Flat foot

From greek.doctor
  • Flat foot = pes planus = pes planovalgus
  • Flat foot occurs due to flattening of one or more of the arches of the foot
    • Due to muscle insufficiency or failing capsules and ligaments
  • Flat foot can occur in children and in adults
  • The arches of the feet develop a while after birth – flatfoot in newborns is normal
  • Etiology
    • Increased bodyweight
    • Being forced to stand early as a baby (too early walking age)
    • Standing all day at work
    • Bad shoes
    • Old age
  • Types of flat foot
    • Pes transversoplanus – flat transverse arch
    • Pes planus – flat longitudinal arch
  • Clinical features
    • In children
      • Pain in muscles of the thigh and calf after activity
      • Due to the muscles actively working to correct the flatfoot
    • In adults
      • Pain in the area of the flat arch during activity
      • In adults the muscles have given up trying to correct the flatfoot
    • Heel valgus
    • Pes transversoplanus -> wide forefoot
    • When tip-toeing a non-fixed flatfoot will gain back the arch
  • Prevention
    • Don’t let your child walk too early (before 1 year)
    • Preventative muscle exercises
    • Tickle baby feet
    • Prevent obesity
  • Treatment
    • Conservative
      • Heel wedge – corrects heel valgus
      • Arch support
        • Arch support is not treatment – they will cause do the job of the muscles, causing them to get weaker
        • Arch support can prevent pain but does not treat the underlying flatfoot
    • Surgical: Calcaneo-stop procedure
      • A screw is drilled into the calcaneus
      • The screw causes discomfort to the patient -> this forces the patient to use their muscles to correct their foot
  • Complications:
    • Pes planus fixatus (= fixed flatfoot)
      • Due to tarsal coalition (fusion of tarsal bones), which occurs secondary to untreated flatfoot or as a developmental malformation
      • When tip-toeing a fixed flatfoot will not gain back the arch
      • Tarsal coalitions can be resected surgically
    • Hallux valgus
    • Bunion
    • Hammertoe
    • Osteoarthritis