Flat foot in pediatrics

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It is an orthopedic disease that can affect both adults and children and is a common foot problem in pediatrics. Flat foot in pediatrics is not symptomatic early.

It has two types, Flexible and rigid types.

If you want to be familiar with this common condition, read the article to last word.

What is flat foot?

Physiologic flat foot

Infants and most of children have unstable foot arch that is easily noticed by parents.

Normally, infants have pad of fat at the medial aspect of the foot.

This pad obscure the normal medial longitudinal arch of the foot, but usually the arch re-appear at sometimes or if the baby started walking.

At this type, the parents will see the arch if he sit or walk on tip-toes. This arch will disappear upon standing straight. Therefore, parents will concern about this

Rigid flat foot

It is another rare type of flat foot in pediatrics.

In this type the flat food is persistent and the arch is not seen whatever the position of the child is, that’s to say the arch is not apparent during both standing and walking tip-toe.  

flat foot in pediatrics

Causes of flat foot in pediatrics

Pediatric flat foot may be an isolated condition

Sometimes it may be a part of clinical syndrome involving generalized laxity of ligaments, or neuromuscular disease secondary to genetic or collagen disease.

Cause of flexible flat foot are several such as

  • Physiologic
  • Obesity
  • Limb rotation
  • Accessory navicular bone
  • Generalized laxity: for example: hypotonia and cerebral palsy.
  • Marfan syndrome and Down syndrome
  • Ankle equinus

Causes of rigid flat foot:

  • Traumatic injury
  • Iatrogenic cause
  • Tarsal coalition and Congenital vertical talus

Clinical picture of pediatric flat foot

Early in life, the pediatric flat foot has no symptoms and is just noticed by the parents.

The medial pad of fat usually starts to disappear after the age 2 years.

Later on, the child may complain of pain in his soles, pain and tenderness in legs.

He may refrain from sports and exercises, refuses playing with mates as well as difficulty during walking.  

It is commonly associated with

Heel valgus, which is lateral deviation of the foot at the ankle.

It can cause abnormal shape of the shoes if it is of sever degree, especially if the flat foot is a part of generalized laxity.

Flexible flat foot is not occasionally causing disability.

Rigid flat foot is present all the time and mostly is symptomatic and requires special treatment.

Diagnosis of flat foot in pediatrics

There are several methods of diagnosis of pediatric flat foot such as visual inspection, anthropometric values, footprint parameters and radiographic evaluation.

It is best to diagnose it after the age of 10 years, at this age of complete development of the medial longitudinal arch of the foot.

Before this age, the physician may consider it as a physiological flat foot and is painless.

Inspection:

Includes observation of the medial longitudinal arch of the foot and ankle, gait and musculoskeletal system

It also in as well as, involves examination of the Achilles tendon and the flexion of the foot.

Anthropometric assessment:

Simply it means to take measurement of surface landmarks or bony prominences.

Foot print:

There are three footprint measurements for instance  the arch index and Chippaux-Smirak index.

Imaging studies:

Computed tomography and magnetic resonance imaging, as well as plain x-ray

Treatment of pediatric flat foot

The treatment of pediatric flat foot is controversial.

Usually, the flexible type of pediatric flat foot requires no treatment.

On the contrary, there is a need of treatment of the rigid type.

The treatment modalities for example exercises, activity modification, proper shoe and orthoses, and medication. 

If the patient is obese, sure weight control is mandatory, and any lax ligaments should be treated as well.

Physiologic asymptomatic flat foot:

Usually needs just medical follow up.

Physiologic symptomatic flat foot:

On the contrary of asymptomatic flat foot, It needs treatment for instance analgesics and stretching exercises as well as education and advice.

The child and parents should be informed that this condition may disappear with time.

Parents should be advised to

keep medical periodic observation to monitor the progress.

Physician should advice parents also about proper selection of the shoes. and shoes should support the arch and should have a firm sole.

Foot orthotics:

Is done via in-shoe foot orthoses and arch supports.

They control the excessive motion of the foot and support the arch and reduce the burden on feet.

Surgical treatment:

In the form of reconstructive operation to reduce pain and realign the foot.

Role of Physiotherapy:

The physiotherapist analyzes the patient’s gait to select the best exercises to benefits the patient.

It encourages barefoot walking and stretches the weak ligaments and muscles.

Passive stretching of the Achilles tendon if there if associating equinus, that’s to say deformity

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