Pes Planusta Konservatif Tedavinin Fonksiyonel Duruma Etkisi

Abstract

Pes planus hem statik hem de dinamik hareketler sırasında zemine temas eden ayak taban yüzeyinin arttığı ve hem yetişkin hem de çocuk popülasyonunda sıklıkla karşılaşılan bir durumdur. Görülme sıklığı tüm popülasyonda %13,60 ila %26,62 arasındadır. Pes planuslu bireylerde bozulmuş ayak postürü duyusal girdi, kas aktivasyonu ve fonksiyonel durumu olumsuz etkiler ve ağrıya neden olur. Tedavi öncelikle konservatiftir. Konservatif müdahaleler hastaların %83 ila %87,5’inde başarılı sonuç vermiştir. Konservatif tedavide ilk hedef medial longitidunal arkı desteklemektir. Bu amaçla sıklıkla kullanılan müdahaleler ayak iç kaslarına veya çevre kaslara egzersiz, rijit ve esnek bantlama, elektroterapi, ortez veya tabanlıklardır. Bu yöntemlerin tedavideki etkinliği sıklıkla ayak postürü, basınç dağılımı, kas kuvveti ve kas kesit alanının artması ile değerlendirilmiştir. Ancak pes planusun bireylerde denge bozukluğu, azalmış sıçrama yüksekliği, azalmış yürüme mesafesine neden olarak fonksiyonu etkilediği bilinmektedir. Çünkü pes planusta meydana gelen medial longitidunal ark yüksekliğinin azalması, ayak pronasyonunun artması ve plantar fleksiyon kas gücünün azalması ayağın medial kısmında plantar basıncın artmasına neden olur. Plantar basınçtaki değişiklik ise kinetik zincir aracılığıyla tüm vücut segmentlerinde hizalanma ve yüklenmeyi değiştirerek kişinin fonksiyonel performansını etkiler. Konservatif tedavilerin pes planuslu bireylerde fonksiyonlar üzerine etkileri belirsizdir. Bu nedenle bu derlemede esnek pes planuslu yetişkinlerde kullanılan güncel konservatif tedavi yöntemlerinin fonksiyonel durum üzerine etkileri sunulmuştur. Sonuçta pes planuslu yetişkin bireylerde intrinsik kasları hedef alan egzersizler ve tabanlıklar statik ve dinamik denge ile fonksiyonu iyileştirmede ve ağrıyı azaltmada etkili görünmektedir. Bantlama tekniklerinin fonksiyona etkileri tartışmalıdır. Elektroterapi yöntemlerinin ise fonksiyonel duruma etkileri daha fazla araştırılmaya muhtaçtır. Sonuç olarak pes planuslu bireylerde hedef fonksiyona göre etkili olduğu bildirilmiş konservatif tedavi yöntemleri tercih edilmelidir.

Keywords

• Düztaban
• egzersiz
• konservatif tedavi
• pronasyon

The Effect of Conservative Treatment of Pes Planus on Functional Status

Abstract

Pes planus is a frequently encountered condition in both adult and pediatric populations, characterized by an increased contact area between the plantar surface of the foot and the ground during both static and dynamic movements. Its prevalence in the general population ranges from 13.60% to 26.62%. In individuals with pes planus, impaired foot posture negatively affects sensory input, muscle activation, and functional status, and can lead to pain. Treatment is primarily conservative, with successful outcomes reported in approximately 83% to 87.5% of cases. The initial goal of conservative treatment is to support the medial longitudinal arch. Frequently used conservative interventions include exercises targeting intrinsic or surrounding foot muscles, rigid and flexible taping techniques, electrotherapy, orthoses, and insoles. The effectiveness of these methods is commonly assessed through improvements in foot posture, pressure distribution, muscle strength, and increases in muscle cross-sectional area. However, pes planus is known to impair functional performance by causing balance disturbances, reduced jump height, and decreased walking distance. This is primarily due to the decrease in medial longitudinal arch height, increased foot pronation, and reduced plantar flexor muscle strength, which collectively lead to increased plantar pressure on the medial aspect of the foot. This alteration in plantar pressure affects the alignment and loading of all body segments through the kinetic chain, thereby influencing overall functional performance. Despite the prevalence of conservative treatments, their effectiveness in improving these functional limitations remains unclear. Accordingly, this review presents the current evidence regarding the effects of conservative treatment methods on functional status in adults with flexible pes planus. Findings suggest that exercises targeting intrinsic foot muscles and the use of insoles appear to be effective in enhancing both static and dynamic balance, improving function, and reducing pain. The effects of taping techniques on function remain controversial, while the impact of electrotherapy on functional status requires further investigation. In conclusion, conservative treatment strategies that have been shown to be effective for specific functional goals should be prioritized in the management of individuals with pes planus.

Keywords

• Conservative treatment
• exercise
• pes planus
• pronation

References

1. Aenumulapalli, A., Kulkarni, M. M., & Gandotra, A. R. (2017, Jun). Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J Clin Diagn Res, 11(6), Ac17-ac20. https://doi.org/10.7860/jcdr/2017/26566.10059
2. Ataabadi, P. A., Abbassi, A., Letafatkar, A., & Vanwanseele, B. (2022, 2022/07/01/). The effects of foot orthosis and low-dye tape on lower limb joint angles and moments during running in individuals with pes planus. Gait & posture, 96, 154-159. https://doi.org/https://doi.org/10.1016/j.gaitpost.2022.05.024
3. Bednarczyk, E., Sikora, S., Kossobudzka-Górska, A., Jankowski, K., & Hernandez-Rodriguez, Y. (2024, 2024/03/01/). Understanding flat feet: An in-depth analysis of orthotic solutions. Journal of Orthopaedic Reports, 3(1), 100250. https://doi.org/https://doi.org/10.1016/j.jorep.2023.100250
4. Cote, K. P., Brunet, M. E., Gansneder, B. M., & Shultz, S. J. (2005, Mar). Effects of Pronated and Supinated Foot Postures on Static and Dynamic Postural Stability. J Athl Train, 40(1), 41-46.
5. Franco, A. H. (1987, May). Pes cavus and pes planus. Analyses and treatment. Phys Ther, 67(5), 688-694. https://doi.org/10.1093/ptj/67.5.688
6. Fukuda, K., Nagamune, N., Okamura, K., Ikeda, T., & Kanai, S. (2025, Oct 10). Immediate effect of a combined neuromuscular electrical stimulation and eccentric load session on acute muscle swelling of the abductor hallucis. Phys Ther Sport, 76, 147-153. https://doi.org/10.1016/j.ptsp.2025.10.002
7. Hertel, J., Gay, M. R., & Denegar, C. R. (2002, Jun). Differences in Postural Control During Single-Leg Stance Among Healthy Individuals With Different Foot Types. J Athl Train, 37(2), 129-132.
8. Holmes, C. F., Wilcox, D., & Fletcher, J. P. (2002, May). Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports Phys Ther, 32(5), 194-201. https://doi.org/10.2519/jospt.2002.32.5.194

9. Jor, A., Lau, N. W. K., He, Y., Daryabor, A., Lam, W.-K., Hobara, H., Gao, F., & Kobayashi, T. (2025, 2025/09/01/). Effects of foot orthoses on lower extremity joint kinematics and kinetics in runners with asymptomatic flatfeet: A systematic review and meta-analysis. Gait & posture, 121, 281-294. https://doi.org/https://doi.org/10.1016/j.gaitpost.2025.06.003
10. Jung, D.-Y., Kim, M.-H., Koh, E.-K., Kwon, O.-Y., Cynn, H.-S., & Lee, W.-H. (2011). A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Physical Therapy in Sport, 12(1), 30-35. https://doi.org/10.1016/j.ptsp.2010.08.001
11. Jung, D.-Y., Koh, E.-K., & Kwon, O.-Y. (2011). Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial. Journal of back and musculoskeletal rehabilitation, 24(4), 225-231. https://doi.org/10.3233/BMR-2011-0299
12. Kabak, B., Kocahan, T., Akınoğlu, B., Genç, A., & Hasanoğlu, A. (2019). Does pes planus influence balance performance in Athletes? Spor Hekimligi Dergisi/Turkish Journal of Sports Medicine, 54(3).
13. Khorshidi, H., Raeisi, Z., & Yalfani, A. (2025, 2025/06/01/). Comparing the effects of Kinesio and dynamic tapes on plantar pressure and postural stability in the pre- and post-fatigue phases: The case of men with pes planus. Gait & posture, 119, 48-55. https://doi.org/https://doi.org/10.1016/j.gaitpost.2025.02.017
14. Kim, E. K., & Kim, J. S. (2016, Nov). The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients. J Phys Ther Sci, 28(11), 3136-3139. https://doi.org/10.1589/jpts.28.3136
15. Kodithuwakku Arachchige, S. N. K., Chander, H., & Knight, A. (2019, 2019/03/01/). Flatfeet: Biomechanical implications, assessment and management. The Foot, 38, 81-85. https://doi.org/https://doi.org/10.1016/j.foot.2019.02.004
16. Lee, C.-R., Kim, M.-K., & Cho, M. (2012). The Relationship between Balance and Foot Pressure in Fatigue of the Plantar Intrinsic Foot Muscles of Adults with Flexible Flatfoot. Journal of physical therapy science, 24, 699-701. https://doi.org/10.1589/JPTS.24.699
17. Moon, D., & Jung, J. (2021, Oct 13). Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial. Healthcare (Basel), 9(10). https://doi.org/10.3390/healthcare9101358
18. Namsawang, J., Eungpinichpong, W., Vichiansiri, R., & Rattanathongkom, S. (2019, Jul). Effects of the Short Foot Exercise With Neuromuscular Electrical Stimulation on Navicular Height in Flexible Flatfoot in Thailand: A Randomized Controlled Trial. J Prev Med Public Health, 52(4), 250-257. https://doi.org/10.3961/jpmph.19.072
19. Nickpey, Z., Boozari, S., & Farjad Pezeshk, A. (2025, Oct 27). Effects of kinesio tape on countermovement jump kinetic variables in physically active females with flat feet before and after fatigue: a randomized controlled trial. BMC Sports Sci Med Rehabil, 17(1), 309. https://doi.org/10.1186/s13102-025-01355-4
20. Okamura, K., Hamaguchi, M., Ueno, Y., & Kida, T. (2024, Feb 1). Effect of Neuromuscular Electrostimulation With Blood Flow Restriction on Acute Muscle Swelling of the Abductor Hallucis. J Sport Rehabil, 33(2), 121-127. https://doi.org/10.1123/jsr.2023-0140
21. Panichawit, C., Bovonsunthonchai, S., Vachalathiti, R., & Limpasutirachata, K. (2015). Effects of Foot Muscles Training on Plantar Pressure Distribution during Gait, Foot Muscle Strength, and Foot Function in Persons with Flexible Flatfoot. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet, 98, S12-17.
22. Park, S.-Y., & Kim, S.-G. (2025). Effect of Anti-Pronation Athletic Tape Types: A Randomized Crossover Trial on Ankle Strength, Gait Parameters, and Balance Control Ability in Women with Flexible Flat Feet. Applied Sciences, 15(12), 6858. https://www.mdpi.com/2076-3417/15/12/6858
23. Pérez Olivera, A. L., Solan, M. C., Karamanidis, K., Mileva, K. N., & James, D. C. (2022, 2022/01/01/). A voluntary activation deficit in m. abductor hallucis exists in asymptomatic feet. Journal of biomechanics, 130, 110863. https://doi.org/https://doi.org/10.1016/j.jbiomech.2021.110863
24. Pita-Fernandez, S., Gonzalez-Martin, C., Alonso-Tajes, F., Seoane-Pillado, T., Pertega-Diaz, S., Perez-Garcia, S., Seijo-Bestilleiro, R., & Balboa-Barreiro, V. (2017). Flat foot in a random population and its impact on quality of life and functionality. Journal of clinical and diagnostic research: JCDR, 11(4), LC22. https://doi.org/10.7860/JCDR/2017/24362.9697.
25. Rakhmatova, R., Miçooğulları, M., & Tok, M. I. (2025, Sep). How does pes planus affect jumping performance and balance ability? J Back Musculoskelet Rehabil, 38(5), 1094-1105. https://doi.org/10.1177/10538127251324728
26. Rome, K., & Brown, C. L. (2004, Sep). Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehabil, 18(6), 624-630. https://doi.org/10.1191/0269215504cr767oa
27. Sheikh Taha, A. M., & Feldman, D. S. (2015, Dec). Painful Flexible Flatfoot. Foot Ankle Clin, 20(4), 693-704. https://doi.org/10.1016/j.fcl.2015.07.011
28. Siu, W. S., Shih, Y. F., & Lin, H. C. (2020, Apr-Jun). Effects of Kinesio tape on supporting medial foot arch in runners with functional flatfoot: a preliminary study. Res Sports Med, 28(2), 168-180. https://doi.org/10.1080/15438627.2019.1638258
29. Soni, J., Sawant, S., & Shah, S. (2025, Oct). Efficacy of Core Stability Exercises and Intrinsic Foot Training on Patients With Flat Foot: A Comparative Study. Cureus, 17(10), e95659. https://doi.org/10.7759/cureus.95659
30. Sung, P. S. (2016, Mar). Kinematic analysis of ankle stiffness in subjects with and without flat foot. Foot (Edinb), 26, 58-63. https://doi.org/10.1016/j.foot.2015.11.003
31. Şahin, F. N., Ceylan, L., Küçük, H., Ceylan, T., Arıkan, G., Yiğit, S., Sarşık, D., & Güler, Ö. (2022, Sep 15). Examining the Relationship between Pes Planus Degree, Balance and Jump Performances in Athletes. Int J Environ Res Public Health, 19(18). https://doi.org/10.3390/ijerph191811602
32. Tosovic, D., Ghebremedhin, E., Glen, C., Gorelick, M., & Brown, J. M. (2012). The architecture and contraction time of intrinsic foot muscles. Journal of Electromyography and Kinesiology, 22(6), 930-938.
33. Tsai, L. C., Yu, B., Mercer, V. S., & Gross, M. T. (2006, Dec). Comparison of different structural foot types for measures of standing postural control. J Orthop Sports Phys Ther, 36(12), 942-953. https://doi.org/10.2519/jospt.2006.2336
34. Ünsalan, M., Miçooğulları, M., & Angın, S. (2025, Sep). Effects of Kinesio-taping and rigid-taping on vertical jump in individuals with pes planus: A randomised crossover comparison. J Eval Clin Pract, 31(6), e14228. https://doi.org/10.1111/jep.14228
35. Vaish, A., & Vaishya, R. (2020, 06/18). Nonsurgical Treatment of Adult Acquired Flatfoot is Effective: A Narrative Review. Apollo Medicine, 17. https://doi.org/10.4103/am.am_15_20
36. Wapner, K. L., & Chao, W. (1999). Nonoperative Treatment of Posterior Tibial Tendon Dysfunction. Clinical Orthopaedics and Related Research®, 365, 39-45. https://journals.lww.com/clinorthop/fulltext/1999/08000/nonoperative_treatment_of_posterior_tibial_tendon.5.aspx
37. Yıldırım Şahan, T., Aydoğan Arslan, S., Demirci, C., Oktaş, B., & Sertel, M. (2021, 2021/06/01/). Comparison Of Short-Term Effects Of Virtual Reality and Short Foot Exercises In Pes Planus. The Foot, 47, 101778. https://doi.org/https://doi.org/10.1016/j.foot.2021.101778
38. Yurt, Y., Şener, G., & Yakut, Y. (2019, Feb). The effect of different foot orthoses on pain and health related quality of life in painful flexible flat foot: a randomized controlled trial. Eur J Phys Rehabil Med, 55(1), 95-102. https://doi.org/10.23736/s1973-9087.18.05108-0