RSM-DPA-001
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
What Should You Assess When the Foot Collapses Inward Under Load?
An arch that lowers during walking may be comfortable, painful or progressively changing. The visible pattern alone cannot tell a therapist whether the foot needs treatment. Timing, symptoms and the task that brings them on make the observation useful.
At RSM, I follow heel and arch motion through stance, then compare ankle dorsiflexion, tibial rotation and hip strategy. These findings guide what to examine with the hands; they do not automatically identify a weak muscle or a damaged tendon.
This article shows how to distinguish resting posture from loaded movement, connect tibialis posterior and calf function with specific comparisons, and decide between a matched re-test and referral. The goal is a clearer clinical decision, not a permanently rigid high arch.
In This Article
- What Should You Assess When the Foot Collapses Inward Under Load?
- In This Article
- 1. Arch Height or Walking Pronation: Identify the Relevant Phase
- 2. Tibialis Posterior: Inversion, Arch Support and Medial-Ankle Palpation
- 3. Tibial Rotation and Hip Strategy: Follow the Foot Without Assuming a Cause
- 4. Knee-to-Wall Dorsiflexion: Compare Range Without Changing the Foot Position
- 5. Painful or Progressive Collapse: Referral and the Original Walking Re-Test
- Related RSM Clinical Blogs
- Study Dynamic Posture Assessment at RSM
1. Arch Height or Walking Pronation: Identify the Relevant Phase
Begin with when the foot changes, not how low the arch looks in a photograph. During a comfortable walk, distinguish initial contact, the body passing over the foot and heel rise. Note when the heel everts, the arch lowers and the familiar medial-foot, ankle or knee symptom appears.
A low arch at rest does not determine this sequence. Buldt and colleagues found some associations between planus posture and walking motion, but the studies were heterogeneous and effects often small. Video shows movement; it cannot directly quantify pressure beneath the foot.
I first record the usual footwear, pace and symptom-onset distance. A painless short walk cannot represent a complaint that only begins after prolonged walking. Compare the relevant phase within a tolerable task, and keep a comfortable, adaptable foot from becoming a treatment target simply because it pronates.
2. Tibialis Posterior: Inversion, Arch Support and Medial-Ankle Palpation
Tibialis posterior runs from the posterior tibia, fibula and interosseous membrane into a tendon behind the medial malleolus, with a major attachment at the navicular. Its line of pull produces foot inversion and assists ankle plantar flexion while supporting the medial arch.
With the lower leg supported, compare a small active inversion movement and relaxed resting contact. Locate the medial malleolus and navicular before lightly tracing the tendon corridor. Inversion ability and local tenderness are separate findings; neither a low arch nor tenderness proves isolated muscle weakness.
The muscle belly lies deep, while the tibial nerve and posterior tibial vessels also pass behind the medial malleolus. Do not use stronger pressure to claim greater diagnostic certainty. Stop contact that causes tingling or spreading plantar symptoms, and investigate persistent sensory change instead of labelling it a tight tendon.
3. Tibial Rotation and Hip Strategy: Follow the Foot Without Assuming a Cause
Observe tibial rotation separately from the femur moving inward at the hip. The planted foot can evert as the tibia rotates internally, but the relationship varies. Gluteus medius runs from the lateral ilium to the greater trochanter and contributes hip-abductor force that opposes hip adduction during single-leg support.
Dodelin and colleagues found differences in foot, knee and pelvic motion between pronated and neutral foot-function groups during instrumented barefoot walking. This does not establish that pronation caused injury or that every knee moving inward has a weak hip.
For a tolerable shallow single-leg knee bend, I may add fingertip support while preserving foot position and depth. Compare the familiar symptom, hip adduction and arch motion. A different response suggests that support and task demand deserve attention; it does not isolate one muscle. Remove the support before repeating the original comparison.
4. Knee-to-Wall Dorsiflexion: Compare Range Without Changing the Foot Position
When the heel lifts before comfortable forward progression, compare weight-bearing ankle dorsiflexion. In a supported knee-to-wall lunge, advance the knee toward the second toe with the heel down. Use the same foot direction and measurement method, noting calf tension, anterior-ankle discomfort or the familiar symptom.
Soleus and gastrocnemius transmit plantar-flexor force through the Achilles to the calcaneus and help oppose forward tibial progression. Gastrocnemius also crosses the knee. The bent-knee lunge therefore changes muscle length and loading, but cannot identify a shortened soleus or a restricted joint capsule by itself.
Repeat the lunge with the original setup after an agreed intervention, then repeat the walking baseline separately. Small range differences may reflect measurement error, as the lunge-test review emphasises. A farther knee reach obtained by turning the foot or lifting the heel is not evidence of improved ankle mobility.
5. Painful or Progressive Collapse: Referral and the Original Walking Re-Test
Painful progressive arch loss, swelling behind the medial malleolus or increasing difficulty rising onto the toes warrants clinical assessment. Progressive collapsing foot deformity involves more than an arch silhouette; tendon and ligament function and foot flexibility can affect care. A failed heel rise alone does not establish the diagnosis.
Do not force repeated loading or deep tendon pressure to demonstrate a correction. Acute injury with inability to bear weight needs prompt assessment. If no concerning change is present, choose a tolerable goal linked to the complaint, such as walking the usual short route more comfortably, rather than rebuilding the arch through massage.
Repeat that route at the original pace, footwear and distance, and record the same stance or heel-rise symptom. A slower walk or added support must be labelled a modified task. Less pain with persistent pronation may still matter, while one easier walk does not establish recovery at a longer distance. Persistent deterioration changes the plan toward further assessment.
Related RSM Clinical Blogs
Browse all Dynamic Posture Assessment clinical guides
▷ Foot Stays on the Outside Edge: Supination & Compensation — Dynamic Posture Assessment · Compare the opposite loading pattern and whether the foot can move away from its outside edge.
▷ Foot Pronation With Tibial Rotation: Calf, Foot & Hip — Deep Tissue Massage · Develop calf-layer palpation and contact selection after the foot–tibia comparison.
▷ Tight Calves When Running: Load, Ankle Mobility & Foot Mechanics — Sports Massage · Extend the assessment to running load, calf function and symptom timing.
Study Dynamic Posture Assessment at RSM
The Dynamic Posture Assessment & Kinetic Chain Training Course develops movement observation, visual feedback and comparisons linking foot support with the knee, hip and trunk. Trigger Point Therapy develops the clinical palpation skills used to investigate movement findings with the hands.
For the next practical layer, Deep Tissue Massage develops tissue-layer and contact decisions. Sports Massage connects calf and foot findings with running demand and treatment timing; it also builds on the TPT foundation. Check current entry requirements when planning progression.
View the course schedule and entry requirements · Ask about course suitability and registration
About the Author
Hironori Ikeda, MSc Sports Medicine
Hironori leads RSM International Academy in Chiang Mai, Thailand. His teaching connects functional anatomy, clinical palpation and kinetic-chain assessment with practical massage decisions.
Read Hironori’s professional background and teaching approach