Pes Planus May Affect Active Proprioception and Dynamic Balance in Young Adults, Study Finds

A new case-control study suggests that young adults with asymptomatic flexible pes planus may demonstrate subtle but measurable differences in active ankle proprioception and dynamic balance compared with peers without pes planus. The findings highlight the potential value of assessing sensorimotor function—not just foot structure—during clinical evaluation.

Key Takeaways

• Young adults with flexible pes planus demonstrated significantly different active ankle joint position sense, although passive proprioception did not differ from controls.
• Dynamic balance deficits were observed only in the posterolateral direction of the Y Balance Test, suggesting that balance impairments may be direction-specific rather than generalized.
• The authors suggest incorporating sensorimotor assessment into clinical evaluation of patients with flexible pes planus and call for larger longitudinal studies to determine whether these early findings translate into future functional impairment.

Study Evaluated Balance and Proprioception in Flexible Pes Planus

Although pes planus is one of the most common foot deformities encountered in clinical practice, its effects may extend beyond altered foot mechanics. Investigators from Türkiye sought to examine whether young adults with flexible pes planus demonstrate measurable differences in proprioception and dynamic balance compared with individuals without the condition.

The cross-sectional case-control study included 90 university students aged 18 to 30 years, with 45 participants diagnosed with flexible pes planus and 45 matched controls.¹ The researchers identified pes planus using the Navicular Drop Test, while Jack's Test confirmed flexibility of the deformity. The investigators assessed ankle proprioception using active and passive joint position sense testing with a digital goniometer and evaluated dynamic balance using the Y Balance Test. Groups were similar with respect to age, sex, body mass index, dominant limb, smoking status, and alcohol use.¹

Active Proprioception Differences Identified

One of the study's principal findings was a statistically significant difference in active joint position sense between participants with pes planus and controls. In contrast, passive joint position sense did not differ significantly between groups.¹

The authors note that active and passive proprioception rely on somewhat different sensorimotor mechanisms. Active joint position sense incorporates both peripheral sensory input and central motor control, whereas passive testing depends primarily on afferent sensory feedback. They suggest that subtle neurosensory alterations associated with flexible pes planus may become more apparent during active movement, even in otherwise healthy young adults.¹

Importantly, the study population consisted of asymptomatic individuals, indicating that these proprioceptive differences may be detectable before clinical symptoms develop.¹

Dynamic Balance Changes Were Direction-Specific

Balance performance produced a similarly nuanced pattern of results.

Using the Y Balance Test, investigators found no significant differences between groups in the anterior or posteromedial reach directions. However, participants with flexible pes planus demonstrated significantly lower performance in the posterolateral reach direction, suggesting that dynamic balance deficits may be specific to certain movement patterns rather than affecting overall balance performance.¹

The authors propose several explanations for this finding. Posterolateral reaching places greater multiplanar demands on the ankle and hip while requiring increased neuromuscular control. Because the medial longitudinal arch contributes to force absorption and sensorimotor feedback, structural changes associated with pes planus may have a greater impact during these more mechanically demanding movements.¹

The authors also note that the posterolateral reach was performed after the anterior and posteromedial trials during testing, raising the possibility that accumulated fatigue may have contributed to reduced performance in that direction.¹

Clinical Implications for Podiatric Practice

While the study does not establish a causal relationship between flexible pes planus and neurosensory dysfunction, it supports the concept that flatfoot may influence more than static foot posture.

For podiatrists, the findings suggest that assessment of patients with flexible pes planus may benefit from including evaluation of dynamic balance and sensorimotor control alongside traditional structural examination. The authors suggest that individualized exercise programs targeting proprioception and balance may represent an appropriate component of conservative management, particularly when deficits are identified early.¹

Because the participants were young and asymptomatic, the study also raises the possibility that early functional differences could precede the development of symptoms, although this remains to be confirmed.¹

Study Limitations

The investigators acknowledge several limitations. Only individuals with flexible pes planus were included, preventing comparison with rigid deformities. The cross-sectional design does not permit conclusions about causation or long-term progression. Additionally, proprioception was evaluated only during dorsiflexion, and factors such as physical activity level, muscle strength, sports participation, and sex-specific analyses were not incorporated.

The authors conclude that prospective longitudinal studies involving larger and more diverse patient populations are needed to clarify how pes planus influences proprioception, balance, and neuromotor function over time.¹

Reference

1. Yardimci FB, Yilmaz Z, Anaforoglu B. Proprioception and balance in young adults with pes planus. J Am Podiatr Med Assoc. 2026;116:50. doi:10.3390/japma116040050.

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