14. Pes planovalgus

Essay 14- Pes planovalgus (flatfoot)

Definition

• Deformation of the foot characterized by a flattening of the longitudinal arch of the foot (pes planus) and an outward tilting of the heel and eversion of the forefoot (valgus)

Etiology

• Abnormal position of the feet in intrauterine development
• Muscular or ligamentous weakness
• Neurological disorders
• Trauma or injury

Symptoms

• Foot pain
• Arch fatigue
• Difficulty with balance and stability
• Abduction of the front section of the foot is expressed in a lateral dislocation
• Pronation is characterized by lowering of the inner edge of the foot and raising of the outer edge.
• Planus means lowering of the longitudinal vault of the foot.
• The patient steps on the whole sole as the foot does not have a distinct vault
• Physiological flatfoot- present in children up to the age of 3 years
• Muscles are not strong enough initially so encourage to walk barefoot and arches will develop on their own

Diagnosis

• Clinical exam:
• Gait is clumsy and shaking
• X-ray:
• When planovalgus deformation is present the axis goes across the medial section of the scaphoid bone and heads medially of the first ray of the foot
• There is disruption of the ratio of the axes between the calcaneus and the talus due to lateral subluxatio of the calcaneus

Treatment

• Conservative treatment is done by step-by-step redressing and plaster bandages.
• Orthopaedic shoes
• Insoles
• Exercises
• Denis-Brown's method (an aluminum rim) is applicable too
• Surgical treatment is subdivided into operations on soft tissue only and combined type
• Use of orthopedic pads in early childhood to correct the deformity is not advised!
• This is because it can result in hypotrophy of the muscles supporting the arch!