In the human body, the base of
support is the feet, it contains bones which are held together by muscles and
ligaments. In the foot there are three arches, the longitudinal medial arch,
longitudinal lateral arch, and the transverse arch. The pressure of the weight
of the body is absorbed by the medial longitudinal arch, and this arch length could
shorten due to ligaments laxity or foot muscles weakness. (Pourghasem et al., 2016)

The foot works as a lever, and the
body weight is borne by it, normally the center is where the weight and strain
fall through the foot, and the muscular activity helps in balancing the weight
and strain. The muscle which helped in balancing the weight will stop
supporting the foot if it stops to function as a lever. This condition of a
weak foot is recognized as flatfoot, which is now no longer works as a lever
but is causing pain and physical discomfort. There are three most visible deformity elements, the
foot takes the valgus position, and the body weight falls on its inner area,
while the leg rests on the displaced talus it changes its position and turns in,
and the foot turns out, this leads to shifting the strain line that transmits
the power to the fulcrum to deviate from center of the foot to its inner side,
in relation to the leg the foot is abducted or everted. The arch is becoming
broad and flat, causing the foot to be flat.(Whitman, 2010)

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Flatfoot is the most common type of
the deformity in the foot, changes in the skeletal structure, ligaments, and
muscles occur due to it, the change in the tarsal bones leads to transformation
in its motion mechanism thus the fatigue is triggered, arthritis and a deformity
which is secondary to it happens in the front part of the foot. Pain and fatigue
are reproduced by walking or standing. The foot function is impaired when
practicing sports or excessive activities, in flatfoot damage to the lower limb
occurs due to the load on the tibia causing pain to it and the knees.(Seo and Park, 2014)

The flatfoot condition can be
categorized to congenital or acquired, and the congenital type can be divided
into two flexible and rigid. In flexible flatfoot, the medial longitudinal arch
appears when the foot is in a non-weight bearing position and disappears while
standing, in the rigid flatfoot the arch is absent even when the foot assumes a
non-weight bearing position.(Pourghasem et al., 2016)

 The World Health Organization stated that less
than 1% of the population is affected by Rigid flatfoot which causes pain and
disability that may require surgery. While in the U.S. adult population between
2 to 23% is affected by flexible flatfoot.(Banwell et al., 2014)

Symptomatic Flatfoot is considered pathological, the hindfoot medial region and the posterior tibial tendon is
where the pain generally occurs, sometimes it may be associated with the tendon
sheath effusion.(Toullec, 2015)

Painful
symptoms accompanying flexible flatfoot include, a wide distribution of pain
and an increase in fatigue rate in lower limb area, osteoarthritis, achilles
tendinopathy and patellofemoral disorders may appear. Other signs observed
include the abnormal appearance of rearfoot kinematics such as a rearfoot
excessive eversion or by an increase in the eversion range, abnormal kinetics
of the foot and ankle such as joint moments elevated or loading forces abnormal
values and change in the physical function by abnormal timing and activation of
muscles or by raising consumption of energy. These functional consequences are
the reason for