Pes Planus Test

The Pes Planus Test—also commonly called the “flatfoot” assessment—is a clinical procedure used to determine whether a person has a normal, flexible, or rigid loss of the medial longitudinal arch of the foot (pes planus). Pes planus can be congenital or acquired, and is characterized by the collapse of the arch, often visible as a “flat” footprint and sometimes associated with pain, gait issues, or lower limb dysfunction.

How the Test is Performed

• Inspection (Weight-Bearing and Non-Weight-Bearing):

  • The client stands barefoot while the therapist observes the medial longitudinal arch from the side and behind.

  • The therapist asks the client to sit or lie down (non-weight-bearing), observing whether the arch reappears when unloaded.

  • Flexible flatfoot: The arch flattens only during weight-bearing and reappears when not bearing weight.

  • Rigid flatfoot: The arch remains absent in both positions, suggesting more serious pathology.

• ‘Too Many Toes’ Sign:

  • Seen when looking from behind—a visible abduction of the forefoot so that more than the 5th and part of the 4th toe can be seen laterally, indicating overpronation and midfoot collapse.

• Jack’s Test (Hubscher Maneuver):

  • The examiner dorsiflexes (lifts) the hallux (big toe) while the client stands. Restoration of the arch with this maneuver indicates a flexible deformity.

• Single Heel Raise Test:

  • The client stands on one leg and raises up onto the ball of the foot. In flexible pes planus, the heel should invert; failure to do so suggests posterior tibial tendon dysfunction.

Clinical Significance

• Flexible flatfoot is common and usually benign, especially in children and adolescents—typically only treated if symptomatic.

• Rigid flatfoot or cases associated with pain, limitation, or rapid progression require further investigation for structural, neuromuscular, or inflammatory pathology.

• Pes planus can contribute to ankle, knee, hip, or back discomfort, abnormal gait, and increased risk of injury, particularly in athletes or those with high physical demands.

• Evaluation should also include assessment of posterior tibial tendon integrity and Achilles/calf flexibility.

Assessment

• Use the Pes Planus Test for clients with:

  • Foot or ankle pain

  • Lower limb overuse or postural complaints

  • Gait abnormalities or postural asymmetry

• Document:

  • Whether the flatfoot is flexible or rigid

  • Presence of the “too many toes” sign

  • Function and pain with single heel raise test and arch changes

  • Associated leg, pelvic, or back alignment and symptoms

Treatment

• For flexible, asymptomatic pes planus:

  • No aggressive manual therapy is necessary; educate about supportive footwear and arch mechanics.

  • Provide gentle soft tissue release to overused structures (plantar fascia, peroneals, calf).

  • Reinforce foot strengthening and proprioception exercises as part of a global kinetic-chain approach.

  • Encourage proper gait and posture.

• For painful or rigid flatfoot:

  • Avoid forceful mobilization of a rigid foot; instead, focus on pain management, referral, and co-management with a physiotherapist, foot specialist, or orthotist for further diagnosis and orthotic prescription.

  • Monitor progress, and encourage compliance with footwear and orthotic use.

Safety and Referral

• Urgent referral is warranted for rigid pes planus, rapid progression, or cases associated with systemic symptoms or neurological changes.

• Orthopedic or podiatric input is advised for chronic pain, functional limitation, or failure to respond to conservative therapy.