Paediatric Flatfoot

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Flatfeet/Pes planus/pronated foot

Literature is confusing regarding terminology – all generally refer to a foot shape in which the medial longitudinal arch is closer to the ground. Many cases are part of normal development – young children tend to have fat pad in arch giving appearance of flat foot.

Causes of abnormally flat or pronated feet in children:
Congenital vertical talus
Abnormal insertion of posterior tibial tendon
Posterior tibial dysfunction
Forefoot varus
Equinus
Peroneal spastic flatfoot
Medially located STJ or rearfoot axis
Ligamentous laxity
Torsional disorder of lower limb
Idiopathic
Windlass function in kids

Weakness of inversion strength has been shown not to be associated with a pronated foot – a weakness in plantarflexion strength was found.

‘Physiological’ flat foot:

Classification
• clinical appearance
• aetiology
• plane of compensation

Low Tone pronation

Considerable debate in literature as to natural history and the need to intervene if asymptomatic  ethical decision to intervene in consultation with parents.
General guidelines  treat if subtalar joint is pronated after heel off; symptomatic; severe; significant medial column collapse; significant transverse plane motion; history of symptomatic problems in parents

Treatment options:
Shoe modifications – Thomas heels; rigid heel counters; heel raise; medial heel flare; move heel medially
In-shoe modifications – heel wedges; arch cookies; triplane wedges
Foot orthoses – prefabricated orthoses, functional; inverted devices; high medial flange devices; gait plates; UCBL; prefabricated
Adjunct therapy – stretching (especially if <10º at ankle); muscle strengthening Surgical -

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