This concept of the ‘Retarded Bony Development of the Midtarsus‘ as a pediatric flatfoot was first mentioned by Philip Brachman in 1966 in his book, Foot Therapy for Children. There are no other mentions of it on the literature. Due to the current offensive use of the word, ‘retarded’, this probably should be referred to as delayed or slowed bony development of the midtarsus.
It has been more than 25 years since we first described the clinical findings in the conditions that we termed the osseous retardation of the mid-tarsus in children. Since that time we have amassed a large number of x-rays of children’s feet, between the ages of 4 and 7, which demonstrate this marked retardation in the development of the navicular, alone and in some instances, the middle and medial cuneiforms and the heads of the lesser metatarsals.
Brachmann describes these children as being easily fatigued and having a high prevalence of vague foot and leg pains at night. Generally on assessment there is nothing else of note except for a flatter pronated foot. However on x-ray, they are characterized by delayed ossification of a number of the mid-tarsal bones:
X-ray of a normal foot and a ‘retarded’ midtarsus development in two 6yr olds from Brachman’s book, Foot Therapy for Children (1966)
This is different than Kohler’s disease of the navicular bone that also occurs at this age and the symptoms are different.
Brachman suggests that these feet need support while waiting for the normal bony development to occur by the use of the metal Whitman’s plates.
Commentary:
- Not a lot is understood regarding this foot that Brachman was describing and it has not been mentioned in subsequent literature to his 1966 book, except for a reproduction of that chapter verbatim in his 1984 book.
- It could be that the delayed development of these midtarsal bones is a consequence of the flat pronated foot and not a cause of it.
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