“Get up on your toes” is a figure of speech urging you to prepare to start something energetically. But when your child appears to be walking on tiptoe most of the time, you sense that something isn’t quite right.
Many parents fear something dire is going on, whether it might be tightness of the Achilles tendons in need of intensive physical therapy, surgery or some neurological issue which sounds even worse. Fortunately, although those situations do sometimes happen, more commonly the answer is far simpler and easier to deal with.
Feet which overpronate (flatten) too much are unstable—there is a lack of ‘leverage’ during walking and running—which is a very inefficient way of getting around. To combat this, raising up on the toes puts the foot in a more stable position. Also, depending on the balance between the forefoot and the rearfoot and the tightness of the Achilles tendon, the heel may lift off the ground prematurely during the gait cycle.
In these cases, muscles, tendons and ligaments have to work extra hard resulting in early fatigue, achiness and pain, affecting their gait and their athletic activities. Over many years, this can lead to foot deformities and arthritic damage to the feet, knees, hips and back.
Most of the time, if your child can stand with both heels on the ground, there is no major tightening of the Achilles tendon. Fortunately, providing proper support and balancing of the feet with a good set of orthotics such as our LittleSteps pediatric orthotics or our adult versions for those over the age of 10 can help deal with the majority of these situations. Using good orthotics on a daily basis can change things rather quickly, decreasing the toe walking and allowing your child to participate fully in their sports activities with less fatigue and pain—not to mention preventing larger problems into adulthood.
Strengthen the Tibialis Posterior Muscle & Tendon With a Calf Raise
One of the best ways to reduce pes planus and mitigate it is to strengthen the posterior tibialis muscle and tendon complex. So as we walk and gait in a terminal stance, that foot should supinate where it’s not flat
What we can do to help develop this is to do a simple calf raise.
By going up on your toes you can see whether or not the heel goes into supination and that’s really what we’re looking for.
That’s going to help pull on the midfoot and even some of the rear foot there as the tendons come through to provide stability into the opposite of flat feet.
So we would typically like to do this in three sets of 10 to 15 reps a couple times a week to help just get some strength and stability of that complex.
Improve Your Hip Extension
The second way to help mitigate flat feet or pes planus is to actually work the hip in getting the hip to extend.So what happens commonly is we walk, if you don’t have hip extension mobility, then the foot can’t resupinate.
The foot will go into pes planus or flat feet. We really want to make sure that we give the ankle joint enough time to dorsiflex. Which then allows that windlass mechanism to kick in, where the foot can start to supinate at the rear foot.
How we do this is having the patient go into a lunge like position, having a stretch cage is helpful, and the patient will drive back and forth and really work on getting motion in the hip.
If you don’t have mobility at the ankle joint, then what happens is the subtalar joint will revert and it causes motion at the midtarsal joint to give false dorsal flexion.
So we really want to make sure we’re getting true, authentic dorsiflexion so that the midtarsal joint doesn’t have to unlock which then will allow the foot to get rigid and become a stiff lever in the gate. So that’s just an easy way to get dorsiflexion.
So the last way we can mitigate pes planus is actually working the strength of the hip.
If I’m standing and I have weak hips, it’s going to potentially make my knees cave in which down the chain is going to make my feet go into pronation as a compensation.
If I work on strengthening some of my butt muscles and deep hip rotators, I can potentially help mitigate those forces of my flat feet.
One exercise that we really like to do here at Back in Motion is a hip airplane, and so we have the patient hold onto something because it’s not a balance exercise.
Then from here, they are going to rotate their hip into what we call external rotation and extension. And that’s going to get these deep hip rotator muscles working, which is going to help prevent ultimately from being in this knock-knee position, which can make her feet flat.
So there you have it. Those are three simple ways to mitigate pes planus or flat feet. We talked about the calf raise to work the posterior tibial tendon, and working the hip indirectly by mobilizing into extension, so that the midtarsal joint doesn’t have to unlock.
And lastly we talked about strengthening the glutes to help prevent some of that femoral internal rotation so that doesn’t happen at the feet.
Incorporating these tips above could help with everything from knee pain, back pain, hip pain, plantar fasciitis, and so much more.
About The Author: Dr. Scott Gray
Dr. Scott Gray is an internationally recognized and expert physical therapist & sports performance coach specializing in sport, athletic, and back and neck injuries. He is the inventor of a revolutionary form of treatment called the GRAY METHOD™. This type of treatment unlike others, addresses the CAUSE rather than just your SYMPTOMS with a full body approach. Learn more about what Back In Motion in Ft. Myers, FL has to offer other than physical therapy including sports performance training, personal training.