Q: My son is 8 years old and has flat feet. Kindly guide about it.
A: Pes planus/ pes planovalgus (or flat foot) is the loss of the medial longitudinal, heel valgus deformity, and medial prominence. This is often observed with the medial arch of the foot coming closer (than typically expected) to the ground or making contact with the ground.

All typically developing infants are born with flexible flat feet, with arch development first seen around 3 years of age and then often only attaining adult values in arch height between 7 and 10 years of age. In considering developmental flatfoot, the medial longitudinal arch of the foot normally develops by the age of 5 or 6. This occurs as the fat pad in babies is gradually absorbed, balance improves and skilled movements are acquired. In some children, however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the or poor stability in other areas such as around the hips.

Flexible flat foot (flexible FF): The longitudinal arches of the foot are present on heel elevation (tiptoe standing) and non-bearing but disappear with full weight bearing on the foot. FF is termed developmental FF when observed in infants and toddlers and is part of normal development. Between the ages of 8 and 10 however, a clinician may consider this a true FF.

Rigid flat foot: The longitudinal arches of the foot are absent in both heel elevation (tiptoe standing) and weight bearing. This is normally associated with underlying pathology.

Roughly 20% to 37% of the population has some degree of pes planus, With most cases being the flexible variety. It is more common in children (about 20-30% of children with some form of flat feet) with most children going on to develop a normal arch by 10 years old. Genetics play a strong role with it typically running in families.

The etiology of pes planus has several factors implicated and can be either congenital or acquired. Congenital vertical talus, Congenital talipes equinovarus, Tibial torsional deformity, Presence of the accessory navicular bone, General ligament laxity, Genetic malformation such as and , Familial factors, Peroneal spasm, Vertical. Acquired can be caused by Diabetes, injury and some medical conditions. Flat feet can also occur as a result of pregnancy, Iatrogenic factors such as tendon (PTT) transfer, Traumatic injury

The aim of physical therapy is to minimise pain, increase foot flexibility, strengthen weak muscles, train proprioception, and patient education and reassurance. As part of the assessment process, the physiotherapist can assist in evaluating the gait, gross motor skills and the impact the foot deformity has on functional activities. Assess endurance, speed, fatigability, pain and ability to walk on different terrains, with a focus on assessing function, not just structural abnormalities.

Q: My mother had a stroke and has developed shoulder-hand syndrome. She has pain in her left arm that is affected. How physio therapy can help in getting relief?
A: It is also known as Post-or reflex sympathetic dystrophy of the upper limb. Shoulder-hand Syndrome (SHS) is a multifactorial disorder characterised by edema and swelling of the hand, hyperalgesia, severe pain, and loss of function in the with changes in skin colour and temperature. The cause is still unknown, but it may be due to one or multiple causes one of which may include prolonged immobility.

The intervention is a Multidisciplinary approach that includes medication and Physical Therapy. The physical therapy treatment can include mirror therapy which is effective in improving sensory-motor function and reducing pain and edema in the upper limb in post-stroke patients, Orthoses, a functional shoulder orthoses helps prevent shoulder subluxation in post-stroke patients and reduces the risk of a shoulder-hand syndrome, Modalities like laser and TENS, which are effective in reducing pain and edema in the affected hand and shoulder, improves R.O.M. and Promotes Independency in post-stroke patients can be used by a therapist according to the condition.

Q: I am a 44-year-old female and have been experiencing severe pain in my heel for a week and cannot walk or stand for a long time, the problem is worst in the morning, I am a housewife.
A: You may have a condition called “Plantar Fasciitis”, it is diagnosed by a physical therapist after proper examination and testing. Plantar fascia is a thick connective tissue in the feet, it provides support to the arch it is a shock absorber. The condition is characterised by degenerative changes in the fascia. Symptoms include medial heel pain that worsens with weight-bearing, as well as after rest or non-weight bearing. It is often an overuse injury, due to repetitive strain plantar fascia experiences micro tears. The risk factors include high-arched feet, flat feet, foot deformities, prolonged standing, running, improper footwear, obesity, muscle tightness, etc. A physical therapist can use modalities and specialised techniques for plantar fasciitis. You can be guided by an exercise plan, using a cold pack, rolling a ball/bottle under the feet, and having appropriate footwear to deal with the condition.