Flexible Flatfoot

Aka: Flexible Flatfoot, Physiologic Flatfoot

1. Epidemiology
   1. Hereditary condition seen in Children and adults
   2. Incidence: Common (7-22% of population)
      1. Present in almost all infants
      2. Present in 45% of preschool children
      3. Present in 10% older than age 10
2. Etiology
   1. Tight Achilles Tendon (heel cord)
   2. Heel held in eversion
   3. Ligamentous laxity
   4. Benign normal variant
3. Symptoms
   1. Rarely symptomatic
   2. Pain and burning sensation may occur
   3. Easy Fatigue may occur with activity
4. Signs
   1. Foot is mobile without fixed deformity
   2. Weight bearing:
      1. Normal medial arch disappears
      2. Heels everted
      3. Forefoot pronated and abducted
   3. Non-Weight bearing
      1. Feet appear normal
   4. With heel inverted
      1. Passive ankle dorsiflexion limited
      2. Results from tight heel cord
   5. Infant findings
      1. Flatfoot hidden by fat infant foot
      2. Noticed when child begins standing
5. Associated conditions
   1. Hyperextension of fingers, elbows, and knees
   2. Family History of Flatfoot and ligamentous laxity
   3. Flexible Flatfoot may be due to tight heel cord in
      1. Muscular Dystrophy
      2. Mild Cerebral Palsy
      3. Congenital tightness heal cord
   4. Stiff, painful Flatfoot (unusual)
   5. Trauma, occult infection, foreign body,
   6. Tarsal Coalition
   7. Bone Tumors
   8. Kohler's Disease (Osteochondrosis of Tarsal Navicular)
   9. Genu Valgum (Knock-Kneed)
   10. Internal Tibial Torsion
6. Imaging: Lateral Foot XRay (weight bearing)
   1. Indicated for stiff, painful foot
   2. Findings
      1. Loss of normal arch
      2. Plantar flexion of talus
7. Differential Diagnosis
   1. Tarsal Coalition (teens)
   2. Rigid Flatfoot
8. Management
   1. None typically needed
   2. Shoe correction and Orthotics have no scientific proof in modifying Flatfoot
      1. Although Orthotics may offer symptomatic relief
   3. Exercises: Stretch tight heal cord (Effective)
      1. Internally rotate legs
      2. Place forefeet on 2.5 cm board
      3. Patient leans forward against wall
9. Course
   1. Mild deformities improve spontaneously with age
      1. Associated with tightening of ligaments
   2. Symptoms rarely occur in children and adults
      1. Abnormally high arch responsible for most Foot Pain
10. Patient Resources
    1. Hughston Sports Medicine Foundation
       1. http://www.hughston.com/hha/a_13_4_1.htm
11. References
    1. Churgay (1993) Am Fam Physician 47(4):883 [PubMed]
    2. Manusov (1996) Am Fam Physician 54(3):1012-26 [PubMed]
    3. Hoppenfeld (1976) Exam. Spine Extremities, p.159-60,223