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