Flatfoot (a.k.a Pes Planus)
Flatfoot is very common in children. It attributes 90% of the foot problem for clinic visits. Most of the time this condition is asymptomatic and do not require any medical treatment. Despite the fact that flatfoot rarely lead to disability, parents are still concerned about it as it is believed to lead to altered walking pattern in the future.
At the time of birth, a fat pad is present underneath the medial longitudinal arch. It is thought to resolve between the age of 2 and 5 as the foot arch is formed. By 2 years old, a child usually develops foot arch that is visible when sitting. Most of children are “flat-footed” when they start walking. The medial longitudinal arch of foot remains stable from 7 to 9 years old. Flexible flatfoot usually resolves by the age of 10, yet in some people, it persists into adolescence and adulthood.
Flatfoot is characterized by reduced in medial longitudinal arch, resulting in the body weight shifted to the inner side of the foot during standing and walking (weight bearing positions). Therefore, it may give rise to the issue of static alignment of the ankle and foot structure, or dynamic functional abnormality of the legs. This overloading mechanism resulting from the flattened medial longitudinal arch is transferred to the parts above the ankle which are knee, hip and lower back.
Pediatric flatfoot can be divided into two categories:
• Flexible flatfoot – characterized by a normal arch during non-weight bearing and a flattening of the arch during weight bearing.
I. Asymptomatic flexible flatfoot – children with asymptomatic flexible flatfoot should be monitored clinically for onset of symptom and signs of progression.
II. Symptomatic flexible flatfoot – may result in complaints, such as pain along the inner part of the foot, leg pain, reduced in endurance, altered walking pattern and etc.
• Rigid flatfoot – characterized by a stiff, flattered arch in both weight bearing and non-weight bearing positions.
I. Non-surgical treatments for the pain and disability caused by flatfoot such as:
✓ Advice and education
- Patients or their parents should be counseled regarding the facts that the flatfoot deformities may resolve with maturation depends on the age and underlying conditions. Severities of the deformity are present ranging from mild to very severe symptomatic flatfoot. Onset of symptoms and signs of progression should be monitored clinically.
✓ Foot wear selection and modification
- Proper supportive shoe is the vital first step in correcting the flexible flatfoot.
High-top sneaker may be indicated if instability within the ankle and subtalar joints is detected. Certain type of shoe such as sandals should be avoided because they may fail to provide the structural support to the immature flatfoot.
✓ Foot orthoses
- One of the primary conservative interventions for pediatric flatfoot is in-shoe foot orthoses and arch support which help in relieving the pain or discomfort, mitigating the plantar pressure and maintaining the dynamic stability in weight bearing position.
✓ Exercise and physiotherapy treatment
- The main focus of exercise program is on stretching tight structures, strengthening the weak components, improving proprioception (joint sense) and postural balance.
- However, Riccio et al have shown that using proper rehabilitation exercises may enhance the effectiveness of treatment in pediatric flexible flatfoot.
II. Surgical intervention will be advised if those conservative methods have failed, and the child is suffering from the symptoms which affecting the daily activities.
James B. Carr II, Scott Yang, Leigh Ann Lather. 2016. Pediatric Pes Planus: A Stateof-the-Art Review. Pediatrics 137 (3): 1-10.