KIDS - FLATFOOT (PES PLANUS)
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What is Flatfoot in Kids?
Flatfoot is a common condition diagnosed in thousands of kids and adults every year. I think the best way to start this talk is to say the vast amount of research into flatfoot has failed to demonstrate any increased risk for problems down the road. Basically most flatfoot is a variation of normal, especially in kids. With that said, its important to recognize that flatfoot is actually a broad category and there are many varieties. Some types of flatfoot are actually more problematic than others. So we will first talk about the most common type, which is what we consider normal, and then will review some other types which are not. It’s a normal anatomic variant (in fact some studies say it occurs in 20% of the population). The talonavicular joint is in contact with the floor (sometimes you also see the forefoot abducted, midfoot prontated).
How is Flatfoot in Kids diagnosed?
You can measure the severity with a Meary angle (the talus-1st MT angle: which is normally 0° but ↑ with flatfoot). Its important to get XRs to make sure theres nothing else going on to cause this (such as tarsal coalition, it can be mistaken at times for vertical talus aka convex pes valgus). If its flexable (the longitudinal arch returns with plantarflex (stand on tip toes), and inversion of hindfoot, also assess the subtalar flexability (walk on heels).
How is Flatfoot in Kids treated?
Treatment of shoe inserts, modification have no effect, if really bad use an orthoic, and if excess valgus then strength the PT. Surgery is rarely required unless you are experiencing significant pain.
What is the long term outcome?
The patients do great.