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Pes Planus

Feet Flat


Presentation

Pes planus seldom produces any signs and symptoms. In cases when it does, pain is the most common complaint. In addition, the other symptoms include the following:

  • Feet begin to ache after long hours of standing or after playing sports.
  • Children often complain of pain in the ankle, foot and the lower leg [7].
Plethora
  • A diverse range of pre-fabricated and customised FOs were utilised and effectiveness measured through a plethora of outcomes.[ncbi.nlm.nih.gov]
Military Personnel
  • In fact, one study found that military personnel with feet that were flat reported fewer injuries than service personnel with normal or higher arches.[theshoesforme.com]
Ulcer
  • A cohort of 1047 veterans with diabetes (contributing 2047 feet) was enrolled in a prospective study of diabetic ulcer risk factors (the Seattle Diabetic Foot Study). Significant differences between foot types were found.[ncbi.nlm.nih.gov]
  • Ulcers form due to factors such as lack of feeling, foot deformities, irritation, trauma, and poor circulation (peripheral vascular disease). Symptoms Many people who develop foot ulcers have lost the ability to feel pain, so pain is uncommon.[physiciansfootcare.com]
Delayed Wound Healing
  • One complication occurred: delayed wound healing (excellent result). Clinical results were excellent in eight feet, good in eight, fair in four, and poor in one.[ncbi.nlm.nih.gov]
Foot Pain
  • The patients' foot pain levels, functional asssessment, satisfaction and quality of life were recorded. Pedobarography was used in measuring both static and dynamic plantar pressure.[ncbi.nlm.nih.gov]
  • Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on[ncbi.nlm.nih.gov]
  • Abstract We determined the arch index of able-bodied indigenous Kenyan and Tanzanian individuals free of foot pain by using their dynamic footprints to classify the foot arch type and determine the prevalence of pes planus according to a previously described[ncbi.nlm.nih.gov]
  • The dynamic footprints of 305 able-bodied subjects, free from foot pain, comprising 139 males and 166 females aged between 13 and 17 years, were studied from randomly selected secondary schools in the city of Blantyre.[ncbi.nlm.nih.gov]
  • Symptoms or signs of the condition include: Feet with a convex rocker-bottom shape Foot pain starting at the outside rear of the foot Pain that’s aggravated by playing sports or walking on uneven ground Rigid Flatfoot-Related Conditions Feet that are[theshoesforme.com]
Anterior Knee Pain
  • The prevalence of anterior knee pain was 4% in both the control and mild pes planus groups, while it was 7% in the moderate and severe pes planus groups (p 0.0001).[ncbi.nlm.nih.gov]
  • Abstract This study examined the prevalence of anterior knee pain (AKP) and pes planus (PP) in Israeli defense force recruits and assessed the relationship between these conditions.[ncbi.nlm.nih.gov]
  • The rotational changes of the ankle and knee can push the kneecap in the wrong direction causing anterior knee pain. More info: patellofemoral pain syndrome.[physioworks.com.au]
  • The rotational changes of the ankle and knee can push the kneecap in the wrong direction causing anterior knee pain. More info: patellofemoral pain syndrome .[physioworks.com.au]
  • Prevalence of anterior knee pain and pesplanus in Israel defense force recruits. Mil Med. 2010;175:855-857 13. Ndife J. Epidemiological survey of foot problems in a predominantly subsistence farming community. African J of Ecology 1998; 36:2-5 14.[biomed.uninet.edu]
Medial Tibial Stress Syndrome
  • This can result in medial tibial stress syndrome : shin splints or tibia stress fractures.[physioworks.com.au]
  • This can result in medial tibial stress syndrome : shin splints or tibia stress fractures .[physioworks.com.au]
Impulsivity
  • OBJECTIVE: The purpose of this research was twofold: (1) to study the impulsive acceleration of the calcaneus at heel strike in subjects with neutrally aligned (i.e., normal) feet and (2) to explore how the acceleration may differ in subjects with pes[ncbi.nlm.nih.gov]
  • Sometimes avoids them altogether Impulsive.[dyspraxiafoundation.org.uk]
Abnormal Gait
  • Abstract Flatfoot is a foot condition caused by the collapse of the medial arch of the foot, and it can result in problems such as severe pain, swelling, abnormal gait, and difficulty walking.[ncbi.nlm.nih.gov]
  • BACKGROUND: Static measurement in clinical and radiologic evaluation is often used in assessment of pes planus, but it is important to know whether pes planus leads to abnormal gait pattern.[ncbi.nlm.nih.gov]
Posture Abnormal
  • The MASS4D custom orthotic provides the structural support needed to correct this postural abnormality when in use, addressing issues such as the collapse of the arch and the eversion of the heel.[mass4d.com]

Workup

Diagnosis of pes planus is made by a preliminary physical examination of the foot. The formation of arch upon standing on the toes will determine the type of flat foot present. For example, if an arch is formed when the individual stands on the toes then the condition is known as flexible foot. However, when no such arch in formed then the condition is referred to as rigid flat foot.
Individuals with flexible foot require no further tests or treatment. But, those diagnosed with rigid flat feet have to undergo the following diagnostic procedures:

  • Plain X-ray and weight bearing X-ray of the affected foot to further understand the condition [8]. 
  • Imaging studies such as CT scan of the bones and MRI of the tendons of the foot are also required to occur at definite diagnosis.
Joint Space Narrowing

Treatment

Children and toddlers affected by pes planus do not actually require any treatment if they are not experiencing any pain or discomfort while walking and even otherwise [9]. However, when the condition causes pain then the following methods are available:

  • A foot support known as orthotic is inserted into the shoes that provides support to the feet. In certain cases, doctors also recommend special shoes with heels to be tailor made that need to be worn until the arch forms naturally.
  • Certain lifestyle changes such as regular exercise to lose weight may be recommended. Affected individuals are advised to avoid standing or walking for longer durations.
  • Medications may be prescribed to relieve the pain and discomfort.
  • Surgical intervention is usually the last resort and is employed only when other treatment methods are not effective enough or the condition is causing great discomfort to the individual [10]. This involves, creating an arch in the foot, fusion of the bones, and repairing the tendons.

Prognosis

Majority of the cases of pes planus do not need any treatment as individuals do not experience any symptoms. In conditions when they experience pain, several treatment methods are employed to relieve pain and discomfort. Some cases of flat foot may require surgical intervention to correct the problem. Individuals benefit from the method and the prognosis is usually favorable. Pes planus from tendon rupture may require prompt surgical intervention, delay in the intervention may result into a poor prognostic outcome [6].

Complications

Pes planus by itself can rarely cause any serious complications. However, when the condition requires surgery then post-surgical complications include the following:

  • Infection 
  • The bones that were fused do not heal
  • Pain persists even after the procedure
  • Foot deformity does not get corrected
  • Loss of ankle movement

Etiology

Pes planus results when the tendons in the foot are loose. It is a common condition for infants and toddlers as the tendons take some time to tighten and form an arch. Other causative factors that give rise to pes planus include the following:

  • Heredity 
  • Illnesses or injury to the legs that damage the tendons
  • Diseases such as muscular dystrophy and cerebral palsy can also give rise to pes planus
  • Posterior tibial tendon insufficiency [1]
  • Obesity [2]
  • Traumatic rupture of foot ligaments [3]
  • Other disease conditions such as rheumatoid arthritis and diabetes can cause the arch to flatten in individuals who otherwise did not have pes planus

Epidemiology

Pes planus is a common condition affecting about 25% of the American population. In majority of the cases, the condition is reversible and can get corrected if treatment is initiated at right time. Acquired pes planus is fairly common in middle-aged women who are obese [4].

Sex distribution
Age distribution

Pathophysiology

Under normal circumstances, the tendons of the foot develop in a way to form an arch. In condition of pes planus, the tendons do not form a longitudinal arch. However, if such a condition occurs normally then it gets corrected by itself as the child grows up. The tendons tighten and gradually form an arch. In some cases, it takes several years for the arch to develop and in some the arch does not develop at all. There are basically 3 types of pes planus namely: Flexible flat foot, short Achilles tendon and posterior tibial tendon dysfunction with interosseous ligament involvement [5].

Prevention

Pes planus cannot be prevented since it is more of a heredity condition. However, the onset of secondary complications can be prevented by appropriately following the treatment recommended by a podiatrist.

Summary

Pes planus, commonly referred to as flat foot, is a condition wherein the foot does not form the normal arch in the standing position. It a common condition affecting millions of individuals across the globe. Such a kind of condition is normally identified in infants and toddlers.

Pes planus can get corrected by the time the child is 3 years old. Flat foot may be present in one or both the feet. There are no associated symptoms and pes planus can seldom lead to any serious consequences.

Patient Information

Definition

Pes planus also known as flat foot is a condition characterized by absence of an arch in the foot in the standing position. This condition is a normal phenomenon in infants and toddlers and usually gets corrected as the child grows. With growing age, the tendons tighten and gradually form an arch. It has been estimated that about 20 – 25% of the population fall prey to such a condition. Pes planus seldom gives rise to serious secondary conditions.

Cause

Heredity is one of the common causes of pes planus. In addition, other conditions such as diseases and injury to the feet are also known to give rise to flat foot.

Symptoms

In majority of the cases, flat foot has no accompanying signs or symptoms. But, certain types of pes planus such as rigid flat feet may cause pain and discomfort while walking.

Diagnosis

Affected individuals are made to stand on their toes and the examination is carried out. If an arch is formed in this position, it implies that the individual is suffering from flexible flat foot. Such a condition does not require any further diagnosis. If no arch is formed then further tests such as CT scan, MRI and X-ray of the feet is carried out for differential diagnosis.

Treatment

Individuals are given foot support to be worn inside the shoes that provide support to the foot while walking. Medications may also be prescribed if there is pain and inflammation. Surgery is employed to fuse the bones together or lengthen the tendons if they are too short to form an arch.

References

Article

  1. Arai K, Ringleb SI, Zhao KD, et al. The effect of flatfoot deformity and tendon loading on the work of friction measured in the posterior tibial tendon. Clin Biomech (Bristol, Avon). Jun 2007; 22(5):592-8.
  2. Funk DA, Cass JR, Johnson KA. Acquired adult flat foot secondary to posterior tibial-tendon pathology. J Bone Joint Surg Am. Jan 1986; 68(1):95-102.
  3. Levy JC, Mizel MS, and Wilson LS, et al. Incidence of foot and ankle injuries in West Point cadets with pes planus compared to the general cadet population. Foot Ankle Int. Dec 2006; 27(12):1060-4.
  4. Myerson M, ed. Posterior tibial tendon insufficiency. Current Therapy in Foot and Ankle Surgery. St Louis, Mo: Mosby-Year Book; 1993:123-35.
  5. Campbell KJ, Michalski MP, Wilson KJ, Goldsmith MT, Wijdicks CA, LaPrade RF. The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study. J Bone Joint Surg Am. Apr 16 2014; 96(8):e62.
  6. Goldner JL, Keats PK, Bassett FH 3rd, Clippinger FW. Progressive talipes equinovalgus due to trauma or degeneration of the posterior tibial tendon and medial plantar ligaments. Orthop Clin North Am. Jan 1974; 5(1):39-51.
  7. Pinney SJ, Lin SS. Current concept review: acquired adult flatfoot deformity. Foot Ankle Int. Jan 2006; 27(1):66-75.
  8. Kong A, Van Der Vliet A. Imaging of tibialis posterior dysfunction. Br J Radiol. Oct 2008; 81(970):826-36.
  9. Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. Jul 7 2010; CD006311.
  10. Key JA. Partial rupture of the tendon of the posterior tibial muscle. J Bone Joint Surg Am. Oct 1953; 35-A (4):1006-8.

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Last updated: 2017-08-09 17:54