Pes Planus When Foot Orthoses and Eccentric Exercises Have Not Achieved Pain or Function Goals

Symptomatic pes planus is managed along a structured nonoperative pathway. When the initial line of treatment does not produce sufficient improvement within the expected timeframe, a defined next step exists.

Prior Treatment — Goals Not Achieved

The first-line approach — foot orthoses combined with eccentric strengthening exercises of the posterior tibial tendon — was followed for 10 weeks. The targets of decreased foot pain and improved foot function index scores were not reached within that period, indicating escalation is warranted.

Next-Line Intervention

The next-line protocol centres on a custom ankle-foot orthosis. The complete specification — device design, fitting criteria, and any adjunct measures — is contained in the full protocol and is not reproduced here.

Treatment Goals

Decreased foot pain and improved foot function.

References

DOI: 10.1053/j.jfas.2019.09.001

Symptomatic adult-acquired flatfoot may be adequately managed with an ankle-foot orthosis.
A study by Augustin et al showed that 90% of patients who used a custom Arizona ankle-foot orthosis had decreased pain and improved function over a 2-year follow-up period.
Nielsen et al found the incidence of successful nonoperative management with the use of a custom low-articulated ankle-foot orthoses over a 27-month observation period to be 73%, with patients not needing surgical intervention.

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