Flat Feet Exercise Program: A Research-Based Solution
As a Physiotherapist, I'm always seeking evidence-based approaches to help patients with common musculoskeletal issues like flat feet. Interesting research published in the Journal of Physiotherapy reveals that a specific exercise program can significantly improve foot alignment in people with flexible flat feet. This randomised controlled trial provides compelling evidence that could better inform how we approach flat foot management in clinical practice.
Key Research Finding
A comprehensive 6-week exercise program reduced navicular drop height by 0.4cm more than basic exercises alone and improved medial longitudinal arch angle by 16 degrees in people with flexible flat feet. These improvements were statistically significant (95% CI 0.4 to 0.5 for navicular drop; 95% CI 13 to 19 for arch angle) and clinically meaningful for foot alignment.
Study Overview and Methodology
The study followed 52 participants with flexible flat feet in a randomised controlled trial with concealed allocation and blinded assessors. Participants were allocated to either an experimental group performing comprehensive exercises or a control group performing basic ankle movements for 6 weeks.
Participant Characteristics
| Characteristic | Experimental Group | Control Group |
|---|---|---|
| Average Age | 21.1 years | 20.5 years |
| Body Mass Index | 23.0 kg/m² | 23.5 kg/m² |
| Baseline Navicular Drop | 1.5 cm | 1.6 cm |
| Baseline Arch Angle | 120° | 115° |
Research Methods
The study employed rigorous methodology to ensure reliable results:
- Randomised Design: Participants were randomly assigned to experimental or control groups using concealed allocation
- Blinded Assessment: Outcome assessors were unaware of group assignments to prevent measurement bias
- Objective Measures: Navicular drop height and medial longitudinal arch angle were measured using standardised protocols
- Intention-to-Treat Analysis: All randomised participants were included in the final analysis, maintaining group comparability
Key Research Findings
The study yielded several important findings with significant clinical implications:
Structural Improvements in Foot Alignment
The comprehensive exercise program produced substantially greater improvements in both primary outcome measures compared to basic exercises. The 0.4cm reduction in navicular drop represents meaningful clinical progress, as navicular drop >1cm is diagnostic of flat feet.
Progressive Benefits Over Time
Improvements were achieved through a progressively challenging program that advanced from sitting to standing to single-leg stance positions over the 6-week period. This progressive overload principle appears crucial for strengthening the dynamic stabilizers of the foot arch.
Excellent Compliance and Safety
The program demonstrated excellent adherence with only one dropout in the experimental group (96% completion rate) and no reported adverse events. This suggests the exercises are both safe and practical for most people with flexible flat feet.
The Evidence-Based Exercise Program
Here's the exact program that produced these significant results, performed three times per week for 6 weeks:
Core Exercise Components
| Exercise Type | Specific Exercises | Progression |
|---|---|---|
| Short Foot Exercises | Toe spread, hallux extension, doming, lesser toe extension | Weeks 1-2: Sitting Weeks 3-4: Standing Weeks 5-6: Single-leg stance |
| Gluteal Strengthening | Hip abduction, hip extension | Increase hold time from 0 to 10 seconds over 6 weeks |
| Ankle Movements | Dorsiflexion, plantarflexion | Consistent throughout program |
| Stretching | Calf stretches | Consistent throughout program |
Why This Program Works
- Targets Intrinsic Foot Muscles: Short foot exercises specifically activate abductor hallucis, flexor digitorum brevis, and quadratus plantae - key dynamic stabilisers of the medial longitudinal arch
- Addresses Kinetic Chain: Gluteal strengthening helps control hip internal rotation, reducing compensatory foot pronation
- Progressive Overload: Systematic progression challenges the foot stabilisers as they strengthen
Study Limitations and Generalisability
Population Specificity
The study focused on young adults (18-21 years), which may limit direct application to older populations or those with different activity levels. Additionally, the sample size, while sufficient for precise estimates, was relatively small.
Measurement Considerations
Outcomes were biomechanical rather than patient-reported measures like pain or function. While structural improvements are important, their relationship to symptom reduction requires further investigation.
Long-Term Effects Unknown
The study assessed outcomes immediately after the 6-week intervention without follow-up to determine if improvements were maintained long-term. Ongoing exercise may be necessary to sustain benefits.
Conclusion and Clinical Takeaways
This research provides strong evidence that a comprehensive, progressive exercise program can significantly improve arch position in people with flexible flat feet. The 6-week program combining short foot exercises, glute strengthening, and stretching resulted in meaningful improvements in both navicular drop height and medial longitudinal arch angle.
The consistent benefits across participants suggest that addressing both local foot muscles and proximal hip stabilisers creates an optimal approach for flat foot management. By incorporating these evidence-based exercises into your self-treatment plan, we can utilise an active approach that goes beyond passive supports and may produce lasting structural improvements.
Struggling With Flat Feet or Foot Pain?
If you're dealing with flat feet that aren't responding to conventional approaches, consider an online consulation with me that addresses both structural alignment and muscular contributors to foot function.
Schedule an Online ConsultationReference
Brijwasi, T., & Borkar, P. (2022). A comprehensive exercise program improves foot alignment in people with flexible flat foot: a randomised trial. Journal of Physiotherapy, 68(4), 1-8. https://doi.org/10.1016/j.jphys.2022.11.011