While the bony structure of the foot cannot be physically rebuilt or altered, the functional arch, supported by dynamic soft tissues, can be significantly improved. The medial longitudinal arch is not a static bridge of bone but a dynamic, flexible structure maintained by a complex interplay of ligaments, tendons, and muscles. A collapsed or lowered arch (flatfoot or pes planus) is often a result of muscle weakness or tendon dysfunction, not a fixed skeletal deformity. By strengthening the muscles that support this arch, individuals can restore its dynamic stability, improve its functional height, and enhance its ability to absorb shock and propel the body during movement.
The Anatomy and Function of the Foot Arch
The foot’s architecture relies on three arches, with the medial longitudinal arch being the highest and most prominent. This arch is formed by the calcaneus, talus, navicular, three cuneiforms, and the first three metatarsal bones. Ligaments, such as the plantar calcaneonavicular ligament (or spring ligament) and the plantar aponeurosis, provide passive support, acting like tie-beams to hold the bones in position.
The arch’s true strength comes from its dynamic support system: a network of intrinsic and extrinsic muscles. Intrinsic muscles are contained entirely within the foot, like the abductor hallucis, which stabilizes the arch from underneath. Extrinsic muscles, such as the tibialis posterior, originate in the lower leg and attach to the foot bones, acting like a sling to invert the foot and pull the arch upward. This combination of bony shape, ligaments, and muscular support allows the arch to function as a flexible, spring-like mechanism for shock absorption and propulsion during movement.
Active Strengthening Through Targeted Exercise
Targeted exercises are designed to recruit and strengthen the specific muscles responsible for dynamically supporting the arch. One effective method is the “foot doming” or short foot exercise, which involves actively shortening the foot from heel to ball without curling the toes. This action isolates and strengthens the intrinsic foot muscles, particularly the abductor hallucis, a primary stabilizer of the medial arch.
The tibialis posterior is an extrinsic muscle that acts as a sling to invert the foot and lift the arch. Exercises that combine plantar flexion (pointing the foot down) with inversion (turning the sole inward) against resistance, often using a resistance band, are effective for strengthening this muscle. Training the tibialis posterior helps prevent excessive pronation, the inward rolling of the foot that causes the arch to collapse during gait.
Activities like towel scrunches, where the toes gather a towel placed on the floor, improve toe flexor strength. Picking up marbles with the toes engages the small muscles on the bottom of the foot, enhancing dexterity and muscle control. Consistent performance of these active exercises helps the foot muscles become more resilient and better able to maintain functional arch height under the stress of daily activities.
Supportive Measures: Orthotics and Proper Footwear
Supportive measures, such as orthotics and appropriate footwear, work alongside exercise to manage arch alignment and reduce strain. Orthotics are devices placed inside shoes to provide external support to the foot structure. Over-the-counter arch supports offer general cushioning and mild support but are generic and not tailored to an individual’s specific foot mechanics.
Custom-made orthotics, prescribed by a professional, are fabricated from a mold of the patient’s foot, providing precise contouring and biomechanical correction. These devices do not actively rebuild the arch but support it in a more optimal position, reducing pain and strain. By reducing mechanical stress, orthotics allow the foot muscles to work more efficiently, assisting with the strengthening process initiated through exercise.
Choosing footwear that complements the foot’s natural shape and any prescribed orthotics is important for long-term foot health. Shoes should offer a firm heel counter for stability and enough depth to accommodate an insert without crowding the toes. Proper footwear ensures that the benefits gained from muscle strengthening and orthotic support are maintained during all weight-bearing activities.
When to Seek Professional Medical Intervention
While exercises and supportive gear can manage many arch-related issues, certain symptoms warrant evaluation by a medical professional like a physical therapist or a podiatrist. You should seek professional help if you experience persistent or worsening pain in the arch or heel, swelling around the inside of the ankle, or difficulty standing on your tiptoes. These signs can indicate a more serious condition, such as adult-acquired flatfoot deformity, which often involves dysfunction of the tibialis posterior tendon.
A podiatrist can perform a comprehensive biomechanical assessment and may order diagnostic imaging to determine the underlying cause of the arch collapse. Treatment may involve specialized physical therapy, custom bracing, or injection therapy. For severe, rigid deformities or cases where conservative treatments have failed, surgical options may be necessary to restore function and alignment. These procedures can include tendon transfers (such as using the flexor digitorum longus tendon) or bony procedures like medial displacement calcaneal osteotomy or joint fusion (arthrodesis) for complex, arthritic cases.