Pediatric Pes Planus: A Review

Abstract

The foot is a complex structure of the body responsible of the body support during the dynamic and static phase of the movement. The foot is composed by two components: the "talar" portion, consisting of talus, navicular bone, cuneiforms and I-II-II metatarsals, has a dynamic function during the walk, and a "calcaneus" consisting of calcaneum, cuboid, IV -V metatarsals, responsible of the load in the static phase of walking. In addition, the hindfoot acts as a rigid lever arm of the propulsion phase of the movement. The plantar vault consists of three arches: medial longitudinal arch, lateral longitudinal arch and transversal arch; the lowering of the plantar vault is often caused by a reduction in the medial longitudinal arch. The development and the function of the foot are strictly regulated by sensory and mechanical receptors located in the subtalar joint.Flat foot can be classified as flexible or rigid; the flexible foot is the most common form (95%) and it is secondary to capsuleligament laxity, decreased muscle strength, obesity, Spring ligament insufficiency or altered limb alignment; the rigid foot (5%) is caused by a congenital vertical talus, tarsal coalescence (astragalocalcaneal and calcaneo-navicular), trauma, juvenile arthritis, neuro-muscular dysfunction. Some authors define the flexible flat foot as "physiological" when it is asymptomatic and without functional alterations [1]. In the flexible foot the plantar vault is there without load and disappears under load, while in the rigid foot the reduction of the plantar vault is not affected by the load. Rigid flat foot can be accompanied by pain, due to a reduction of the subtalar articulation. This is often an expression of congenital bone deformities (accessory navicular), accompanied by neuromuscular disorders (cerebral palsy and myelomeningocele) [7]. Clinical ExaminationSuspect of flat foot is often reported by parents due to abnormal wear and tear of the shoes of their kids and rapid fatigue after sport or prolonged standing. Clinical examination starts with the evaluation of the lower limb alignment, with particular attention to the rotation of the hips (often anteversion) and knees (often in internal rotation), the presence of generalized joint laxity (Marfan Syndrome or connective tissue disorders), the brevity of the achilles tendon (Silfverskiold test), the shape of the foot with and without load, and the presence of pain. Foot pain in this case may be either medial, localized in the midfoot or plantar fascia, or lateral, at the sinus tarsi; in flat feet with short achilles tendon the pain is caused by the tendon shortening.Clinical examination should be performed by observing the front, back and lateral profiles of the lower limbs. In the front profile there is a medial load of the foot with abduction of the forefoot, internal rotation of the tibia and convergent patellar strabism, valgus deformity of the hallux (in the most severe forms); in the AbstractFlat foot is a complex three-dimensional skeletal disorder with multifactorial etio...