Flat Feet

Flat Feet(Pes Planus)

Flat feet or Pes Planus

What is Pes Planus?

Flat feet (Pes Planus) refers to a change in foot shape in which the foot does not have a normal arch when standing

Causes

Flat feet are a common condition. The condition is normal in infants and toddlers. Flat feet occur because the tissues holding the joints in the foot together (called tendons) are loose.
The tissues tighten and form an arch as children grow older. This will take place by the time the child is 2 or 3 years old. Most people have normal arches by the time they are adults. However, the arch may
never form in some people.

Aging, injuries, or illness may harm the tendons and cause flat feet to develop in a person who has already formed arches. This type of flat foot may occur only on one side.
Rarely, painful flat feet in children may be caused by a condition in which two or more of the bones in the foot grow or fuse together. This condition is called tarsal coalition.

The most common cause of heel pain is plantar fasciitis, inflammation where this long ligament attaches to the heel bone. The pain may b e sharpest when you first wake up and put pressure on the foot. Arthritis, excessive exercise, and poorly fitting shoes also can cause heel pain, as can tendonitis. Less common causes include a bone spur on the bottom of the heel, a bone infection,  tumor, or  fracture.

Heal painAnatomy of the heal

Symptoms

Most flat feet do not cause pain or other problems. Children may have foot pain, ankle pain, or lower leg pain. They should be evaluated by a health care provider if this occurs. Symptoms in adults may include tired or achy feet after long periods of standing or playing sports.

Exams and Tests

In people with flat feet, the instep of the foot comes in contact with the ground when standing. To diagnose the problem, the health care provider will ask you to stand on your toes. If an arch forms, the flat foot is called flexible. You will not need any more tests or treatment.

If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including:

  • CT scan to look at the bones in the foot
  • MRI scan to look at the tendons in the foot
  • X-ray of the foot

Treatment

Flat feet in a child do not need treatment if they are not causing pain or walking problems. Your child’s feet will grow and develop the same, whether special shoes, shoe inserts, heel cups, or wedges are used. Your child may walk barefoot, run or jump, or do any other activity without making the flat feet worse. In older children and adults, flexible flat feet that do not cause pain or walking problems can make use of molded innersoles.

If you have pain due to flexible flat feet, the following may help:
An arch-support (orthotic) that you put in your shoe. Molded custom made innersoles are the most effective in support and correction.
Rigid or painful flat feet need to be checked by a health care provider. The treatment depends on the cause of the flat feet.

For tarsal coalition, treatment starts with rest and possibly a cast. Surgery may be needed if pain does not improve.
In more severe cases, surgery may be needed to:

  • Clean or repair the tendon.
  • Fuse joints in the foot into a corrected position
  • Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Background

Progressive pes planus, or flatfoot, deformity in adults is a common entity that is encountered by orthopedic surgeons. Despite the significant incidence of this condition, the pathophysiology is still debated. The failure of one anatomic entity alone is unlikely to explain the clinical presentation of adult-acquired flatfoot deformity (AAFD). Instead, a mismatch between active and passive arch stabilizers is a more likely scenario

Presentation and Assessment

History:

Patients may present with noticeable pes planus (PP), parental concerns, or foot pain.

Children:

History of the PP and any changes.
Symptoms: walking/running ability and any foot pain.
Past medical history: other diseases, developmental delay.

Adults:

Is the PP new? Is it symmetrical?
Is there foot pain or interference with walking?
Are there any other lower limb symptoms, eg knee pain?
Past medical history: injuries, other related disease (neurological, rheumatological, musculoskeletal).

Examination

Observe the PP.
With the patient standing, look at his or her feet from above and behind. Loss of the arch is visible, with the medial side of the foot close to the ground. Look at the feet from behind – with PP the heel moves outwards (valgus) and the toes may also be pointed outwards.

Is the PP flexible?
Ask the patient to stand on tiptoe. With flexible PP, this will reveal the arch, and the heel will move inwards (varus position).

Examination follows

Look for signs of tibialis posterior dysfunction (if history is suggestive of this):
Ask the patient to do 10 unsupported heel raises (stand on one foot on tiptoe, unsupported). Patients with tibialis posterior dysfunction will be unable to do this. Further assessment of tibialis posterior dysfunction is detailed in the reference below. Assess related problems, if relevant, eg neuropathy or arthritis.

Investigation

In some cases, standing foot X-rays may be used to show the degree of deformity:
Standing lateral view shows the longitudinal arch and talonavicular joint. Standing AP view shows the degree of heel valgus (talocalcaneal angle).

Arches of your feet

Pes Planus can also cuase:

Pes Planus may also cause

Treatment: molded innersole

Pes Planus is a common foot problem. Flat feet can be congenital or developed in child hood. Flat feet has defects that can cause effects in the feet and the skeleton. Knock knees is a common defect of Pes Planus. Pes Planus can be supported and corrected by a Corrective molded innersole that can be fitted in any shoe.

Flat foot or Pes Planus Your feet and the spine alignment.

The effects of the molded inner sole

Molded innersoles are designed to press the bones in the feet to normal, or to hold it in that position for it not to progress. Molded innersoles measured manufactured and fitted to each patient individually.

Molded innersole

Alignment of skeleton through feet

Your feet plays a big role in the alignment of your legs, pelvis, spine and neck. Muscle spasms occur when joints and tendons are miss-align. The correct shoe or foot orthotic can help with the alignment and muscle spasms together with a Physiotherapist.

Alignment of the skeleton through the feet

Foot Pain

When your feet ache after a long day, you might just curse your shoes. After all, eight out of 10 women say their shoes hurt. But pain that’s not due to sky-high heels may come from a stress fracture, a small crack in a bone. One possible cause: Exercise that was too intense, particularly high-impact sports like basketball and distance running. The weakened bones of osteoporosis increase your risk.

The shoe last shape

The different types of shoes has different types of effects and defects on your feet.

The high heel shoe is not medically appropriate
in comfort and in health. All the pressure is on the forefoot and heel, Where the normal shoe last, gives you comfort and anatomically the foot bones is in normal.

Your shoe may also affect your feet

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