Address safety, settle excessive irritability and maintain useful movement.
What to do
Reduce aggravating walking load and provide supportive footwear/orthosis when appropriate
Begin tolerable inversion and calf activation
Assess diabetes, neuropathy and skin integrity
Exercise dosage
Seated inversion isometric: 4 x 20 seconds
Gentle ankle ROM and short walking bouts
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress posterior tibial and calf strengthening
Train intrinsic foot muscles and balance
Build walking tolerance with support as needed
Exercise dosage
Band inversion: 3 x 10–15
Calf raises: 3 x 8–12, progress bilateral to unilateral as tolerated
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress uneven-ground walking, stairs and work demands
Maintain orthotic support if clinically beneficial
Refer if deformity progresses or function remains poor
Exercise dosage
Single-leg heel raise and balance: 2–3 sets
Walking duration progressed gradually with symptom monitoring
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Joint mobilisation may address coexisting stiffness but does not restore tendon integrity.
Avoid forceful correction of rigid deformity.
Modalities — Use / Avoid
Foot orthoses/bracing may reduce load and improve function in selected stages.
No modality reverses advanced tendon degeneration.
Return / Discharge Criteria
Walking tolerance improved
Heel-rise strength and balance adequate
Foot alignment stable or supported
No progressive deformity or skin issue
Common Clinical Mistakes
Treating all flat feet as symptomatic tendon dysfunction
Ignoring rigid deformity and arthritis
Strengthening without footwear/load modification
Clinical Pearls
The modern term progressive collapsing foot deformity recognises more than one tendon alone.
Single-leg heel rise is useful but not definitive.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
