Treatment of flat feet in adults using kinesio taping

Flat feet are the reason for visiting an orthopedic traumatologist for foot problems in children in 9 out of 10 cases. Deformities of the lower extremities are very common in children and in most cases are physiological and do not require treatment. Although flat feet rarely cause disability, they are still a major problem. It is generally believed that this later leads to gait disturbances. Flat feet are formed from two main components: sagging medial arch and hallux valgus. Abduction of the medial arch of the foot is a universal sign in children with flat feet.

How is flat feet formed?

In newborns and toddlers, under the medial longitudinal arch of the foot there is a fatty pad that supports the fragile arch of the foot as a natural “arch support.” However, this fat pad is absorbed between 2 and 5 years of age as the arch of the foot forms and independent walking begins. Almost always, children who begin to walk independently develop “flat feet.” Weak muscles and poor neuromuscular control lead to flattening of the foot during exercise. A decrease in the longitudinal arch of the foot is the primary manifestation of flat feet, resulting in the body weight falling on the medial (inner) side of the foot when standing and walking. Thus, flat feet are viewed not only as a problem of static alignment of the ankle and foot structures, but also as a dynamic functional deviation of the lower extremities. This overload mechanism, resulting from flattening of the medial longitudinal arch, affects proximal areas such as the knees, hip, and lower back.

The prevalence of flat feet in the age groups 2-6 and 8-13 years is 37-59% and 4-19%, respectively. Children's flat feet appear in the first years of life, and persist in only 3% of the adult population. The prevalence of flat feet is inversely proportional to age.

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What are the types of flat feet in children?

Children's flat feet can be divided into “flexible” and “rigid”. Flexible flatfoot is characterized by a normal arch when not weight-bearing and flattening of the arches when standing or walking. It can occur either asymptomatically or with pain in the foot. Rigid flatfoot is characterized by rigid flattening of the arch both with and without load. Babies are born with flexible flat feet, and a normal arch develops in the first decade of life. Most cases of hard (rigid) flat feet are associated with another pathology that requires special attention from a doctor. Such conditions include general ligament laxity, neurological and muscular abnormalities, and genetic disorders.

Advantages of taping

The advantage of kinesio taping is that it does not restrict human movement. In combination with exercise therapy and manual techniques (massage), the application of elastic bandages provides a good therapeutic effect, manifested in:

• relieving pain in the sole,
• foot support,
• strengthening ligaments and muscles,
• joint restoration,
• reducing swelling.

Tapes are made from elastic, hypoallergenic material that provides the necessary ventilation of the skin and has water-repellent properties. The application of elastic bands stays firmly on the skin for several days.

What factors contribute to the development of flat feet?

Factors that may predispose to flat feet include age, gender, body composition, ligament laxity, family history, type of shoe, and age at which shoe wear began. Boys are twice as likely to have flat feet as girls. Obese and overweight children are more likely to have flat feet than children of normal weight. Children with ligamentous laxity may also be predisposed to flat feet due to poor arch development. Another important factor may be a family history of flat feet. Beginning to wear unsuitable shoes before the age of six may be another predisposing factor for flat feet.

How does flat feet manifest?

Flexible flat feet rarely cause pain or disability in infancy and childhood. Children in this age group usually come in for testing because their parents are concerned about the appearance of their feet or because of a family history of wearing special shoes during childhood. In some patients, flat feet can be severe and noticeably deform the shoes. Flat feet can sometimes be painful, with more specific complaints after intense exercise or long walks. The pain is characterized as diffuse in the feet and legs. In more severe forms, pain appears in the knees and back.

Types of suitable tapes

Tapes are special elastic bands that can be used to provide the necessary immobilization of joints while removing excess load. With the help of such tapes, the limb is fixed in the optimal position, which makes it possible to avoid painful sensations. Strict adherence to the technique of applying tapes allows you to maintain the mobility of the limb, the skin under the bandage breathes. The patch does not disrupt natural water metabolism (sweating).

Foot taping is carried out using the following types of patches:

• Y-shaped,
• I-shaped,
• X-shaped,
• lymph tapes.

In most cases, procedures are carried out using standard patches made of cotton fabric and having a hypoallergenic adhesive layer. Tapes are characterized by high elasticity, allow air and moisture to pass through, and adhere well to the application site.

Lymphatic taping is performed using tapes that have a noodle-like separation at one end. The beams are applied in the direction of the lymph nodes. This method is most widespread in sports medicine.

In special cases, a rigid tape made of synthetic materials and containing reinforced glue can be used. Heel taping is most often done using Y-shaped tapes in the direction from the heel to the Achilles tendon. Prevention of foot injuries and treatment of flat feet (secondary type) is provided with the help of wide plasters at the level of the sole. The maximum result in the treatment of flat feet can be achieved by combining taping with special physical exercises.

How is flatfoot diagnosed?

The clinical evaluation of a child with flat feet should consist of a general musculoskeletal examination and gait pattern in addition to an examination of the foot and ankle. Foot and ankle assessment begins with assessing ankle dorsiflexion and plantarflexion (with knee extension and flexion), as well as hindfoot, midfoot, and forefoot ranges of motion. Assessment of the Achilles tendon is also important and less than 10º of flexion indicates Achilles tendon contracture. The child should be assessed for general ligamentous laxity, which can be assessed using the Beighton scale. It is often helpful to learn about family flat feet and examine the feet of other family members in the examination room. Flexible flat feet can cause shoes to wear out quickly and unevenly in older children and teens, so shoes should also be evaluated. As part of the routine clinical evaluation of any foot problem, examination may be performed at the front, side, and back of the foot in non-weight-bearing positions, as well as during walking, to determine the presence or absence of foot deformities. The podoscope provides a more detailed assessment to show the contact area under the foot.

Visual assessment is a simple method of assessing the curvature and alignment of the foot. The Foot Posture Index (FPI-6) has recently been developed and normative values ​​are currently being collected.

The anthropometric approach to characterizing the foot involves direct measurement of landmarks or bony prominences. Some well-known anthropometric measures in this approach include arc height, longitudinal arc angle, hindfoot angle, navicular drop, and navicular drift. Direct measurement of arch height provides an objective approach to determining differences in foot structure.

Footprint analysis continues to be the most popular approach for analyzing and assessing flat feet. For clinical diagnosis, three fingerprint measurements are most commonly used: the vault index, the Cippo-Smirak index, and the Staheli vault index. These measurements are considered reliable criteria for screening for flat feet.

Additional tests may include x-rays (weight-bearing), computed tomography (CT), and magnetic resonance imaging (MRI).

Indications and contraindications

Foot arch taping is recommended in the following cases:

• painful sensations,
• foot bruise, tendon and muscle tears,
• achilles bursitis,
• longitudinal flatfoot,
• foot dislocation,
• neuralgic diseases - paresis, neuritis of the tibiofibular nerve, tarsal tunnel syndrome and other tunnel neuropathies),
• arthrosis,
• arthritis,
• foot sprain,
• plantar fasciitis (“heel spur”),
• hallux valgus deformity of the foot,
• muscle spasms, etc.

Taping of heels is carried out as a prevention of sports injuries, as well as to speed up rehabilitation after injuries to the limbs. Pediatricians prescribe foot taping in children to prevent foot collapse.

Contraindications to taping are:

• allergic reactions,
• individual intolerance,
• deep vein thrombosis,
• skin diseases, ulcers, open wounds.

Treatment of flat feet

To prescribe treatment, it is very important to divide patients into two groups: with flexible or rigid flat feet. As mentioned earlier, rigid flat feet are usually associated with complex bony deformities and require more detailed evaluation by an orthopedic surgeon. Flexible flatfoot can be divided into asymptomatic and symptomatic.

Flexible flatfoot is physiological, asymptomatic and does not require treatment. Children with asymptomatic flexible flatfoot should be monitored clinically for symptoms and signs of progression. Continued progression requires reevaluation to identify another underlying disease. Because growth-related changes in foot alignment and mobility will continue until about age eight, developmental foot problems are expected to resolve by this age. Thus, persistence of flat feet in children over 8 years of age requires further evaluation, despite the absence of symptoms.

In contrast to asymptomatic flexible flatfoot, symptomatic forms lead to subjective complaints, impair function and produce significant objective results. These include pain along the medial part of the foot, pain in the shin and knee, decreased endurance, gait disturbances, protruding medial head of the talus, everted heels, and tightness of the Achilles tendon. Initial treatment options include changes in physical activity, wearing proper shoes and orthoses, stretching and strengthening exercises, and nonsteroidal anti-inflammatory drugs (for more severe cases). In addition, comorbidities such as obesity, ligamentous laxity, muscle hypotonia, and proximal limb problems should be identified and treated whenever possible. If the outcome is positive and symptoms resolve, follow-up is recommended.

Conservative treatment of flexible flatfoot begins with patient and parent education. Children and their parents should be informed that flatfoot deformity may disappear as they grow older, and that there is no evidence that this deformity will lead to a painful condition in adulthood. Concerned parents should be advised that physiological flexible flatfoot has a natural history of improvement over time. Periodic monitoring may be indicated to identify signs of progression. However, parents should be aware that non-physiological flexible flatfoot is characterized by progression over time and the degree of deformity is more severe. In these cases, periodic monitoring is indicated.

Tape removal methods

Before you begin removing the tapes, they should be soaked with a special spray or wet with hot water. Next, you need to wait a few minutes and begin to carefully roll the patches into rolls. You should move in the direction of hair growth.

The tapes should be removed slowly at a slight angle, avoiding strong tension. After removing the bandage, it is recommended to lubricate the skin with cream or balm. You can remove the application at home.

We offer to expand your area of ​​competence and master the basic methods of taping in online courses conducted at our Academy. You will be able to gain the necessary theoretical knowledge and consolidate practical skills in master classes. Upon completion of training, certificates are issued.

Selection of shoes for flat feet

Recommendation of appropriate supportive shoes is the first line treatment for flexible flat feet. Typically, children's closed-toe shoes can provide structural support to immature feet. The running shoes should comfortably support the orthotic device if this is the next intervention. Shoes should have a hard sole so that the orthosis does not put pressure on the inside of the shoe. Modern soft sneakers are not suitable for these purposes. It is better to use classic leather models from New Balance and Adidas.

High-top sneakers may be indicated when significant instability is detected in the ankle and subtalar joints. Certain types of shoes, such as sandals and moccasins, should be avoided as they may not provide the structural support that a skeletally immature patient needs. It is noteworthy that previously conservative treatment required the use of orthopedic shoes and insoles. However, despite any therapeutic benefits they may provide, orthopedic shoes unfortunately shape not only the feet, but also the personality of the child wearing them. Currently, it is generally accepted throughout the world that orthopedic shoes do not improve the natural development of the foot.

Orthopedic insoles

One of the main conservative interventions for pediatric flatfoot is orthopedic orthoses and arch supports in shoes. Research has shown that while orthotics can help correct soft tissue deformities, they do not affect bone structures. Dynamic stabilization insoles and custom foot orthoses have a significant positive impact. In general, it is believed that asymptomatic flat feet do not require orthoses. However, prescribing orthoses for symptomatic flexible flatfoot may help reduce pain and avoid surgery.

Over time, leg orthoses significantly reduce leg pain and increase functionality. The use of dynamic foot orthoses for pediatric flexible flatfoot helps restore structure and support to the medial and lateral aspects of the foot. One of the primary purposes of using functional orthoses is to control the degree of pronation of the subtalar joint, thereby providing support and alignment to the talocalcaneal joint. For more severe flatfoot deformity or ligament laxity in patients with ankle instability or posterior tibial tendon symptoms, ankle orthoses or more proximal devices may be more appropriate.

What to do with persistent symptoms of flat feet?

If there are signs of inflammation, non-steroidal anti-inflammatory drugs may also be prescribed.
According to the consensus of the professional community, if conservative methods have failed and the child does not experience relief from symptoms, surgery is indicated. The goals of surgery are simple: to reduce or eliminate pain and realign the foot. Although achieving these goals can be difficult due to the wide variety of clinical presentations, ranging from mild to severe flatfoot with multiple contributions of flatfoot, surgical correction can be challenging. Call a doctor at home Make an appointment with a doctor or call +7 (812) 331-17-74

Rules for applying elastic bands

To ensure reliable fixation of kinesioplasters and compliance with the wearing period of the bandage, the following recommendations for their application should be followed:

• Tapes are applied 30 minutes before physical activity;
• The skin in the application area should be clean;
• If there is hair, it is shaved off;
• Tapes of the required length are cut from the roll. Y-tape is created by cutting a standard straight tape lengthwise. The skin is treated with an alcohol-containing solution and allowed to dry;
• The paper backing from the patch is removed gradually as it is glued. You should try not to touch the adhesive part with your fingers;
• Before applying the tape, a large area is slightly stretched (depending on the tape application pattern);
• The beginning and end of a tape 3-5 cm long are fixed on the skin without tension. The middle part of the tapes is glued with a stretch of up to 75%;
• When applying the patches in the direction from the periphery to the center, it provides muscle relaxation, and in the opposite direction, it tones the muscle tissue;
• The tapes should be rubbed by hand to activate the adhesive;
• The application should not cause discomfort;
• If pain, “pins and needles”, a feeling of numbness, or changes in skin color occur, the tapes should be re-taped with less tension;
• With kinesio tapes you can take water procedures and visit the pool. The application should not be rubbed with a washcloth. After water procedures, the bandage should be carefully blotted with a dry towel;
• When applied correctly, the patches can be worn on the body for up to 1.5-2 weeks.