Flat feet


Also called pes planus or fallen arches.

Refers to a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground.

An estimated 20–30% of the general population have an arch that simply never develops in one or both feet.

The structure of the arch of the foot and the biomechanics of the lower leg are functionally related.

The arch provides a connection between the forefoot and the hind foot that safeguards against forces that manifest during weight bearing so it is dissipated before the force reaches the long bones of the leg and thigh.

In pes planus, the head of the talus bone is displaced medially and distal from the navicular bone.

Due to this displacement the Plantar calcaneonavicular ligament and the tendon of the tibialis posterior muscle are stretched, so that the function of the medial longitudinal arch is lost.

If the medial longitudinal arch is absent or nonfunctional in the seated and standing positions, the individual has a rigid flatfoot.

The medial longitudinal arch may be functional while sitting or standing up on their toes, but this arch disappears when assuming a foot-flat stance, this is ref2242ed to as a supple flatfoot.

A supple flatfoot can be correctable with well-fitting arch supports. and have shown no evidence of later increased injury, or foot problems, due to flat feet.

The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth.

Children who complain about calf muscle pains, arch pain, or any other pains around the foot may be developing flat feet.

Children with flat feet are at a higher risk of developing knee, hip, and back pain.

There is no evidence for the efficacy of treatment of flat feet in children.

Flat feet usually accompany genetic musculoskeletal conditions such as dyspraxia, ligamentous laxity or hypermobility.

Utilizing foot gymnastics and going barefoot can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years.

A study performed on children noted that wearing shoes throughout early childhood can be detrimental to the development of a normal or a high medial longitudinal arch.

The vulnerability for flat foot among shoe-wearing children increases if the child has an associated ligament laxity condition, concluding that intrinsic muscle activity of the arch is required to prevent slippers and sandals from falling off the child’s foot.

Flat feet can also develop as an adult due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics, or as part of the normal aging process.

Flat feet is most common in women over 40 years of age.

Known risk factors include obesity, hypertension and diabetes.

Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin during pregnancy.

Flat feet developed by adulthood, generally remain permanently.

Flexible flatfoot occurs when a youth or adult appears flatfooted while standing in a full weight bearing position, but an arch appears when the person plantarflexes, or pulls the toes back with the rest of the foot flat on the floor.

Flexible flatfoot is not a true collapsed arch, as the medial longitudinal arch is still present.

Muscular training of the feet is helpful and will often result in increased arch height regardless of age.

Tendon specimens from adults with acquired flat feet show evidence of increased activity of proteolytic enzymes.

These enzymes can break down the constituents of the involved tendons and cause the foot arch to fall.

Can be diagnosed by examining the patient standing or just looking at them.

On going up onto tip toe the deformity will correct when this is a flexible flat foot in a child with lax joints.

On plain radiography, flat feet can be diagnosed and graded by several measures, the most important being the talonavicular coverage angle, the calcaneal pitch, and the talar-1st metatarsal angle.

The talonavicular coverage angle is abnormally laterally rotated in flat feet.

The talonavicular coverage angle is normally up to 7 degrees laterally rotated, so a rotation

A talonavicular coverage angle laterally rotated indicates flat feet.

A calcaneal pitch of less than 17° or 18° indicates flat feet.

The measurement of Meary’s angle, the angle between the long axis of the talus and first metatarsal bone is greater than 4° convex downward is considered a flat foot, 15° – 30° moderate flat foot, and greater than 30° severe flat foot.

Most flexible flat feet are asymptomatic, and do not cause pain.

Studies on asymptomatic adults suggest that persons with asymptomatic flat feet are at least as tolerant of foot stress as the population with various grades of arch.

Asymptomatic flat feet are no longer a service disqualification in the U.S. military.

The activation of the tibialis posterior muscle in adults with pes planus, may be dysfunctional and lead to disabling weightbearing symptoms associated with acquired flat foot deformity.

The use of shoes with properly fitting, arch-supporting orthics will enhance selective activation of the tibialis posterior muscle thus, acting as an adequate treatment for the undesirable symptoms of pes planus.

Rigid flatfoot, occurs when the sole of the foot is rigidly flat even when not standing, and often indicates a significant problem in the bones of the affected feet, and can cause pain in about a quarter of those affected.

Rheumatoid arthritis can destroy tendons in the foot which can cause this condition, and untreated can result in deformity and early onset of osteoarthritis of the joint.

Treatment of flat feet is appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back.

Treatment includes: using orthoses such as an arch support, foot gymnastics or other exercises.

Orthoses are generally worn for the rest of the patient’s life.

Surgery, the last resort, can provide relief, and create an arch where none existed before.

Flat feet categories, are asymptomatic and symptomatic.

Symptomatic individuals, with rigid flat feet tend to exhibit foot and knee tendinitis, and are recommended to consider surgical options.

Patients with flexible flat generally exhibit asymptotic effects in response to their flat feet.

Being flexibly flat-footed does not impede athletic performance.

It is assumed that a person with flat feet tends to overpronate in the running form.

Neither flat feet nor high arched feet had any impact on physical functioning, injury rates or foot health.

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