain especially on the inside portion. Pain is normally at its peak the first several steps getting out of bed, after sitting for a period of time, and standing stationary. Some people may find relief using over the counter shoe inserts or taping of the foot. Custom made foot orthotics may also be indicated.
The treatment plan for foot pain may include the use of soft tissue mobilization, dry needling, joint mobilization, stretching, strengthening, and a shoe evaluation.