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Welcome, medical contents search April 29, 2013
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Pes Planus

more about Pes Planus

Flat feet

  • In this condition, the normal arch shape, present in a child's instep, is not easily seen or is absent.  This affects both feet.  Stand the child on a small platform so the parent or physician can easily see the feet.
  • Holding onto the child firmly so the child doesn't fall, one can see the border of the foot running lengthwise from the heel to the great toe.  This border should rise off the ground, forming a raised arch at the instep.  In Flat Feet, this border is flush with the platform, making it look like the instep has no arch.

  • Flexible Flat Feet rarely cause foot pain, but fixed Flat Feet might cause painful feet or low back pain.

  • This condition has 2 causes:
    1. Flexible Flat Feet: the ligaments (very tough fibrous bands of tissue connecting bone to bone) along the instep are loose, and they have a little too much "give" in them.  With the stress of weight bearing, the instep sags.  This is called ligamentous laxity. Infants have a fat pad under the skin of each sole, between the skin and the ligaments, that hides their arch at the instep.  It is usually hard to tell if an infant has a normal instep or not.  Almost all cases of Flat Feet are the very minor situation of flexible Flat Feet.
    2. Fixed Flat Feet: Several bones at the rear of the foot, near the heel, are fused and don't have a clear-cut joint between them.  These are usually bones that lay along the instep.  This gives an abnormally flat shape to the instep.  This is a bone problem, not a case of lax ligaments.

  • When the child's foot is not bearing weight (lifted off a platform) the normal arch at the instep, running the length of the foot, is easily seen.
  • When the child is on level ground and asked to toe-walk, again the normal arch at the instep is easily seen.  Both of these tests show that the child really has not lost the arch at the instep, but just has flexible flat feet.
  • In infants in whom the fat pad might obscure the instep, the parent frequently has to wait until the child is older, to tell if there are flat feet.
  • In the case of fixed flat feet, the physician cannot maneuver the foot to have the shape of a normal arch at the instep.
  • In the case of fixed flat feet, the normal arch does not appear when there is no weight bearing.  Patients with fixed flat feet have painful feet.
  • One needs an X-ray of the bones to make a diagnosis of the exact type of fixed flat feet.
  • Some infants with fixed flat feet have deformities visible at the soles, with soles that are bulging like the bottom piece of wood on a rocking chair.  These are called "rocker-bottom" feet.

  • Flexible Flat Feet usually need no treatment, and in most cases the appearance becomes normal over the childhood years.  Rarely, flexible Flat Feet might need treatment because of painful feet.  Well-made shoes with an arch support prevent the arch from sagging.  Some families add arch supports inside the child's regular shoes.  High-top sneakers are another good treatment, because they give ankle support and there is often an arch support in the sneaker.
  • Fixed Flat Feet are best treated in consultation with an orthopedist.  Anti-inflammatory medicine such as ibuprofen, shoe inserts, and casts may be helpful.  Surgery to divide the place where 2 bones are abnormally fused might be needed.

  • One might have painful feet or back pain as a complication of fixed Flat Feet.

  • A close examination of the feet by a physician should be done if the child has the appearance of Flat Feet, or painful feet, or back pain.  The back also needs to be examined in the case of back pain.
  • Buying special shoes at a shoe store, without visiting a physician, is not a good plan in this condition because there may be no abnormality present, or the parent might buy the wrong type of shoe.

  • Various rare foot deformities can have fixed Flat Feet as a part of the deformity.

more about Pes Planus

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