Pes Planus

(Fallen Arches, Flatfoot)

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Definition

-  Collapsing arch of foot due to medial longitudinal arch pathology

-  Arch may come into contact with ground

 

Features

-  Congenital or acquired

-  Flexible or rigid

-  Flexible can correct with Heel rise test, rigid does not correct

-  Caused by mismatch of active & passive arch stabilizers

-  May be caused by tibialis posterior tendon rupture

-  20% adults, mostly flexible

-  In young children may correct up to 5-6yrs old

-  Normal in infants & toddlers

-  Staged 1-3

-  1: tenderness along inframaleolar course of post tibial tendon, adequate heel rise test

-  2: dynamic deformity usually hindfoot valgus + forefoot abduction, pain, limited heel tise test

-  3: fixed hindfoot deformity

 

Associated S/S

-  Pain: esp along course of tibialis post tendon

-  Hindfoot valgus

-  Forefoot abduction

 

 

Ix

-  Heel rise test: ability to weight bear on toes on single extremity

-  Correction of flat arch = flexible falt foot (more common in children w lax ligaments)

-  Weight bearing x-rays: AP, oblique, lateral

-  Too many toes visualised posteriorly

 

Mx

-  NSAIDs

-  Flexible rarely treates

-  Orthotics

-  Stage 1: conservative = immobilization 1/12 then stretch & strengthen

-  Stage 1 or 2: orthotics

-  Sx as indicated

-  Not indicated if not painful or hypermobile joints (Marfans, Ehlers Danlos..)